Pattern and Prevalence of Psychiatric Comorbidity in Patients with Essential Hypertension in Port Harcourt, Nigeria
American Journal of Psychiatry and Neuroscience
Volume 4, Issue 1, January 2016, Pages: 5-12
Received: Dec. 24, 2015; Accepted: Jan. 13, 2016; Published: Jan. 31, 2016
Views 3871      Downloads 166
Nkporbu Aborlo Kennedy, Department of Neuropsychiatry, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
Stanley Princewill Chukwuemeka, Department of Neuropsychiatry, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
Ohaeri Jude, Federal Neuropsychiatric Hospital, Enugu, Nigeria
Article Tools
Follow on us
Essential hypertension, a non communicable disease, is assuming an epidemic dimension, of the nature of a communicable condition. It, predominantly affects the physical, social and psychological well-being of the middle to elderly age group, with the former incidentally contributing over 50% of Nigeria workforce, hence interfering with the nation’s economic well- being . Although few of such studies have been done in this environment, hypertensionhas been variously cited to be commonly associated with psychiatric comorbidity. The aim of this study, therefore, was to determine the pattern and prevalence of psychiatric co-morbidity among subjects with essential hypertension attending the out patient clinic of the University of Port Harcourt Teacing Hospital (UPTH). In this cross-sectional study, following ethical approval from the appropriate committee of the hospital and informed consent from the participants, 360 subjects making up the study group were recruited based on the study’s inclusion exclusion criteria, after a Pilot Study (In addition, the hypertensives were screened for HIV infection and also investigated for other chronic medical illnesses). Subjects were further administered with the study’s instruments including the socio-demorgraphic questionnaire, GHQ-12 and WHOCIDI. The data were analyzed using the SPSS version 20. Confidence interval was set at 95% while P- value of less than 0.05 was considered statistically significant. The study found a 64.4% (n=232) rate of psychiatric comorbidity among the hypertensive patients with depressive illness the highest with 73(29.4%). This was followed by GAD with 16.1%, sexual dysfunction 9.0%, mixed anxiety and depression 7.8%, substance abuse 2.3%, dysthymia 0.3%, while panic without agoraphobia and personality disorders 0.9% each. Severity of hypertension correlated positively with psychiatric comorbidity. The study found that psychiatric co-morbidity among the hypertensive patient is common in UPTH. It therefore becomes imperative that the intervention measures for chronic disorders of these natures should include a well planned, elaborate and articulated neuropsychiatric evaluation for an effective and holistic management of these patients.
Pattern, Prevalence, Psychiatric Comorbidity, Essential Hypertension, UPTH
To cite this article
Nkporbu Aborlo Kennedy, Stanley Princewill Chukwuemeka, Ohaeri Jude, Pattern and Prevalence of Psychiatric Comorbidity in Patients with Essential Hypertension in Port Harcourt, Nigeria, American Journal of Psychiatry and Neuroscience. Vol. 4, No. 1, 2016, pp. 5-12. doi: 10.11648/j.ajpn.20160401.12
Copyright © 2016 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Oviasu VO. The Pattern and Prevalence of Heart Disease in Benin, Nigeria. Nig. Med. J. 1989; 8: 83-85.
WokomaFS, Alasia DD. Blood pressure pattern in Barako: a rural community in Rivers State, Nigeria. The Nigeria Journal, 2011; 11: 813.
Akpa MR, Alasia DD, Emmen-Chioma PC. An appraisal of hospital based blood pressure control in Port Harcourt, Nigeria. The Nigeria Health Journal.2008; 8: 27-30.
Unachukwu CN, Agomoh DI, Alasia DD. Pattern of non-communicable diseases among medical admissions in Port Harcourt, Nig. Nig. Journal of Clinical Practice.2008; 11(1): 14-17.
