The American Journal of Medicine
Volume 123, Issue 4 , Pages 342-349 , April 2010

Low Blood Pressure and Depressive Symptoms among Chinese Older Subjects: A Population-based Study

  • Tze-Pin Ng, MD

      Affiliations

    • Gerontological Research Programme, Faculty of Medicine, National University of Singapore, Singapore
    • Department of Psychological Medicine, National University of Singapore, Singapore
    • Corresponding Author InformationRequests for reprints should be addressed to Tze-Pin Ng, MD, Gerontological Research Programme, National University of Singapore, Department of Psychological Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074
    • ,
  • Liang Feng, PhD

      Affiliations

    • Gerontological Research Programme, Faculty of Medicine, National University of Singapore, Singapore
    • Department of Psychological Medicine, National University of Singapore, Singapore
    • ,
  • Mathew Niti, PhD

      Affiliations

    • Health Service Research and Evaluation, Ministry of Health, Singapore
    • ,
  • Keng-Bee Yap, MMed

      Affiliations

    • Gerontological Research Programme, Faculty of Medicine, National University of Singapore, Singapore
    • Department of Geriatrics Medicine, Alexandra Hospital, Singapore

References 

  1. Lawes CM, Vander Hoorn S, Rodgers A International Society of Hypertension. Global burden of blood-pressure-related disease, 2001. Lancet. 2008;371(9623):1513–1518
  2. Van der Kooy K, van Hout H, Marwijk H, et al. Depression and the risk for cardiovascular diseases: systematic review and meta analysis. Int J Geriatr Psychiatry. 2007;22:613–626
  3. Pemberton J. Does constitutional hypotension exist?. BMJ. 1989;298(6674):660–662
  4. Wessely S, Nickson J, Cox B. Symptoms of low blood pressure: a population study. BMJ. 1990;301(6748):362–365
  5. Pilgrim JA, Stansfeld S, Marmot M. Low blood pressure, low mood?. BMJ. 1992;304(6819):75–78
  6. Meyer CM, Armenian HK, Eaton WW, Ford DE. Incident hypertension associated with depression in the Baltimore Epidemiologic Catchment area follow-up study. J Affect Disord. 2004;83(2-3):127–133
  7. Bosworth HB, Bartash RM, Olsen MK, Steffens DC. The association of psychosocial factors and depression with hypertension among older adults. Int J Geriatr Psychiatry. 2003;18:1142–1148
  8. Davidson K, Jonas BS, Dixon KE, Markovitz JH. Do depression symptoms predict early hypertension incidence in young adults in the CARDIA study? (Coronary Artery Risk Development in Young Adults). Arch Intern Med. 2000;160:1495–1500
  9. Jonas BS, Franks P, Ingram DD. Are symptoms of anxiety and depression risk factors for hypertension?Longitudinal evidence from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Arch Fam Med. 1997;6:43–49
  10. Wiehe M, Fuchs SC, Moreira LB, et al. Absence of association between depression and hypertension: results of a prospectively designed population-based study. J Hum Hypertens. 2006;20:434–439
  11. Levenstein S, Smith MW, Kaplan GA. Psychosocial predictors of hypertension in men and women. Arch Intern Med. 2001;161:1341–1346
  12. Licht CMM, Geus EJC, Seldenrijk A, et al. Depression is associated with decreased blood pressure, but antidepressant use increases the risk for hypertension. Hypertension. 2009;53:631–638
  13. Niu K, Hozawa A, Awata S, et al. Low blood pressure is associated with depressive symptoms in an elderly population aged 70 years and over: a population-based, cross-sectional analysis. Hypertens Res. 2008;31:409–416
  14. Lenoir H, Lacombe JM, Dufouil C, et al. Relationship between blood pressure and depression in the elderly (The Three-City Study). J Hypertens. 2008;26:1765–1772
  15. Hildrum B, Mykletun A, Holmen J, Dahl AA. Effect of anxiety and depression on blood pressure: 11-year longitudinal population study. Br J Psychiatry. 2008;193:108–113
  16. Hildrum B, Mykletun A, Stordal E, et al. Association of low blood pressure with anxiety and depression: the Nord-Trøndelag Health Study. J Epidemiol Community Health. 2007;61:53–58
  17. Stroup-Benham CA, Markides KS, Black SA, Goodwin JS. Relationship between low blood pressure and depressive symptomatology in older people. J Am Geriatr Soc. 2000;48:250–255
  18. Paterniti S, Verdier-Taillefer MH, Geneste C, et al. Low blood pressure and risk of depression in the elderly (A prospective community-based study). Br J Psychiatry. 2000;176:464–467
