Low blood pressure associated with low mood: a red herring?

Association between cardiovascular health metrics and depression among U.S. adults: National Health and Nutrition Examination Survey, 2007–2014

PURPOSE

The American Heart Association has identified seven modifiable cardiovascular health (CVH) metrics, including four health behaviors (body mass index, smoking, physical activity, and dietary intake) and three health factors (total cholesterol, blood pressure, and fasting glucose). We sought to examine the association between CVH metrics and depression.

METHODS

We analyzed data on 14,561 adults aged 20 years or older from the National Health and Nutrition Examination Survey 2007-2014. Depressive symptoms were assessed using the Patient Health Questionnaire; a score of 0-4, 5-9, and 10 or higher represented no or minimal, mild, moderate or severe depressive symptoms, respectively. CVH was categorized as inadequate, average, or optimum. We used multinomial logistic regression to assess the association between CVH and depression, adjusted for age, gender, race or ethnicity, education, and alcohol use.

RESULTS

Prevalence of inadequate, average, and optimum CVH were 6.1%, 59.7%, and 34.2%; 14.9% and 7.8% of adults had mild and moderate/severe depression, respectively. Compared with participants with optimum CVH, prevalence ratios for moderate or severe depression were 4.39 (95% confidence interval, 3.32-5.80) and 2.64 (2.15-3.24) for those with inadequate and average CVH, respectively. The corresponding prevalence ratios for mild depression were 2.11 (1.77-2.52) and 1.36 (1.19-1.55). The association appeared to be stronger for CVH behaviors.

CONCLUSIONS

There was a graded association between CVH metrics, particularly for health behaviors, and mild and moderate/severe depression among U.S. adults.

Association of low blood pressure with suicidal ideation: a cross-sectional study of 10,708 adults with normal or low blood pressure in Korea

Background

Whether constitutional low blood pressure (BP) causes substantive health problems has been controversial, and subjects with hypotension exhibit a range of symptoms, from mild typical conditions such as tiredness and dizziness to more specific psychological conditions and even cognitive disorders. This study investigated whether low BP is associated with suicidal ideation in the general population.

Methods

Four years of data from the 2010–2013 Korean National Health and Nutrition Examination Survey were used. Among the 23,163 participants, aged 19–101 years, 10,708 with normal or low BP were included in the analysis of the association between low BP and suicidal ideation. The criterion used for low BP was systolic BP (SBP) < 100 mmHg, and in comparative analyses, the criteria used for low BP were SBP < 110, < 95, and < 90 mmHg. The association of prehypertension or hypertension with suicidal ideation was also examined. Suicidal ideation was assessed by a questionnaire.

Results

Compared with the normotensive reference group, the odds ratios (ORs) for suicidal ideation were significantly higher in the three hypotensive groups after adjusting for sex, age, body mass index, total cholesterol level, household income, educational level, marital status, current smoking status, alcohol intake, and the interaction between sex and age (OR = 1.29, 95% confidence interval [CI], 1.08 to 1.55; OR = 1.44, 95% CI, 1.14 to 1.82; and OR = 1.71, 95% CI, 1.11 to 2.62 for SBP < 100, SBP < 95, and SBP < 90 mmHg, respectively). Adding the clinical morbidities of diabetes mellitus, stroke, myocardial infarction/angina pectoris, and depression as covariates had little effect on the strength of the associations (OR = 1.25, 95% CI, 1.04 to 1.50; OR = 1.43, 95% CI, 1.13 to 1.81; and OR = 1.74, 95% CI, 1.14 to 2.68 for SBP < 100, < 95, and < 90 mmHg, respectively).

Conclusions

Low SBP showed an association with suicidal ideation in the general Korean population. The association was significant for low BP, defined as a SBP < 100 mmHg, and the strength of the association increased as the criteria for low BP increased in strictness.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5106-5) contains supplementary material, which is available to authorized users.

Association between Ideal Cardiovascular Health Metrics and Depression in Chinese Population: A Cross-sectional Study

The study aimed to examine the association between ideal cardiovascular health (CVH) metrics and depression. We conducted a population-based, cross-sectional study of 6,851 participants aged 20 years or older (3,525 men and 3,326 women) living in Tangshan City, China. Information on the seven CVH metrics (including smoking, body mass index, dietary intake, physical activity, blood pressure, total cholesterol and fasting blood glucose) was collected via questionnaires, physical examination and laboratory test. Depression status was assessed using the Epidemiologic Studies Depression Scale (CES-D) and a score of 16 or above was considered depression. The relationship between CVH metrics and depression was analyzed using logistic regression. Of the 6,851 participants, 525 (7.7%) were in depression status. After adjustment for potential confounders, men in the highest quartile of ideal CVH metric summary score had a reduced likelihood of having depression compared to those in the lowest quartile (adjusted odds ratio (AOR): 0.46, 95% confidence interval (CI): 0.28-0.75, p = 0.002). A similar trend was found among women, even though the association was not significant (AOR = 0.74, 95%CI: 0.46-1.18, p = 0.211). This study suggested that better CVH status is associated with a lower risk of depression especially in Chinese male and young population.

