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Simon J. C. Davies, Parviz Ghahramani, Peter R. Jackson, Lawrence E. Ramsay, P-252: Psychiatric aspects of multiple drug intolerance, American Journal of Hypertension, Volume 14, Issue S1, April 2001, Page 113A, https://doi.org/10.1016/S0895-7061(01)02126-4
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Abstract
Poor adherence to antihypertensive drugs is common and increases risk of cardiovascular morbidity. Drug side effects may contribute to poor adherence, but some patients who repeatedly discontinue medication may misinterpret non-specific symptoms as drug side effects, possibly due to psychiatric problems. In hypertensive patients attending hospital we examined the relation between drug intolerance and the presence of panic disorder, panic attacks, anxiety and depression. From standardised records of a hypertension clinic we identified all patients recorded as having had 2 or more episodes of intolerance to antihypertensive drugs, and a sample of patients of similar age and sex who had no record of drug intolerance. Intolerance was defined as reduction in dose or stopping an antihypertensive drug due to putatative adverse effects. All episodes of intolerance were verified by case note scrutiny, then evaluated independently by 2 raters who were blind to patient characteristics, and categorised for subjectivity (symptomatic or asymptomatic) and when symptomatic, for specificity of the side effect to the drug. Patients were classified by the number of a) symptomatic non specific intolerances, b) symptomatic specific intolerances and c) total intolerances. All patients were mailed questionnaires, for self-completion, on panic disorder and panic attacks, a Hospital Anxiety and Depression Scale and the trait anxiety section of Spielberger's Inventory. Analysable questionnaires were returned by 233 of 276 (85%) patients, who had experienced 576 episodes of intolerance. Of these, 532 (92%) were symptomatic (284 (53%) drug specific and 248 (47%) non-specific). There was no relation of drug intolerances to age, sex or number of antihypertensive drugs prescribed. Number of symptomatic non-specific intolerances was associated with significantly higher DBP (p=0.012, e.g. 0 v ≥4 episodes: 160/89mmHg v 172/99mmHg). Total episodes of intolerance were associated significantly with panic attacks (p=0.008), anxiety (actual HAD score p=0.027, HAD Score>7 p=0.024, trait anxiety p=0.042) and depression (actual HAD score p=0.011, HAD Score>7 p=0.018). Symptomatic non-specific drug intolerances, were related significantly to panic attacks (p=0.008), anxiety (actual HAD score p=0.043) and depression (actual HAD score p=0.005, HAD score>7 p=0.008). Specific intolerances showed no significant associations with psychiatric morbidity. These data suggest recurrent intolerance to antihypertensive drugs is associated with psychiatric problems. This association is with non-specific rather than specific side effects. Physicans treating hypertensive patients need to recognise and manage the psychiatric aspects of multiple drug intolerance.
