Stress, Anxiety, and Self-Efficacy in Hypertension: Evidence from a Romanian Case—Control Study

TL;DR

The study finds that stress, anxiety, and low self-efficacy are linked to hypertension in Romanian adults, suggesting psychological factors should be addressed in treatment.

Contribution

This is the first systematic evaluation of psychological factors in hypertension management in Romania, highlighting region-specific insights.

Findings

Hypertensive individuals reported higher stress and anxiety and lower self-efficacy compared to controls.

Type A behavior was not associated with hypertension in this population.

Psychosocial interventions could improve hypertension treatment adherence and outcomes.

Abstract

Background: Hypertension and psychological distress often coexist, though evidence from Eastern Europe is still limited. Stress, anxiety, and self-efficacy influence blood pressure control and treatment adherence. Their effect on hypertension prevention and treatment has not been systematically evaluated in Romania. Aim: This study evaluated the associations between stress, anxiety, and self-efficacy in Romanian adults with and without hypertension to identify modifiable psychological factors relevant for integrated cardiovascular management. Methods: A retrospective case–control study was conducted among 215 adults, including individuals with hypertension and normotensive controls. Participants completed validated questionnaires assessing stress vulnerability, perceived stress, state and trait anxiety, self-efficacy, and Type A behavior, together with demographic and occupational data. Results: Hypertensive participants reported higher stress vulnerability, perceived stress, and anxiety, as well as lower self-efficacy, compared with controls. Type A behavior showed no association with hypertension. These differences remained consistent after accounting for demographic characteristics. Conclusions: Hypertension in Romanian adults is associated with a distinct psycho-emotional profile characterized by elevated stress and anxiety and reduced self-efficacy. Type A personality showed no association. The results emphasize the importance of recognizing and addressing modifiable psychological determinants in hypertension care. Integrating psychosocial assessment with personalized interventions, including mindfulness-based approaches, digital health support, and nurse-led telemonitoring, could improve treatment adherence, reduce emotional burden, and contribute to overall cardiovascular health. This region-specific evidence supports expanding hypertension management to include psychological care alongside standard medical approaches.

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