Waist-to-hip ratio, dyslipidemia, glycemic levels, blood pressure and depressive symptoms among diabetic and non-diabetic Chinese women: a cross-sectional study

OBJECTIVES

To explore the relationship between depressive symptoms and waist-to-hip ratio, dyslipidemia, glycemic levels or blood pressure among diabetic and non-diabetic Chinese women.

METHODS

11,908 women aged ≥40 years were enrolled in this cross-sectional study, including 2,511 with type 2 diabetes and 9,397 without. Depressive symptoms (defined as having mild-to-severe depressive symptoms) were assessed by the Patient Health Questionnaire-9 (PHQ-9) diagnostic algorithm. The prevalence and the odds ratios (ORs) with 95% confidence intervals (CIs) for having depressive symptoms were estimated using logistic regression analysis.

RESULTS

The age-adjusted prevalence of depressive symptoms was significantly higher in non-diabetic subjects with waist-to-hip ratio (WHR) ≥0.9 (8.6%, age-adjusted OR 1.51 [95% CI 1.17, 1.95]), total cholesterol (TC)>6.22 mmol/L (8.8%, 1.58 [1.16, 2.15]), and Hemoglobin A1c (HbA1c) ≥6.00 mmol/L (7.7%, 1.69 [1.34, 2.14]), while it was significantly lower in non-diabetic subjects with diastolic blood pressure (DBP) between 80 to 89 mmHg (6.2%, 0.78 [0.64, 0.95]). These relationships remained significant even after controlling for multiple factors (WHR ≥0.9: multivariable-adjusted OR 1.39 [95% CI 1.07, 1.80]; TC>6.22 mmol/L: 1.56 [1.14, 2.12]; HbA1c ≥6.00 mmol/L: 1.64 [1.30, 2.08]; DBP 80-89 mmHg: 0.78 [0.64, 0.95]). However, no significant trend between depressive symptoms and WHC, TC, HbA1c, DBP was observed in diabetic women, and no significant trend relationship between depressive symptoms and BMI, WC, TG, or SBP was observed in both non-diabetic and diabetic women. Moreover, the prevalence of depressive symptoms was significantly higher in previously-diagnosed diabetes, compared with non-diabetic subjects, while no significant differences were observed between newly-diagnosed diabetes and non-diabetic subjects.

CONCLUSION

The present study showed a relationship between WHR, TC, HbA1c, DBP and depressive symptoms among non-diabetic women, while no significant relationship between them was observed among diabetic women, even after controlling for multiple confounding factors.

Association between depression and anxiety on blood pressure dysregulation and pulse in the Health and Retirement Study

OBJECTIVE

Extreme blood pressure (BP) values are associated with symptoms of anxiety and depression, but findings from studies are conflicting. The present study tested linear and curvilinear models of the association between anxiety and depression symptoms and BP in the Health and Retirement Study. The relationship between anxiety and depressive symptoms and pulse was also tested.

METHOD

Participants were aged 50 to 104 (N = 4179) and completed the Health and Retirement Study Psychosocial Questionnaire and Physical Measurements in 2006. BP and pulse were measured using an automated cuff. The means of three BP and pulse measurements taken 45 to 60 s apart were used. Depressive and anxiety symptoms were measured with brief forms of the Center for Epidemiological Studies Depression Scale and Beck Anxiety Inventory.

RESULTS

Ordinal regression analyses examined the relationship between BP and anxiety and depressive symptoms. In models adjusted for medical illness and medications, anxiety was associated with systolic hypotension, and depression was associated with diastolic hypotension. Higher pulse was associated with depression but not anxiety.

CONCLUSIONS

Findings suggest that BP dysregulation, specifically hypotension, may be a useful indicator of anxiety and depression. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Low blood pressure and depressive symptoms among Chinese older subjects: a population-based study

BACKGROUND

The relationships between blood pressure and depression are unclear. There are inconsistent reports of an association between low blood pressure and depressive symptoms.

