Drug intolerance due to nonspecific adverse effects related to psychiatric morbidity in hypertensive patients
Drug intolerance due to nonspecific adverse effects related to psychiatric morbidity in hypertensive patients
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DOI：
10.1001/archinte.163.5.592
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发表时间：
2003-03-10
影响因子：
--
通讯作者：
Ghahramani, P
中科院分区：
文献类型：
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作者：
Davies, SJC;Jackson, PR;Ghahramani, P
背景：抗高血压药物治疗方案依从性差是常见的，并可能增加心血管疾病发病率和死亡率的风险。药物的不良反应可能导致依从性差，但由于精神疾病的发病率，一些停用几种不同降压药物的患者可能会将非特异性症状误解为药物的不良反应。我们研究了抗高血压药物不耐受与惊恐障碍、惊恐发作、焦虑和抑郁之间的关系。我们纳入了所有在1年内到医院高血压门诊就诊且至少有2次不耐受发作的高血压患者（导致降压药剂量减少或停药）记录在标准化问题清单上的患者和没有记录不耐受发作的患者数量相似。精神病发病率，通过自我管理的问卷调查进行评估，针对非特异性和药物特异性不耐受的发作次数进行分析，通过个人病例记录审查进行验证，并由2名对患者身份不知情的评估者独立评分。276例患者中有233例（84%）返回了可分析的问卷，这些患者在评估的679次不耐受发作中经历了576次（85%）。532次发作（92%）是主观的（患者有症状）;其中，284次被判定为药物特异性; 248次为非特异性。非特异性不耐受发作次数越多，舒张压越高（P = 0.003）。非特异性不耐受的发生与惊恐发作（P = 0.008）、焦虑（医院焦虑和抑郁量表评分，P = 0.04）和抑郁（医院焦虑和抑郁量表评分，P = 0.005）相关。药物特异性不耐受与精神病发病率无关。结论：对多种抗高血压药物的不耐受，特别是非药物特异性不耐受，与精神病发病率密切相关。治疗高血压患者的医生需要认识和管理对多种抗高血压药物不耐受的精神方面。
Background: Poor adherence to antihypertensive drug regimens is common and may increase the risk for cardiovascular morbidity and mortality. Adverse effects of the drugs can contribute to poor adherence, but some patients who discontinue several different antihypertensive drugs may misinterpret nonspecific symptoms as adverse effects of the drug because of psychiatric morbidity. We examined the relationship between intolerance to antihypertensive drugs and the presence of panic disorder, panic attacks, anxiety, and depression.Methods: We included all patients with hypertension who attended a hospital hypertension clinic during 1 year with at least 2 episodes of intolerance (resulting in reduction of the dosage or stopping an antihypertensive drug) recorded on standardized problem lists and a similar number of patients with no recorded episodes of intolerance. Psychiatric morbidity, assessed by self-administered questionnaires, was analyzed against the number of episodes of nonspecific and drug-specific intolerance, verified by means of individual case-note scrutiny, and scored independently by 2 assessors masked to patient identity.Results: Analyzable questionnaires were returned by 233 (84%) of 276 patients who had experienced 576 (85%) of 679 episodes of intolerance assessed. Five hundred thirty-two episodes (92%) were subjective (patient was symptomatic); of these, 284 were judged to be drug specific; 248, nonspecific. Having more episodes of nonspecific intolerance was associated with significantly higher diastolic blood pressure (P = .003). Episodes of nonspecific intolerance were associated with panic attacks (P = .008), anxiety (Hospital Anxiety and Depression Scale score, P = .04), and depression (Hospital Anxiety and Depression Scale score, P = .005). Drug-specific intolerance was not associated with psychiatric morbidity.Conclusions: Intolerance to multiple antihypertensive drugs, particularly non-drug-specific intolerance, is strongly associated with psychiatric morbidity. Physicians treating hypertensive patients need to recognize and manage the psychiatric aspects of intolerance to multiple antihypertensive drugs.