Bidirectional association between blood pressure and depressive symptoms in young and middle-age adults: A cohort study

• Published in: Epidemiology and psychiatric sciences Vol. 29
• Main Authors: Jeon, Sang Won, Chang, Yoosoo, Lim, Se-Won, Cho, Juhee, Kim, Han-Na, Kim, Kyoung-Beom, Kim, Jinseok, Kim, Young Hwan, Shin, Dong-Won, Oh, Kang-Seob, Shin, Young-Chul, Ryu, Seungho
• Format: Journal Article
• Language: English; Italian
• Published: Cambridge, UK Cambridge University Press 01.01.2020
• Subjects: Blood pressure; Body mass index; Cohort analysis; Diabetes; Fasting; Glucose; Hypertension; Insulin resistance; Medical screening; Mental depression; Middle age; Original; Original Articles; Psychiatry; Questionnaires; Studies; South Korea; hypotension; blood pressure; Bidirectional association; cohort study; depression; depressive symptoms; hypertension
• ISSN: 2045-7960; 2045-7979
• DOI: 10.1017/S2045796020000542

Abstract Aims To evaluate the bidirectional relationship between blood pressure (BP) and depressive symptoms using a large prospective cohort study. Methods Prospective cohort study was performed in 276 244 adults who participated in a regular health check-up and were followed annually or biennially for up to 5.9 years. BP levels were categorised according to the 2017 American College of Cardiology and American Heart Association hypertension guidelines. Depressive symptoms were assessed using Centre for Epidemiologic Studies-Depression (CESD) questionnaire and a cut-off score of ≥25 was regarded as case-level depressive symptoms. Results During 672 603.3 person-years of follow-up, 5222 participants developed case-level depressive symptoms. The multivariable-adjusted hazard ratios (HRs) [95% confidence interval (CI)] for incident case-level depressive symptoms comparing hypotension, elevated BP, hypertension stage 1 and hypertension stage 2 to normal BP were 1.07 (0.99–1.16), 0.93 (0.82–1.05), 0.89 (0.81–0.97) and 0.81 (0.62–1.06), respectively ( p for trend <0.001). During 583 615.3 person-years of follow-up, 27 787 participants developed hypertension. The multivariable-adjusted HRs (95% CI) for incident hypertension comparing CESD 16–24 and ⩾25 to CESD < 16 were 1.05 (1.01–1.11) and 1.12 (1.03–1.20), respectively ( p for trend <0.001) and in the time-dependent models, corresponding HRs (95% CI) were 1.12 (1.02–1.24) and 1.29 (1.10–1.50), respectively ( p for trend <0.001). Conclusions In this large cohort study of young and middle-aged individuals, higher BP levels were independently associated with a decreased risk for developing case-level depressive symptoms and depressive symptoms were also associated with incident hypertension. Further studies are required to elucidate the mechanisms underlying the bidirectional association between BP levels and incident depression.