METHODS

In a population-based sample of 2611 Chinese older adults aged 55 years and above, including participants with treated (n=1088), untreated (n=545), or no hypertension (n=978), depressive symptoms were determined by the 15-item Geriatric Depression Scale (> or =5), and current systolic blood pressure and diastolic blood pressure measurements were used to classify participants into high, normal, and low blood pressure groups. Estimates of association were adjusted for confounding by use of antihypertensive and depressogenic drugs and other covariables in hierarchical regression analyses.

RESULTS

Systolic blood pressure and diastolic blood pressure were negatively associated with Geriatric Depression Scale scores, independent of other variables. Low systolic blood pressure (odds ratio [OR] 1.54; 95% confidence interval [CI], 1.07-2.22), low diastolic blood pressure (OR 1.67; 95% CI, 0.98-2.85), and low systolic blood pressure or diastolic blood pressure (or both) (OR 1.55; 95% CI, 1.10-2.19) were independently associated with depressive symptoms. The associations with depressive symptoms were particularly observed for low systolic blood pressure (OR 2.13; 95% CI, 1.13-4.03) among treated hypertensive participants, and low diastolic blood pressure (OR 2.42; 95% CI, 1.26-4.68) among untreated or nonhypertensive participants.

CONCLUSION

Low blood pressure was independently associated with depressive symptoms in both older subjects who were treated for hypertension and those who were not.

No prospective association between hypotension and idiopathic fatigue

OBJECTIVE

To test the hypothesis that there is a prospective association between constitutional hypotension and new-onset fatigue in a large, representative sample.

METHODS

In this prospective study using a large population-based cohort dataset, the Health and Lifestyle Survey, a representative sample of the population residing in private dwellings in Great Britain in 1984 (n=9003, ages 18-97 years) had their blood pressure measured and were asked about fatigue. Participants reporting fatigue at baseline were excluded. The outcome was fatigue state in 1991.

RESULTS

No association was shown, unadjusted or adjusted for likely confounders, in the healthy young population [systolic BP: adj. OR (95% CIs)=1.25 (0.90-1.74); diastolic BP: 1.18 (0.84-1.65)] or the whole population [systolic BP: 0.98 (0.77-1.26); diastolic BP: 1.01 (0.79-1.26)].

CONCLUSION

In this British population-based study, hypotension was not a risk factor for incident idiopathic fatigue.

Association of low blood pressure with anxiety and depression: the Nord-Trøndelag Health Study

BACKGROUND

Low blood pressure has mainly been regarded as ideal, but recent studies have indicated an association with depression in elderly people.

OBJECTIVE

To investigate whether low blood pressure is associated with anxiety and depression in the general population.

DESIGN

Cross-sectional study.

SETTING

Participants in the population-based Nord-Trøndelag Health Study (HUNT-2, 1995-7), Norway.

PARTICIPANTS

60,799 men and women aged 20-89 years filled in the Hospital Anxiety and Depression Scale as part of a general health study. Systolic and diastolic blood pressure was classified in age-stratified and sex-stratified centile groups.

MAIN RESULTS

Compared with participants with systolic blood pressure within the 41-60 centile (reference) group, the odds ratio for anxiety was 1.31 (95% confidence intervals (CI) 1.16 to 1.49), for depression 1.22 (95% CI 1.03 to 1.46), and for comorbid anxiety and depression 1.44 (95% CI 1.24 to 1.68) in the group with < or =5 centile systolic blood pressure. Slightly weaker associations were found of low diastolic blood pressure with anxiety and depression. These associations were similar across sex and age groups. Physical impairment, smoking and angina pectoris influenced the associations only marginally, whereas stroke, myocardial infarction, use of drugs for hypertension, body mass index and several other covariates had no influence.

CONCLUSIONS

This study represents epidemiological evidence for an association of low blood pressure with anxiety and depression, which is not caused by cardiovascular disease.

Effects of noncardiovascular comorbidities on antihypertensive use in elderly hypertensives

Although the benefits of antihypertensive drugs have been clearly established, they remain underused by vulnerable older populations. We examined whether the presence of noncardiovascular comorbidity deters use of antihypertensives in elderly with hypertension. We conducted a retrospective cohort study among 51,517 patients > or =65 years of age in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) Program during 1999 and 2000. All were hypertensive and had diagnoses and used treatments during 1999 to qualify for entry into 1 of the following 5 mutually exclusive cohorts: asthma/chronic obstructive pulmonary disease (COPD), depression, gastrointestinal (GI) disorders, osteoarthritis, or none of the 4 comorbidities. Proportions using antihypertensives in 2000 were assessed. Logistic regression analysis was used to identify the independent effects on antihypertensive use of the 4 comorbidities of interest, sociodemographic characteristics, other cardiovascular and noncardiovascular comorbidity, and health care utilization variables. After adjustments in multivariable analyses, antihypertensive use was consistently lower in patients with asthma/COPD (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.40 to 0.47), depression (OR, 0.50; 95% CI, 0.45 to 0.55), GI disorders (OR, 0.59; 95% CI, 0.54 to 0.64), and osteoarthritis (OR, 0.63; 95% CI, 0.59 to 0.67) relative to those without these conditions. Reduced antihypertensive use was also associated with older age, female gender, white race, more severe other comorbidities, absence of some cardiovascular indications, hospitalizations, nursing home care, physician visits, and use of fewer other medications. Highly prevalent, noncardiovascular conditions appear to deter use of antihypertensives in elderly with hypertension.