Adefuye BO, Adefuye PO, Oladepo TO, Familoni OB, Olurunga TO. Prevelence of hypertension and other cardiovascular risk factors in an African Urban, sub-urban religious community. Nigerian Medical Practitioner 2009; 55(1-2): 4-8.
Cooper R, Rotimi C, Ataman S, McGee D, Osotimehin B, Kadiri S et al. The prevalence of hypertension in seven populations of west Africanorigin. Am Public Health 1997; 87(2): 160-8.
Kearney PM, Whelton M, Renoids K, Muntner, P Whenton KP. Global burden of hypertension: analysis of worldwide data Lancet 2005; 365: 217-23.
Murray CJ, Lopez AD. Mortality by cause for eight regions of the world. Global burden of disease. Lancett, 1997; 349: 1269-1276.
Ogbagbon EK, Okesina AB, Biliaminu SA. Prevalence of hypertension and associated variables in paid workers in llorin, Nigeria. Niger J. Clin. Pract. 2008; 11 (4): 342-346.
Lawes CM, Vander Hoorn S, Law MR Eliot P, McMahon S, Rodgers A. Blood pressure and the global burden of disease 2000. part II: estimate of attributable burden J. hypertens 2006; 24: 423-430.
Cappuccio FP, Cook DG, Atkinson RW and Strazzullo P. Prevalence, detection, and management of cardiovascular risk factors in different ethnic groups in south London.Heart1997; 78 (6): 555-63.
Cooper R, Rotimi C, Ataman S, McGee D, Osotimehin B, Kadiri S, et al. The prevalence of hypertension in seven populations of west Africanorigin. Am Public Health.1997; 87 (2): 160-8.
Adedoyin RA, Mbada CE, Balogun MO, Martins T, Adabayo RA, Akintomide A. Prevalence and pattern of hypertension in a semi-urban community in Nigeria Eur. J. Cardiovasco prev. Rehab., 2008; 15(6): 683.687.
Cappuccio FP, Micah FB, Emmeth L, Kerry SM. Prevalence, detection, management and control of hypertension in Ashanti, West Africa. Hypertens, 2004; 43: 10-17.
Cappuccio FP, Cook DG, Atkinson RW, Stuzzullo P. Prevalence, detection, management of cardiovascular risk factors in different ethinic groups in South Africa. J Health, 1997; 78: 555-563.
Lawoyin TO, Azuzu MC, Kaufman J, Rotimi C, Oweaje E, Johnson L, Cooper R. Prevalence of cardiovascular risk factors in an African, urban inner city community. West Afr. Med 2002; 21: 208-211.
Chamontin B, Poggi L, Lang T, Menard J, Chevalier H, GalloisH, Cremier O. Prevalence, treatment and control of hypertension in the French population: data from a survey on high blood pressure in general practice, 1994. Am J Hypertens 1998; 11: 759–62.
Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli S, Hense HW, Joffres NM, Kastarinen M, Poulter N, Primatesta P, Rodriguez-Artalejo F, Steg-mayr B, Thamm M, Tuomilehto J, Vanuzzo D, Vescio F. Hypertension, prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA 2003; 89: 2363–9.
Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000.JAMA 2003; 290: 199–206.
Health Reform Foundation of Nigeria (HERFON) (2009, August) 'Impact challenges and long-term, implications of antiretroviral therapy programme in Nigeria'.
WHO (2002).The world Health Report: reducing risks, promoting healthy life. Geneva: World Health Organization, (Cited 2008 March). Available from: URL en. Pdf.
Rice D, Kelman S, Miller L. The economic burden of mental illness. Hosp Community Psychiatry.1992; 43: .1227-32.
Arodime EB, IkeSO, Nwokedinke SC. Case fatality among hypertensive-related admission in Enugu, Nig. Nig Journal of Clinical Practice, 2009: 12(2): 153-156.
Goldney RD, Phillips PJ, Fisher LJ, Wilson DH. Diabetes, depression, and quality of life—a population study. Diabetes Care 2004; 27: 1066–70.
