Page 43 - BH-3-1

Brain & Heart Depression, anxiety and blood pressure control

• Dementia 36 questions, which address physical functioning and
• Severe valvulopathies role, body pain, general health, vitality, social functioning,
• Heart failure with ejection fraction <35% emotional role, and mental health.
• Severe systematic illness with survival prognosis of
<1 year 3.3. Second phase
• Cancer under treatment (radiotherapy/chemotherapy/ The second phase will enroll 200 patients with hypertension
immunotherapy) and a HADS score of ≥11.
• Established diagnosis of psychiatric disease (treated Patients with hypertension and high HADS scores will be
or not)
• Unwillingness to participate. classified to receive the following:
•
Psychiatric intervention and treatment
3.1.5. Follow-up duration • Standard follow-up
The follow-up duration will be 12 months. A pilot study Toward this process, patients will be fully informed
was conducted, and preliminary data indicated an effect on regarding participation in the second phase.
BP levels within the first 3 months. Therefore, a follow-up • Patients who will decline psychiatric evaluation will
period of 12 months is sufficient to detect significant be enrolled in the standard group.
outcomes. • Patients who will ask for psychiatric evaluation will be
enrolled in the intervention group.
3.1.6. Study population • All the remaining patients will be randomized equally.

The study population included patients with hypertension Regarding the nature of the psychiatric intervention, all
in the Hypertension Unit of the First Cardiology Clinic, patients with hypertension and high depression/stress levels
Athens Medical School, National and Kapodistrian based on the HADS and confirmed depression/stress post-
University of Athens. psychiatric evaluation will be prescribed antidepressants.

3.2. Step one: Responses of the HADS and SF-36 Moreover, they will be asked to undergo follow-up in the
quality-of-life questionnaire behavioral unit of the hypertension unit of our department
to assess the possible initiation of psychotherapy.
According to HADS results, patients with hypertension will
be classified into those with high and low HADS scores. 3.4. Data collection
The HADS was developed in 1983 by A. S. Zigmond A specific care report form will be used for data collection,
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and R. P. Snaith and is used to screen patients with including demographic and somatometric data, medical
depression or anxiety. It cannot be used as a diagnostic history, laboratory results, and hypertensive target organ
tool but only as a screening tool. The questionnaire can be damage information. All patients with hypertension
answered within 5 min. It contains 14 questions (7 items and high HADS scores, irrespective of randomization,
on anxiety and 7 on depression). Every question has four will undergo electrocardiography, ambulatory BP
possible answers, and each one answer is assigned a specific measurement, and cardiac ultrasonography.
number (0 – 3). Scoring results are classified accordingly: Specifically, the following parameters will be recorded:
0 – 7: Normal score (no chance of depression/anxiety) sex, height, weight, waist and hip circumferences,
8 – 10: Marginal (average chance of depression/anxiety) smoking status, hypertension history, diabetes mellitus,
11 – 21: Abnormal (increased chance of depression/ and dyslipidemia status, family history of coronary artery
anxiety) disease, and medical information regarding coronary
artery disease, heart failure, atrial fibrillation, chronic
Subsequently, patients with hypertension and a HADS
score of ≥11 will be enrolled in the second phase. kidney disease, peripheral arterial disease, sleep apnea,
stroke, and drugs administered.
The Health Survey Questionnaire Short Form was
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developed in 1992 by Ware to estimate the health state Electrocardiogram data: Sinus rhythm or atrial
of inpatients. It has been used to assess the quality of life fibrillation, heart rate, PR, QRS, QT (QTc and QTd), Q
of the population. The questionnaire can be completed waves, T-wave inversion, bundle branch block, and axis.
in 5 – 10 min. It has two forms: SF-36 and SF-12. The Cardiac ultrasound data: Left ventricular mass index,
questionnaire aims to document patients’ mental and left ventricular end-diastolic diameter, left atrial diameter,
physical conditions. It is considered a reliable instrument left atrial volume index, aortic root diameter, E, E/A, Em,
with Cronbach’s α of >0.70. The long version consists of and E/Em.

Volume 3 Issue 1 (2025) 6 doi: 10.36922/bh.4923