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

  • Tze-Pin Ng
    Correspondence
    Requests 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
    Affiliations
    Gerontological Research Programme, Faculty of Medicine, National University of Singapore, Singapore

    Department of Psychological Medicine, National University of Singapore, Singapore
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  • Liang Feng
    Affiliations
    Gerontological Research Programme, Faculty of Medicine, National University of Singapore, Singapore

    Department of Psychological Medicine, National University of Singapore, Singapore
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  • Mathew Niti
    Affiliations
    Health Service Research and Evaluation, Ministry of Health, Singapore
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  • Keng-Bee Yap
    Affiliations
    Gerontological Research Programme, Faculty of Medicine, National University of Singapore, Singapore

    Department of Geriatrics Medicine, Alexandra Hospital, Singapore
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      Abstract

      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 (≥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.

      Keywords

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      References

        • Lawes C.M.
        • Vander Hoorn S.
        • Rodgers A.
        • International Society of Hypertension
        Global burden of blood-pressure-related disease, 2001.
        Lancet. 2008; 371: 1513-1518
        • 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
        • Pemberton J.
        Does constitutional hypotension exist?.
        BMJ. 1989; 298: 660-662
        • Wessely S.
        • Nickson J.
        • Cox B.
        Symptoms of low blood pressure: a population study.
        BMJ. 1990; 301: 362-365
        • Pilgrim J.A.
        • Stansfeld S.
        • Marmot M.
        Low blood pressure, low mood?.
        BMJ. 1992; 304: 75-78
        • Meyer C.M.
        • Armenian H.K.
        • Eaton W.W.
        • Ford D.E.
        Incident hypertension associated with depression in the Baltimore Epidemiologic Catchment area follow-up study.
        J Affect Disord. 2004; 83: 127-133
        • Bosworth H.B.
        • Bartash R.M.
        • Olsen M.K.
        • Steffens D.C.
        The association of psychosocial factors and depression with hypertension among older adults.
        Int J Geriatr Psychiatry. 2003; 18: 1142-1148
        • Davidson K.
        • Jonas B.S.
        • Dixon K.E.
        • Markovitz J.H.
        Do depression symptoms predict early hypertension incidence in young adults in the CARDIA study?.
        Arch Intern Med. 2000; 160: 1495-1500
        • Jonas B.S.
        • Franks P.
        • Ingram D.D.
        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
        • Wiehe M.
        • Fuchs S.C.
        • Moreira L.B.
        • et al.
        Absence of association between depression and hypertension: results of a prospectively designed population-based study.
        J Hum Hypertens. 2006; 20: 434-439
        • Levenstein S.
        • Smith M.W.
        • Kaplan G.A.
        Psychosocial predictors of hypertension in men and women.
        Arch Intern Med. 2001; 161: 1341-1346
        • Licht C.M.M.
        • Geus E.J.C.
        • Seldenrijk A.
        • et al.
        Depression is associated with decreased blood pressure, but antidepressant use increases the risk for hypertension.
        Hypertension. 2009; 53: 631-638
        • 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
        • Lenoir H.
        • Lacombe J.M.
        • Dufouil C.
        • et al.
        Relationship between blood pressure and depression in the elderly.
        J Hypertens. 2008; 26: 1765-1772
        • Hildrum B.
        • Mykletun A.
        • Holmen J.
        • Dahl A.A.
        Effect of anxiety and depression on blood pressure: 11-year longitudinal population study.
        Br J Psychiatry. 2008; 193: 108-113
        • 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
        • Stroup-Benham C.A.
        • Markides K.S.
        • Black S.A.
        • Goodwin J.S.
        Relationship between low blood pressure and depressive symptomatology in older people.
        J Am Geriatr Soc. 2000; 48: 250-255
        • Paterniti S.
        • Verdier-Taillefer M.H.
        • Geneste C.
        • et al.
        Low blood pressure and risk of depression in the elderly.
        Br J Psychiatry. 2000; 176: 464-467
        • Donner-Banzhoff N.
        • Chan Y.
        • Szalai J.P.
        • Hilditch J.R.
        Low blood pressure associated with low mood: a red herring?.
        J Clin Epidemiol. 1997; 50: 1175-1181
        • Gilmore C.
        • Green B.H.
        • Copeland J.R.
        • et al.
        Blood pressure as a risk factor for depression in elderly people: a prospective study.
        Acta Psychiatr Scand. 1995; 91: 126-129
        • Patten S.B.
        • Barbui C.
        Drug-induced depression: a systematic review to inform clinical practice.
        Psychother Psychosom. 2004; 73: 207-215
        • Hallas J.
        Evidence of depression provoked by cardiovascular medications: a prescription sequence symmetry analysis.
        Epidemiology. 1996; 7: 478-484
        • Kotlyar M.
        • Dysken M.
        • Adson D.E.
        Update on drug-induced depression in the elderly.
        Am J Geriatr Pharmacother. 2005; 3: 288-300
        • Niti M.
        • Yap K.B.
        • Kua E.H.
        • 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
        • World Health Organization
        MONICA Manual.
        World Health Organization, Geneva, Switzerland1990
        • Yesavage J.
        Geriatric Depression Scale.
        Psychopharmacol Bull. 1988; 24: 709-711
        • 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
        • Lim P.P.
        • Ng L.L.
        • Chiam P.C.
        • et al.
        Validation and comparison of three brief depression scales in an elderly Chinese population.
        Int J Geriatr Psychiatry. 2000; 15: 824-830
        • Nyunt M.S.Z.
        • Jin A.Z.
        • Fones C.S.L.
        • Ng T.P.
        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
        • WHO Expert Consultation
        Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.
        Lancet. 2004; 363 (10): 157-163
        • Mahoney F.I.
        • Barthel D.W.
        Functional evaluation: the Barthel Index.
        Md State Med J. 1965; 14: 61-65
        • Folstein M.F.
        • Folstein S.E.
        • McHugh P.R.
        Mini-mental state.
        J Psychiatr Res. 1975; 12: 189-198
        • Ng T.P.
        • Niti M.
        • Chiam P.C.
        • Kua E.H.
        Ethnic differences in cognitive performance on Mini-Mental State Examination in Asians.
        Am J Geriatr Psychiatry. 2007; 15: 130-139
        • Holmes A.
        • Heilig M.
        • Rupniak N.M.
        • et al.
        Neuropeptide systems as novel therapeutic targets for depression and anxiety disorders.
        Trends Pharmacol Sci. 2003; 24: 580-588
        • Fuxe K.
        • Aguirre J.A.
        • Agnati L.F.
        • et al.
        Neuropeptide Y and central cardiovascular regulation.
        Ann N Y Acad Sci. 1990; 611: 111-132
        • 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
        • Vatten L.J.
        • 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
        • Farnett L.
        • Mulrow C.D.
        • Linn W.D.
        • et al.
        The J-curve phenomenon and the treatment of hypertension.
        JAMA. 1991; 265: 489-495
        • Staessen J.A.
        Potential adverse effects of blood pressure lowering—J-curve revisited.
        Lancet. 1996; 348: 696-697
        • Goodwin J.
        Embracing complexity: a consideration of hypertension in the very old.
        J Gerontol A Biol Sci Med Sci. 2003; 58: 653-658
        • Messerli F.H.
        • Giuseppe Mancia G.
        • Conti C.R.
        • 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