Psychological Burden in Uncontrolled Hypertension: Findings from the ERIDANO Multicenter Study

Background/Objectives: Uncontrolled hypertension (UH), defined as markedly elevated blood pressure without acute target organ damage, is a clinically relevant condition in which psychological burden remains poorly characterized. We aimed to assess the psychological burden of patients with UH and compare it with that of outpatient hypertensive (HTN) and normotensive (NT) individuals. Methods: In this multicenter cross-sectional study, 191 patients with UH, 56 with HTN, and 89 NT individuals were enrolled across six Italian hospitals. Participants completed validated self-report scales assessing anxiety, depressive symptoms, and psychological distress (HADS), perceived stress (PSS-10), and Type D personality traits (DS-14). Statistical analyses included nonparametric group comparisons and multivariable logistic regression with bootstrap resampling. Results: UH patients showed significantly higher levels of anxiety, depressive symptoms, and psychological distress than both control groups (all p < 0.001). Clinically relevant anxiety was observed in 41.9% of UH patients, compared with 25.0% of HTN and 19.1% of NT participants; depressive symptoms were present in 34.6%, 19.6%, and 12.4%, respectively, and psychological distress in 38.7%, 23.2%, and 14.6%, respectively. Perceived stress was higher in UH than in NT individuals (p < 0.001), as were overall Type D personality traits (p = 0.016). In multivariable analysis, higher heart rate, smoking, depressive symptoms, dyslipidemia, and prior hypertension were independently associated with UH vs. HTN. Conclusions: UH patients exhibit a substantial psychological burden. In this Italian sample, screening for anxiety and depression in patients with UH should be considered in routine clinical practice.