Depression Increases The Risk For Uncontrolled Hypertension: Clinical Cardiology: Original Article
Depression Increases The Risk For Uncontrolled Hypertension: Clinical Cardiology: Original Article
Depression Increases The Risk For Uncontrolled Hypertension: Clinical Cardiology: Original Article
AF Rubio-Guerra, L Rodriguez-Lopez, G Vargas-Ayala, Self-rating Depression Scale survey for depression. Associations between
S Huerta-Ramirez, D Castro Serna, JJ Lozano-Nuevo. Depression the results of the blood pressure and depression tests were determined using
increases the risk for uncontrolled hypertension. Exp Clin the Spearman correlation coefficient; RR was also measured.
Cardiol 2013;18(1):10-12. RESuLTS: Of the 40 patients, 23 were depressed, and 21 of these 23 had
poor control of their blood pressure. The RR for uncontrolled hypertension
in depressed patients was 15.5. A significant correlation between systolic
bACkGROuND: Because hypertension and depression share common
(r=0.713) and diastolic (r=0.52) blood pressure values and depression was
pathways, it is possible that each disease has an impact on the natural his-
found.
tory of the other.
CONCLuSION: Depression is common in patients with uncontrolled
ObJECTIVE: To determinate whether depression influences blood pres-
hypertension and may interfere with blood pressure control. Screening for
sure control in hypertensive patients.
depression in hypertensive patients is a simple and cost-effective tool that
METHODS: Forty hypertensive patients undergoing antihypertensive
may improve outcomes.
treatment, excluding beta-blockers and central-acting agents, self-measured
their blood pressure several times a day for three days using a validated,
commercially available device. All patients also completed the Zung key Words: Blood pressure control; Depression; Hypertension
10 ©2013 Pulsus Group Inc. All rights reserved Exp Clin Cardiol Vol 18 No 1 2013
Depression and blood pressure control
Table 1 210
baseline characteristics of patients R = 0.713
p<0.001
200
Depressed Not depressed
190
blood pressure
180
Controlled Uncontrolled Controlled Uncontrolled
Age, years, mean 59 61 59 60 170
mmHg
Sex, male/female, n/n 0/2 7/14 5/11 0/1 160
Blood pressure, 130/68 158/89 125/77 142/91 150
systolic/diastolic, 140
mmHg 130
Depression
120
Mild 2 10 – –
110
Moderate – 7 – –
100
Severe – 4 – –
20 40 60 80
Data presented as n unless otherwise indicated
Zung scale score
Figure 1) Correlation between systolic blood pressure and Zung Self-rating
disorders, patients receiving beta-blockers or central acting agents, Depression Scale score
patients with a history of alcohol and/or psychotropic drug abuse, and
patients receiving antidepressant drugs for any purpose.
The present study was conducted with the approval of the Research
R = 0.52, p<0.001
120
Statistical analysis 60
Associations between the results from the blood pressure and depres- 50
sion tests were determined using the Spearman correlation coefficient; 40
RR was also measured. 20 30 40 50 60 70 80 90
Zung Scale Score
RESuLTS Figure 2) Correlation between diastolic blood pressure and Zung Self-rating
The baseline characteristics of the patients are shown in Table 1. Of Depression Scale score
the 40 patients included in the study, 23 were depressed (57.5%), of
whom two had good blood pressure control and 21 had poor blood We found a high prevalence of depression in hypertensive patients;
pressure control. Of the remaining 17 patients without depression, one this prevalence was approximately nine times greater than what is
patient had poor blood pressure control and 16 patients had good observed in the general population. Although the investigators were
blood pressure control. The average blood pressure in depressed patients not directly involved in the gathering of blood pressure data and
with poor blood pressure control was 158/89 mmHg, and the average depression scores for the patients, we recognize that the present study
blood pressure in patients without depression and good blood pressure was not a blinded study. It is interesting to note that systolic blood
control was 125/77 mmHg (Table 1). pressure control was poor, yet there was good diastolic blood pressure
The RR of experiencing uncontrolled hypertension in patients control in all groups. We do not have an explanation for this finding,
with depression was 15.5. but systolic blood pressure control is typically more difficult to main-
When the blood pressure and self-measured depression test results tain than diastolic blood pressure control (15). Nevertheless, the pres-
were analyzed, a significant correlation between systolic (r=0.713 [95%CI ence of depression in hypertensive patients appears to be a risk factor
0.79 to 0.91]; P<0.001 [Figure 1]) and diastolic (r=0.52 [95% CI 0.56 to for poorly controlled blood pressure.