Spiegel D, Giese-Davis J. Depression and cancer: mechanisms and dis-ease progression. Biol Psychiatry 2003; 54: 269– 82.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, IzzoJLJr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ. Seventhresport of the Joint National committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003; 42: 1206-1252.
Norbert S, Wolfganf T, Johannrs K. Mental Disorders and Hypertension: Factors Associated With Awareness and treatment of Hypertension in the General population of Germany. psychosomatic medicine. 2006; 68: 246- 252.
Erhun WO, Olayiwola, G, AgbaniEO, and Omotoso NS. Prevalence of Hypertension in a University Community in South Western Nigeria. African journal of Biomedical Research Ibadan Biomedical Communication Group.2005; Vol. 8: 15-19.
Gwatkin D, Guillot M, Heuveline P. The burden of disease among the global poor. Lancet, 2000; 354: 586-589.
Wenzel U, Roben T, Schwietzer G, Stahl RAK. The treatment of arterial hypertension: a questionnaire survey among doctors in general practice. Deut Med Wochenschr 2001; 126: 1454–9.
Hartley RM, Velez R, Morris RW, Dsouza MF, Heller RF. Confirming the diagnosis of mild hypertension. BMJ 1983; 286: 287–9.
Gupta K. Undertreatment of hypertension: a dozen reasons. Arch Intern Med 2002; 162: 2246–7.
Oliveria SA, Lapuerta P, McCarthy BD, L’ItalienGJ, Berlowitz DR, Asch SM. Physician-related barriers to the effective management of uncontrolled hypertension. Arch Intern Med 2002; 162: 413–20.
Hyman DJ, Pavlik VN. Poor hypertension control: let’s stop blaming the patients. Cleve Clin J Med 2002: 69(10): 793-9.
Nichotaon W, Long B. Self-esteem, social support, internalized homophiobia, and coping strategies of men.J Consult ClinPsyohcl.1990; 50-873-6. 53.
Hyman DJ, Pavlik VN. Characteristics of patients with uncontrolled hypertension in the United States. N Engl J Med 2001; 345: 479–86.
DiMatteo MR. Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol 2004; 23: 207–18.
DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment—meta- analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 2000; 160: 2101–7.
Schmitz N, Kruse J. The relationship between mental disorders and medical service utilization in a representative community sample. Soc Psychiatry Psychiatr Epidemiol 2002; 37: 380–6.
Barllett J. Addressing the challenges of adherence .J Acquir immune Defic Synd.2002; 29(Suppl 1) S-SO.
Anderson RB, Testa MA. Symptom Distress Checklists as a Component of Quality-of-Life Measurement Comparing Prompted Reports by Patient and Physician with Concurrent Adverse Event Reports Via the Physician. Drug inf. J. 1994; 28: 89-14.
Testa MA, Simonson DC. Measuring Quality of Life in Hypertensive Patients with Diabetes. Postgrad Med. J.1988; 64: Suppl 3: 50-8.
Testa MA, Hollenberg Anderson RA, Williams GH. Assessment of Quality of Life by Patient and Spouse during Antihypertensive Therapy with Atenolol and Nifedipine Gastrointestinal Therapeutic System Am. J. Hypertens. 1991; 4: 363-73.
Lenderking WR, Gelber RD, Cotton DL, et al. Evaluation of the Quality of Life Associated with Zidovudine Treatment in Asymptomatic Human Immunodeficiency Virus Infection. N Engl. J. Med. 1994; 330: 738-43.
Olusina AK, Ohaeri JU, Subjective quality of life of recently discharged Nigerian Psychiatric patients. Soc Psychiatry Epidemiol 2003; 38 (12): 707-4.
Concepts of Health-Related Quality of Life. In: Patrick D.L, Erickson P. Health Status and Health Policy: Quality of Life in Health Care Evaluation and Resource Allocation. New York: Oxford University Press, 1993; 76-112.
