Patients with post-traumatic stress disorder (PTSD) and hypertension were found to be significantly less adherent with their blood pressure medication that hypertensive patients with no PTSD symptoms, based on findings in a research letter published online Dec. 2 in JAMA Internal Medicine.
Researchers led by Ian M. Kronish, MD, MPH, of Columbia University Medical Center in New York City, studied 98 patients with uncontrolled hypertension from a primary care clinic. They determined the presence of PTSD symptoms using a screening tool and assessed medication adherence during the time between two later clinic visits.
Patients who stuck to their medication regimen less than 80 percent of the time (based on the percent of days the prescribed dose was taken) were considered nonadherent.
Average adherence was 86 percent, and 41 percent of the patients were nonadherent. Before adjustment, analysis found that 68 percent of patients with PTSD as defined by the screening tool were nonadherent. In comparison, only 26 percent of patients who had a negative PTSD screen were nonadherent.
After adjustment, the researchers found that those with positive PTSD screens were more than five times as likely to be nonadherent.
Despite its small sample size, single-center design and short assessment duration, the authors argued their study is the first to show that PTSD can independently predict nonadherence among hypertensive patients and also hints at what mechanism may be at play in the relationship between PTSD and heart disease.
“Given the prevalence of PTSD and its strong association with medication nonadherence, our findings provide impetus to evaluate the benefit of enhanced screening and treatment for PTSD in medical settings to improve cardiovascular risk in these patients,” they wrote.