Awareness of hypertension and depressive symptoms: a cross-sectional study in a primary care population

• Published in: Scandinavian journal of primary health care Vol. 36; no. 3; pp. 323 - 328
• Main Authors: Rantanen, Ansa Talvikki, Korkeila, Jyrki Jaakko Antero, Löyttyniemi, Eliisa Susanna, Saxén, Ulla Kirsti Maria, Korhonen, Päivi Elina
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 01.09.2018; Taylor & Francis LLC; Taylor & Francis Group
• Subjects: Aged; Alcohol use; Alcoholism - complications; Associations; Awareness; Beck's depression inventory; Blood Pressure; cardiovascular disease; Cardiovascular diseases; Comorbidity; Cross-Sectional Studies; Depression - etiology; Exercise; Female; Finland; health behavior; Health risk assessment; Humans; Hypertension; Hypertension - complications; Hypertension - psychology; hypertension awareness; Kidney diseases; Labelling; Leisure; Life Style; Lifestyles; Logistic Models; Male; Medical diagnosis; Mental depression; mental disorders; Middle age; Middle Aged; Obesity; Obesity - complications; Odds Ratio; Physical activity; Primary care; Primary Health Care; Recreation; Regression analysis; risk; Risk Factors; Rural Population; Sex Factors; Smoking; Symptoms; Time use; Type 2 diabetes mellitus; Finland; health behavior; cardiovascular disease; risk; Beck’s depression inventory; hypertension awareness; mental disorders
• ISSN: 0281-3432; 1502-7724; 1502-7724
• DOI: 10.1080/02813432.2018.1499588

Objective: To investigate the association of hypertension awareness and depressive symptoms, and to analyse factors predisposing aware hypertensives to depressive symptoms. Design: Cross-sectional study in a primary care population. Setting: Cardiovascular risk factor survey in two semi-rural towns in Finland. Subjects: Two thousand six hundred seventy-six middle-aged risk persons without an established cardiovascular or renal disease or type 2 diabetes. Main outcome measures: Depressive symptoms, previous and new diagnosis of hypertension. Results: Hypertension was diagnosed in 47.9% of the subjects, of whom 34.5% (442/1 282) had previously undetected hypertension. Depressive symptoms were reported by 14% of the subjects previously aware of their hypertension, and by 9% of both unaware hypertensives and normotensive subjects. In the logistic regression analysis, both the normotensive (OR 0.62, 95% CI 0.45-0.86) (p = 0.0038) and the unaware hypertensive subjects (OR 0.54, 95% CI 0.35-0.84) (p = 0.0067) had lower risk for depressive symptoms than the previously diagnosed hypertensives. Among these aware hypertensives, female gender (OR 3.61, 95% CI 2.06-6.32), harmful alcohol use (OR 2.55, 95% CI 1.40-4.64) and obesity (OR 2.50, 95% CI 1.01-6.21) predicted depressive symptoms. Non-smoking (OR 0.57, 95% Cl 0.33-0.99) and moderate leisure-time physical activity compared to low (OR 0.53, 95% CI 0.33-0.84) seemed to buffer against depressive symptoms. Conclusion: Depressive symptoms are common in hypertensive persons even without comorbidities, if the person is already aware of his/her hypertension. Many modifiable, lifestyle associated factors may contribute to the association of hypertension and depressive symptoms. Key Points Hypertension and depressive symptoms are known to form a toxic combination contributing even to all-cause mortality. Comorbidities or the labelling effect of the diagnosis of hypertension can confound their association. Our study shows that depressive symptoms are common in hypertensive persons even without comorbidities, if the person is already aware of his/her hypertension. Many modifiable, lifestyle-associated factors may contribute to the association of hypertension and depressive symptoms. When treating hypertensive patients, consideration of depressive symptoms is important in order to promote favorable lifestyle and control of hypertension.