Table 1.
Summary of the main characteristics and findings of the included articles (n = 13)
| Authors (years) | Participants (M/F, mean age) |
Alexithymia Measures | Other Measures | Main results of alexithymia in HTN participants | Risk bias |
|---|---|---|---|---|---|
| Casagrande et al. (2019b) [18••] |
810 with HTN (434 F; mean age: 60.1, SD: 11.2) 431 without HTN (273 F; mean age: 51.5, SD: 10.2) |
TAS-20 |
Socio-demographic and clinical data: age, gender, marital status, years of education, smoking, alcohol consumption, BMI, SBP, DBP, mean arterial pressure, heart rate, and clinical information Adherence to drug: ad hoc yes/no questionnaire |
Alexithymia prevalence in HTN participants: 16.4% (133). Alexithymia mean (SD) score in HTN participants: 49.01 (12.10) HTN participants reported higher levels of alexithymia compared to individuals without HTN (normotensive individuals), even after controlling for age, education, and BMI In addition, treated HTN reported higher alexithymia scores compared to both untreated participants with and without HTN |
Low |
| Consoli et al. (2010) [19] |
98 with HTN: 73 with essential HTN, 25 with secondary HTN (62 F, mean age essential HTN: 53.4, SD essential HTN: 12.7; mean age secondary HTN: 52.2, SD secondary HTN: 15.7) |
TAS-20 |
Socio-demographic and clinical data: age, gender, education, disease duration, smoking, BMI, SBP, DBP, and clinical information Emotion awareness: LEAS Coping: WCC |
Alexithymia prevalence in essential HTN vs. secondary HTN patients: 25% (18) vs. 20% (5) Alexithymia mean (SD) score in essential HTN vs. secondary HTN patients: 54.2 (11.6) vs. 48.4 (12.1) No statistically significant differences between essential HTN and secondary HTN patients either in alexithymia scores or in alexithymia percentages |
Low |
| Di Trani et al. (2018) [30] |
15 with HTN (8 F; mean age: 48.5, SD: 10.7) 20 without HTN (13 F; mean age: 25, SD: 3.8) |
TAS-20 TSIA |
Socio-demographic data: age and gender Linguistic measures: WRAD, Italian reflection dictionary, disfluency dictionary, and somatic sense |
Alexithymia mean (SD) score in HTN participants: TAS: 40.23 (9.92); TSIA: 28.20 (6.03) HTN participants did not report higher levels of alexithymia on the TAS-20 compared to individuals without HTN, whereas they yielded higher scores on the TSIA than individuals without HTN |
High |
| Gage and Egan (1984) [36] |
66 with HTN (34 F; mean age and SD: N.A.) No control group |
MMPI | Socio-demographic data: age, gender, DBP ≥ 95 mm Hg |
Alexithymia prevalence in HTN participants: 47% (31) In alexithymic HTN participants the severity of HTN was greater than in non-alexithymic HTN participants |
High |
| Grabe et al. (2010) [39] |
503 with HTN (247 F; mean age: 51.0, SD: 0.4) 675 without HTN (417 F; mean age: 42.7, SD: 0.4) |
TAS-20 |
Socio-demographic and clinical data: age, gender, education, marital status, smoking, physical activity, BMI, SBP, DBP, and clinical information Mental distress: CID-S |
Alexithymia prevalence in HTN participants: 23.9% (120) Alexithymia mean (SD) score in HTN participants: 42.6 (0.4) HTN participants yielded higher alexithymia scores and were found to be more alexithymic (score ≥ 49) compared to individuals without HTN |
Low |
| Hänninen et al. (2011) [33] |
744 with HTN: 221 with white-coat HTN, 118 with masked HTN, 405 with sustained HTN (white-coat HTN: 107 F; mean age: 56.2, SD: 8.1; masked HTN: 44 F; mean age: 56.9, SD 8.1; sustained HTN: 187 F; mean age: 58.6, SD: 8.5) 715 without HTN (426 F; mean age: 53.9, SD: 7.2) |
TAS-20 |
Socio-demographic and clinical data: age, gender, education, marital status, smoking, physical activity, alcohol consumption, BMI, office SBP and DBP, home SBP and DBP, and clinical information Psychopathological symptoms: Whiteley-7, BDI, GHQ-12 |
Patients with sustained HTN reported higher alexithymia scores compared to patients with white-coat HTN | Low |
| Jula et al. (1999) [34] |
237 with HTN (99 F; mean age: 45.7 for M, 46.4 for F; SD: 5.1 for M, 4.7 for F) 146 without HTN (78 F; mean age: 44 for M, 44.2 for F; SD: 5.3 for M, 5.4 for F) |
TAS-26 |
Socio-demographic and clinical data: age, gender, socioeconomic class, BMI, alcohol intake, smoking, SBP, DBP, clinical information Psychopathological symptom: BSI-37, STAXI |
Alexithymia prevalence in HTN participants: 57% (79) men; 46% (46) women Alexithymia mean (SD) score in HTN participants: 45.7 (5.1) men; 46.4 (4.7) women HTN participants have significantly higher TAS mean scores and a higher prevalence of alexithymia than individuals without HTN. HTN women had more somatization symptoms than women HC |
Low |
