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Psychiatric comorbidities in patients with hypertension – a study of registered diagnoses 2009–2013 in the total population in Stockholm County, Sweden

Sandström, Ylva Kristoferson; Ljunggren, Gunnar; Wändell, Per; Wahlström, Lars; Carlsson, Axel C.

doi: 10.1097/HJH.0000000000000824

Objective: The objective of this study was to investigate the prevalence of concomitant hypertension and psychiatric disorders in the general population, using administrative healthcare data in Stockholm County.

Design and method: The study population, included all living persons who resided in Stockholm County 1 January 2011 (N = 2 058 408). Individuals with a diagnosis of hypertension were identified with data from all consultations in primary care, specialized outpatient care, and inpatient care 2009–2013. As outcome, data were obtained on all consultations because of certain psychiatric diagnoses between 2011 and 2013, including specifically depression, anxiety disorders, bipolar disorder, and schizophrenia. Age-adjusted odd ratios (ORs) with 95% confidence intervals (95% CI) were calculated for men and women with and without hypertension, with individuals without hypertension as referents.

Results: The age-adjusted ORs for depression in persons with hypertension were 1.293 (95% CI 1.256–1.331,) for men and 1.036 (95% CI 1.013–1.058) for women. The age-adjusted ORs for anxiety in persons with hypertension were 1.279 (95% CI 1.238–1.322) for men and 1.050 (95% CI 1.024–1.076) for women. The OR for bipolar disease were 0.904 (95% CI 0.826–0.990) for men and 0.709 (95% CI 0.656–0.767) for women. For schizophrenia, the ORs were 0.568 (95% CI 0.511–0.632) for men and 0.537 (95% CI 0.478–0.603) for women.

Conclusion: Increased awareness of the risk of depression and anxiety among hypertensive patients is needed to combat hypertension, its complications, and psychiatric suffering in the population. Hypertension is probably underdiagnosed and neglected in individuals with severe psychiatric disorders. We warrant efforts to integrate psychiatric and hypertensive care.

aDepartment of Neurobiology, Division for Family Medicine, Karolinska Institutet, Care Sciences and Society, Huddinge

bPublic Healthcare Services Committee Administration, Stockholm County Council

cDepartment of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet

dCentre for Psychiatry Research, Karolinska Institutet, Stockholm

eDepartment of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden

Correspondence to Axel C. Carlsson, Division for Family and Community Medicine, Karolinska Institutet, Alfred Nobels Allé 12, 141 83 Huddinge, Sweden. Tel: +46 761 74 51 74; fax: +46 8 52488706; e-mail:

Abbreviations: CI, confidence interval; ICD, International Classification of Diseases; ICD-10, International Classification of Diseases, 10th edition; OR, odds ratio; VAL, a central database where all consultations and diagnoses are recorded and stored

Received 25 August, 2015

Revised 29 October, 2015

Accepted 13 November, 2015

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