0.82]; P<0.001 [Figure 2]) blood pressure values was found. In a study involving 452 psychiatric outpatients with a diagnosis
Compliance with treatment (according to the relatives of the of depression, Rabkin et al (16) found that hypertension was three
patients) was >90% before the beginning of blood pressure self- times more prevelant when compared with those without depression,
measurement, and all patients were compliant with their treatment supporting a significant association between depression and hyperten-
regimen as prescribed during the study period. sion. However, this study did not relate the presence of depression
with the level of antihypertensive control. The study by Jokisalo et al
DISCuSSION (17) found that a feeling of hopelessness toward hypertension, frustra-
In the present study, we found that depression was a risk factor for poor tion with treatment and perceived anxiety with blood pressure meas-
blood pressure control in hypertensive patients. urement were associated with poor high blood pressure control.
The study design, which included patients using simple, validated, Finally, a recent meta-analysis demonstrated an approximately 42%
semiautomatic blood pressure monitoring equipment (11) and a self- increased risk for hypertension in depressed patients, especially in
administered, validated and accurate screening test for depression (12) patients for whom the diagnosis of depression was made three years
at home, without the intervention of the investigator, produced reli- before the study (4). The results of these studies further support the
able and acurate information that enabled an unbiased analysis of the correlation between a patient’s psychological status and their level of
results without any influence of the ‘white coat’ phenomenon. It is hypertension control.
important to note, however, that there is not enough evidence to rec- Other studies have failed to find associations between depression
ommend one depression screening test over another (13). and hypertension. Hun et al (18) found no relationship between
We did not include patients who were being treated with beta- depression and the development of hypertension over a four-year time
blockers or central-acting agents because these drugs have been known frame, whereas Licht et al (19) found an association between depres-
to cause depression (14). sion and decreased blood pressure.
The coexistence of depression and hypertension may have prognos- compliance with the treatment regimen was >90% before blood pres-
tic implications not related to blood pressure values because patients sure self-measurement, and that all patients had taken their medica-
with depression exhibit increased sympathetic tone and decreased tion as prescribed during the study period.
parasympathetic activity, which not only contributes to an increase It is important to note that the different antihypertensive treat-
(and poor control) of blood pressure, but also may increase the risk of ments used for blood pressure control in our patients have previously
cardiac arrhythmias (4,5). Interestingly, the use of serotonin reuptake been shown to be equally effective when used as monotherapy (14).
inhibitors decreases sympathetic activation (4), although whether Combinations of agents were given to approximately 50% of the
antidepressant treatment improves blood pressure control requires patients in each group.
addtional investigation.
Because depression and hypertension share a common pathway, it CONCLuSION
is reasonable to consider depression in hypertensive patients (and Our results suggest that depression is a common feature in patients
hypertension in depressive patients) (20). experiencing uncontrolled hypertension, which may contribute to
Furthermore, depressed patients may have poor control of their poor control. Screening for depression in hypertensive patients is a
blood pressure because they have lost interest in adhering to their simple and cost-effective tool that may improve outcomes and should
theraputic regimen (21). At the Hospital General de Ticomán SS DF, we be performed in all hypertensive patients.
ask relatives of our patients to perform a count of the medication to
verify adherence to antihypertensive therapy. In the present study, we DISCLOSuRES: The authors have no conflicts of interest to disclose.
No honorarium, grant, or other form of payment was provided to anyone to
also applied this practice starting one week before the beginning of
produce this article.
blood pressure self-measurement, with the relatives reporting that
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