Psychological Distress and Hypertension Diagnostic Testing: Is There Anything to Worry About?
Psychological Distress and Hypertension Diagnostic Testing: Is There Anything to Worry About?
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心理困扰和高血压诊断测试：有什么值得担心的吗？
DOI：
10.1093/ajh/hpad096
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发表时间：
2024
影响因子：
3.2
通讯作者：
Kronish,IanM
中科院分区：
文献类型：
--
作者：
Särnholm,Josefin;Kronish,IanM
高血压筛查指南建议在诊断高血压之前，通过办公室外血压监测来跟踪办公室血压升高的读数。1、2鉴于高血压在初级保健中的高患病率，很容易想象临床医生低估了在高血压筛查和诊断的背景下出现心理困扰的可能性。然而，对于许多患者来说，高血压是他们第一个被诊断患有慢性病的疾病，而且往往伴随着终身药物治疗和生活方式改变的建议。被诊断为高血压的患者还可能出现不良健康后果，包括心脏病发作、中风、肾衰竭，甚至死亡。因此，在高血压筛查期间可能会出现大量的焦虑和担忧，这是合理的。格林等人的文章。帮助我们在临床试验的背景下考虑这一可能性，比较3种确认高血压诊断的策略。3从很多方面来看，这项研究的结果都令人放心。总体而言，482名办公室血压读数升高且先前没有高血压诊断的患者被随机分为3种确认高血压诊断的策略之一：重复办公室血压读数、家庭血压监测和Kiosk监测。在所有三组中，高血压诊断过程在3周(应该完成确认性测试的时间段)或6个月时没有恶化健康相关生活质量(HRQOL)的全球衡量标准。这一良性发现与先前评估高血压筛查的心理后果的少量研究一致。然而，更深入地研究这些发现，就会描绘出一幅更微妙的图景。在所有三组中，与BP相关的担忧和在3周时发生心血管事件的想法略有增加，尽管这些在6个月后恢复到基线水平。在被问及高血压筛查的心理影响的另一组患者中，与考虑自己的血压有关的侵入性和回避性想法也略有增加。这些发现与HRQOL结果之间的对比突显了使用疾病特异性评估来补充
Hypertension screening guidelines recommend following up elevated office blood pressure (BP) readings with out-of-office BP monitoring before diagnosing hypertension. 1, 2 Given the high prevalence of hypertension in primary care, it is easy to imagine clinicians underestimating the potential for psychological distress to emerge in the context of hypertension screening and diagnosis. Yet, for many patients, hypertension is one of their first diagnoses with a chronic medical condition and is often accompanied by recommendations for life-long medications and lifestyle changes. Patients who are diagnosed with hypertension are also confronted with the possibility of developing adverse health consequences including heart attacks, strokes, kidney failure, and even mortality. Accordingly, it is plausible that substantial anxiety and worry could emerge during hypertension screening. The article by Green et al. helps us consider this possibility in the context of a clinical trial comparing 3 strategies for confirming a diagnosis of hypertension. 3In many ways, the results from this study were reassuring. Overall, 482 patients with elevated office BP readings and no prior diagnosis of hypertension were randomized to one of 3 strategies for confirming a hypertension diagnosis: repeat office BP readings, home BP monitoring, and kiosk monitoring. Across all 3 groups, the hypertension diagnostic process did not worsen a global measure of health-related quality of life (HRQOL) at 3 weeks (the time period by which confirmatory testing was supposed to be completed) or 6 months. This benign finding was consistent with the small number of prior studies that had assessed the psychological consequences of hypertension screening. A deeper dive into the findings, however, paints a more nuanced picture. Across all 3 groups, there were small increases in BP-related worry and thoughts about having a cardiovascular event at 3 weeks, though these returned to baseline by 6 months. There were also small increases in intrusive and avoidant thoughts related to thinking about their BP that were found in a subgroup of patients that were asked additional questions about the psychological impact of hypertension screening. The contrast between these findings and the HRQOL results highlight the importance of using disease-specific assessments to complement