Prospective association between hypotension and idiopathic chronic fatigue

OBJECTIVE

To determine whether there is an association between hypotension and incident cases of idiopathic chronic fatigue.

DESIGN

A prospective study.

SETTING

Johns Hopkins Precursors Study.

PARTICIPANTS

Medical students (n = 876) in graduating classes from 1948 to 1964.

MAIN OUTCOME MEASURE

'Easy fatigability' reported by participants at 5- or 10-year follow-up after graduation.

RESULTS

The unadjusted risk in women was 5.0 (95% exact confidence interval = 1.4 to 17.4) and in men was 1.7 (95% exact confidence interval = 0.8, to 3.5).

CONCLUSION

These preliminary findings suggest that hypotension may be a risk factor for the development of idiopathic chronic fatigue in women.

Predictors of fatigue in healthy young adults: moderating effects of cigarette smoking and gender

Fatigue is a common complaint of patients seen in primary care. Factors that contribute to fatigue in a patient population include poor health status, psychological stress, poor nutrition, and pregnancy. Less well understood are factors that contribute to fatigue among healthy, nonpregnant individuals. Within the framework of the theory of unpleasant symptoms, 40 healthy young smoking and nonsmoking adults between the ages of 18 and 35 were evaluated to determine self-report level of fatigue and contributing physiological, psychological, and situational factors. Results indicate that while self-report of fatigue did not vary in this population based on gender, subjects who were moderate to heavy cigarette smokers were significantly more fatigued than were nonsmokers (F = 10.24, df = 1, 38, P < 0.01), with the effect being specific to male smokers. Self-report of fatigue did not correlate with body mass index, baseline inflammatory or immune status, or blood pressure. Positive psychological and situational predictors of fatigue included depression (r = 0.556, P < 0.001), state anxiety (r = 0.569, P < 0.001), sleep quality (r = -0.399, P < 0.05), and sleep quantity (r = -0.411, P < 0.05). These results suggest that psychological and situational factors are key contributors to fatigue in young adults and that smoking is a risk factor for fatigue in men.

Association of hypotension with positive and negative affect and depressive symptoms in the elderly

BACKGROUND

Previous research associating hypotension with depression has produced inconsistent results. A possible reasons is that depressive symptom scales reflect both high negative affect and low positive affect.

AIMS

To examine the association of hypotension with depressive symptoms, negative affect and positive affect.

METHOD

Community survey of 340 elderly persons aged 77-99 years.

RESULTS

Diastolic hypotension had a weak association with depression, no association with negative affect and a strong inverse association with positive affect. Systolic hypertension was associated with positive affect. Use of antihypertensive medication was independently associated with lower positive affect.

CONCLUSIONS

Diastolic hypotension shows a specific association with low positive affect. This association may explain the weak and inconsistent results of earlier studies relating hypotension to depression.

Relationship between low blood pressure and depressive symptomatology in older people

OBJECTIVES

To determine if low blood pressure is associated with a definable constellation of somatic and psychological symptoms in older persons.

DESIGN

A population-based study.

SETTING

In-home interviews in five southwestern states.

PARTICIPANTS

A total of 2723 Mexican Americans aged 65 or older not living in institutions.

MEASURES

Blood pressure, Center for Epidemiologic Studies Depression Scale (CES-D), global self-rating of health, and self-esteem.

RESULTS

Bivariate analyses indicate a significant relationship between low blood pressure and increased depressive symptomatology; for example, systolic hypotensive subjects scored a CES-D mean of 12.07 +/- .67 compared to 8.99 +/- .95 for normotensives (P < .01). Regression analyses supported these findings when controlling for confounders such as gender, age, and use of antihypertensive medications. Subjects with low blood pressure also scored lower on self-esteem and global self-reported health and reported more days waking up feeling tired.

CONCLUSIONS

These data support the existence of a relationship between low blood pressure and higher levels of depressive symptomatology as well as a constellation of somatic and psychosocial symptoms.