Wenzel U, Roben T, Schwietzer G, Stahl RAK. The treatment of arterial hypertension: a questionnaire survey among doctors in general practice. Deut Med Wochenschr 2001; 126: 1454–9.
Croog SH, Levine S, Tests MA, et al. The Effects of Antihypertensive Therapy on the Quality of Life. N Engl. J Med 1986; 314: 157-64.
Testa MA. Interpreting Quality-of-Life Clinical Trial: Data for use in the Clinical Practice of Antihypertensive Therapy. J Hypertens Suppl, 1987; 5: S9-S13.
Ii W, Liu L, Purnte JG, Li Y, Jiang X, Jin S, Ma. H, Kong L, Ma L, He X, Ma S, Chen C. Hypertension and Health related quality of life: An epidemiological study in Patients attending hospital clinic in China, Journal of Hypertension.2005; 23(9): 1667-1676.
DuPont R, Rice D, MiIler L, Shiraki S, Rowland C, Hanwood H. Economic costs of anxiety. J anxiety. 1996; 2.167-72.
French M, Mauskopf J, League J, Roland E. Estimating the dollar value of health outcomes from drug abuse Interventions. Med Care.1996; 34: 890-910.
Briganti EM, Shaw JE, Chadban SJ, Zimmet PZ, Welborn TA, McNeil JJ, Atkins RC. Untreated hypertension among Australian adults: the 1999–2000 Australian Diabetes, Obesity and Lifestyle Study. Med J Aust 2003; 179: 135–9.
Guidelines Subcommittee. World Health Organization — International Society of Hypertension Guideline for the management of hypertension.JHypertens1999; 17: 151-83.
Peyrot M, Rubin RR. Levels and risks of depression and anxiety symptomatology among diabetic adults. Diabetes Care 1997; 20: 585–90.
Ohene S. Psychiatric Morbidity among Patients with Essential Hypertension Attending Out-Patient Clinics in University of Benin Teaching Hospital. Dissert. WACP. 2003.
Saddocks BI, Saddocks V. Comprehensive Textbook of Psychiatry. 2005; Vol. 1 pg 426-48.
Rostrup M, Kjeldsen SE, EideIK. Awareness of hypertension increases blood pressure and sympathetic responses to cold pressor test. Am J Hypertens. 1990; 3: 912-917.
Oparil S, Zaman MA, Calhoun DA. “Pathogenesis of hypertension”. Ann. Intern. Med. 2003; 139 (9): 761_76.
Kidson MA. Personality and Hypertension J. Psychosom.Res.1973; 17: 35-41.
Cochrane R. Hostility and neuroticism J.Psychosom Res. 1973; 21: 58-62.
Oviasu VO. The pattern of heart disease in Benin, Nigeria. Nig. Med. J. 1983; 3: 192.
Oviasu VO. A study of arterial blood pressure and hypertension in a rural Nigerian community. Afr. J.
Evans D, Charney D. Mood disorders and medical illness a major public health problem. Blot Psychiatry. 2003; 64: 177- 80.
JeeSH, He J, Whelton PK, etal. The Effect of Chronic Coffee Drinking on Blood Pressure: A Meta-analysis of Controlled Clinical trials. Hypertension 1999; 33: 647-652.
Lane JD, Pieper CF, Phillips-Bute BG, Bryant JE, Kuhn CM. Caffieine affects cardiovascular and neuroendocrine activation at work and home. Psychosom Med 2002; 64(4): 595. 603.
Mathews JD. Alcohol use, hypertension and coronary heart disease. ClinSciMol Med 1976; 3: 66 IS663S.
Nkporbu A. K, Ugbomah L, Stanley P.C. Pattern and Prevalence of Psychiatric Consultations in Other Non-Psychiatric In-patient Facilities in the University of Port Harcourt Teaching Hospital: A 5-YEAR REVIEW. The Nigerian Health Journal.2014; 14; 1, 13-20.
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186