| Muneta et al. (1997) [38] | 101 with HTN: 48 whit white-coat HTN, 53 with sustained HTN (white-coat HTN: 34 F, mean age: 59.2, SD: 9.5; 14 M, mean age: 60.1, SD: 11.5; sustained HTN: 32 F, mean age: 58.6, SD: 9.7; 21 M, mean age: 59.5, SD: 13) | MMPI |
Socio-demographic and clinical data: age, gender, clinic SBP and DBP, home SBP and DBP Psychological characteristics and symptoms: SRQ-D, Type A Behavior Pattern Questionnaire, GHQ, ECL |
Alexithymia prevalence: in white-coat HTN participants, 14.3% (2) men; 26.5% (9) women; in sustained HTN participants, 4.8% (1) men, 31.3% (10) women Alexithymia mean (SD) score: in white-coat HTN participants, 12.9 (4.6) men; 15.2 (1.9) women; in sustained HTN participants, 13.7 (1.8) men, 15.8 (2.3) women White-coat HTN participants did not differ from sustained HTN in alexithymia scores |
Medium |
| Niiranen et al. (2006) [35] |
593 with HTN: 371 with sustained HTN, 222 with isolated clinical HTN (sustained HTN: 169 F, mean age: 57.9, SD: 8.6; isolated clinical HTN: 108 F, mean age: 55.8, SD: 8.3) 847 without HTN (370 F; mean age: 53.5, SD: 7.6) |
TAS-20 |
Socio-demographic and clinical data: age, gender, education, smoking, BMI, clinic blood pressure (SBP, DBP), clinical information Psychopathological symptoms: Whiteley-7, BDI, GHQ-12 |
Alexithymia mean (SD) score: in sustained HTN participants, 48.2 (10.9); in isolated clinical HTN participants, 45.2 (10.8) Sustained HTN participants had higher scores of alexithymia and were more alexithymic than those with isolated clinical HTN and without HTN |
Low |
| Paulson (1985) [37] |
53 with HTN (4 F; mean age: 56.5, SD: 6.5) No control group |
BIQ MMPI Schalling-Sifneos Scale |
Socio-demographic and clinical data: age, gender, marital status, education, clinical information |
Alexithymia prevalence in HTN participants: 41% (22) (BIQ) No differences were found between alexithymic and non-alexithymic participants for socio-demographic and clinical data. No correlation was found between BIQ and other scales used |
Medium |
| Piotrowska-Półrolnik et al. (2019) [20••] |
39 with HTN (23 F, mean age: 42.9, SD: 13.5) 37 without HTN (26 F, mean age: 36.7, SD: 11.5) |
TAS-20 | Socio-demographic and clinical data: age, gender, education, marital status, BMI, clinical information, 24 h-ABPM |
Alexithymia prevalence in HTN participants: 17.9% (7). Alexithymia mean (SD) score in HTN participants: 48.33 (N.A.) Alexithymia mean level was higher in HTN participants than in individuals without HTN. There were statistically significant positive correlations between higher alexithymia levels and higher 24-h SBP values |
Medium |
| Rafanelli et al. (2012) [31] |
125 with HTN (52 F, mean age: 66.4, SD: 11) No control group |
DCPR |
Socio-demographic and clinical data: age, gender, education, marital status, working status, clinical information, smoking, family risk, blood pressure ranging Psychological characteristics and symptoms: SCID, PSI, SQ, PWB scale |
Alexithymia prevalence in HTN participants: 36% (45). The alexithymia cluster consisted of 55 patients (68.7%). HTN participants with moderate to severe levels of HTN have been more represented in the anxiety-depression and alexithymia clusters | Low |
| Todarello et al. (1995) [32] |
114 with HTN (64 F, mean age: 52.5, SD: 11) 113 Psychiatric patients 130 without HTN (81 F, mean age: 40.8, SD: 16.7) |
TAS-20 | Socio-demographic and clinical data: age, gender, education, clinical information, SBP, DBP |
Alexithymia prevalence in HTN participants: 55.3% (63). Alexithymia mean (SD) score in HTN participants: 61.99 (13.93) HTN participants had significantly higher levels of alexithymia than psychiatric patients, which had higher scores than individuals without HTN. A significantly higher rate of alexithymia was found in the HTN group than other two groups |
Medium |
HTN Hypertension, TAS Toronto Alexithymia Scale, BMI Body Mass Index, LEAS Levels of Emotional Awareness Scale, WCC Ways of Coping Checklist, TSIA Toronto Structured Interview for Alexithymia, WRAD Weighted Referential Activity Dictionary, NA Not Available, MMPI Minnesota Multiphasic Personality Inventory, CID-S Composite International Diagnostic-Screener, BDI Beck Depression Inventory, GHQ General Health Questionnaire, SBP Systolic Blood Pressure, DBP Diastolic Blood Pressure, BSI-37 Brief Symptoms Inventory, STAXI 31 item Spielberger State-Trait Anger Expression Inventory, SRQ-D Self Rating Questionnaire for Depression, ECL Egogram Check List, BIQ Beth Israel Hospital Questionnaire, ABPM Ambulatory Blood Pressure Monitoring, DCPR Diagnostic Criteria for Psychosomatic Research, SCID Structured Clinical Interview for DSM-IV, PSI Psychosocial Index, SQ Symptom Questionnaire, PWB Psychological Well-Being Scale