  19. Donner-Banzhoff N, Chan Y, Szalai JP, Hilditch JR. Low blood pressure associated with low mood: a red herring?. J Clin Epidemiol. 1997;50:1175–1181
  20. Gilmore C, Green BH, Copeland JR, et al. Blood pressure as a risk factor for depression in elderly people: a prospective study. Acta Psychiatr Scand. 1995;91:126–129
  21. Patten SB, Barbui C. Drug-induced depression: a systematic review to inform clinical practice. Psychother Psychosom. 2004;73:207–215
  22. Hallas J. Evidence of depression provoked by cardiovascular medications: a prescription sequence symmetry analysis. Epidemiology. 1996;7:478–484
  23. Kotlyar M, Dysken M, Adson DE. Update on drug-induced depression in the elderly. Am J Geriatr Pharmacother. 2005;3:288–300
  24. Niti M, Yap KB, Kua EH, et al. Physical, social and productive leisure activities, cognitive decline and interaction with APOE-epsilon 4 genotype in Chinese older adults. Int Psychogeriatr. 2008;20:237–251
  25. World Health Organization. MONICA Manual. Geneva, Switzerland: World Health Organization; 1990;
  26. Yesavage J. Geriatric Depression Scale. Psychopharmacol Bull. 1988;24:709–711
  27. Wancata J, Alexandrowicz R, Marquart B, et al. The criterion validity of the Geriatric Depression Scale: a systematic review. Acta Psychiatr Scand. 2006;114:398–410
  28. Lim PP, Ng LL, Chiam PC, et al. Validation and comparison of three brief depression scales in an elderly Chinese population. Int J Geriatr Psychiatry. 2000;15:824–830
  29. Nyunt MSZ, Jin AZ, Fones CSL, Ng TP. Criterion-based validity and reliability of the Geriatric Depression Screening Scale (GDS-15) in a large validation sample of community-living Asian older adults. Aging Ment Health. 2009;13:376–382
  30. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–16310
  31. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J. 1965;14:61–65
  32. Folstein MF, Folstein SE, McHugh PR. Mini-mental state. J Psychiatr Res. 1975;12:189–198
  33. Ng TP, Niti M, Chiam PC, Kua EH. Ethnic differences in cognitive performance on Mini-Mental State Examination in Asians. Am J Geriatr Psychiatry. 2007;15:130–139
  34. Holmes A, Heilig M, Rupniak NM, et al. Neuropeptide systems as novel therapeutic targets for depression and anxiety disorders. Trends Pharmacol Sci. 2003;24:580–588
  35. Fuxe K, Aguirre JA, Agnati LF, et al. Neuropeptide Y and central cardiovascular regulation (Focus on its role as a cotransmitter in cardiovascular adrenergic neurons). Ann N Y Acad Sci. 1990;611:111–132
  36. Lindholm L, Lanke J, Bengtsson B, Ejlertsson G, Thulin T, Schersten B. Both high and low blood pressures risk indicators of death in middle aged males. Acta Med Scand. 1985;218:473–480
  37. Vatten LJ, Holmen J, Kruger O, et al. Low blood pressure and mortality in the elderly: a 6-year follow-up of 18,022 Norwegian men and women age 65 and older. Epidemiology. 1995;6:70–73
  38. Farnett L, Mulrow CD, Linn WD, et al. The J-curve phenomenon and the treatment of hypertension (Is there a point beyond which pressure reduction is dangerous?). JAMA. 1991;265:489–495
  39. Staessen JA. Potential adverse effects of blood pressure lowering—J-curve revisited. Lancet. 1996;348:696–697
  40. Goodwin J. Embracing complexity: a consideration of hypertension in the very old. J Gerontol A Biol Sci Med Sci. 2003;58:653–658
  41. Messerli FH, Giuseppe Mancia G, Conti CR, et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous?. Ann Intern Med. 2006;144:884–893

 Funding: The study was supported by a research grant (No. 03/1/21/17/214) from the Biomedical Research Council, Agency for Science, Technology and Research (ASTAR), Singapore.

 Conflict of Interest: None.

 Authorship: T.P. Ng designed the study and its analytical strategy, directed its implementation, and reviewed the results and draft of the manuscript. L. Feng helped conduct the literature review, performed the statistical analysis, and prepared the Materials and Methods, and the Discussion sections of the text. M. Niti and K.B. Yap supervised the field activities and directed the quality assurance and control, and reviewed the drafts of the article.

PII: S0002-9343(09)01016-X

doi: 10.1016/j.amjmed.2009.09.026

The American Journal of Medicine
Volume 123, Issue 4 , Pages 342-349 , April 2010

Article Tools