Hypertension: psychological aspects and diagnostic impact in a clinical trial.

The widespread acceptance of evidence that even mildly raised blood pressure is associated with an increased risk of cardiovascular morbidity has led to the setting up of screening programmes and treatment trials for hypertension in several countries. In order to allay anxieties about adverse psychological consequences of their own treatment trial of mild to moderate hypertension in a population of 35-64 year old adults of both sexes, the Medical Research Council supported a special psychiatric study in the pilot phase of the trial. This case-controlled study demonstrated that there was no increase in psychiatric morbidity after diagnosis (labelling) of hypertension nor during one year on the trial. There was, in fact, a fall in such morbidity for trial entrants, related to a greater rate of improvement for those subjects who displayed morbidity and not to any alteration in the incidence of new morbidity. The improvement in psychological state was not associated with any of the antihypertensive drug regimes, nor was it an artefact of selection; rather it appeared to be a beneficial effect of regular clinic attendance. The results of this study are presented and discussed in the context of current research into the psychological aspects of hypertension.