Abstract
Abstract. In the present investigation it is hypothesized that depressive symptoms and antidepressant therapy are associated with systolic and diastolic blood pressure. Moreover, in additional analyses, the interaction effects of age, gender, and depressive symptoms are estimated, and discussed in the context of previous findings. Data from the German Health Interview and Examination Survey for Adults (DEGS1) were analyzed (N = 7,987) by means of multi-response Bayesian hierarchical regression models. Missing data were imputed by the method of chain equations. Independent variables included depressive symptoms, antidepressant medication, gender, age, smoking, physical activity, family history of hypertension, body mass index, and antihypertensive medication. The estimates obtained in the multi-response model revealed that depressive symptoms were negatively associated with arterial blood pressure (−0.09, 99% CI [−0.147; −0.040]). Antidepressant therapy was found to be positively associated with increased blood pressure (1.035, 99% CI [0.333; 1.990]). There were negative interaction effects of depressive symptoms and age among women only (−0.006 99% CI [−0.010; −0.001]). The results agree with previous findings reporting a negative association between depressive symptoms and blood pressure. In addition, regarding the trajectory of blood pressure across the lifespan, interaction effects of depressive symptoms and age were found among females. The results indicate a linear increase in blood pressure with increasing age which, however, tends to flatten and decrease by around age 55 in both males and females. Potential physiological mechanisms may be related to affect regulation taking place at higher levels of cognitive processing and affecting blood pressure regulation, and/or cardiovascular mechanisms related to cerebral blood flow, arterial blood pressure, and depressive symptoms which have not been sufficiently explained so far.
References
1939). Emotional factors in essential hypertension: Presentation of a tentative hypothesis. Psychosomatic Medicine, 1, 173–179.
(1994). Low blood pressure and depression in older men: A population based study. British Medical Journal, 308, 446–449.
(2013). Association of elevated blood pressure with low distress and good quality of life. Psychosomatic Medicine, 75, 422–428. https://doi.org/10.1097/psy.0b013e31828ef0c2
(2016). Association between depressive symptoms, use of antidepressant medication and the metabolic syndrome: The Maine-Syracuse Study. BMC Public Health, 16. https://doi.org/10.1186/s12889-016-3170-2
(2014). The new statistics: Why and how. Psychological Science, 25, 7–29. https://doi.org/10.1177/0956797613504966
(2016). Psychotropic drug use and alcohol consumption among older adults in Germany: Results of the German Health Interview and Examination Survey for Adults 2008–2011. British Medical Journal Open, 6, e012182. https://doi.org/10.1136/bmjopen-2016-012182
(2017). Affective impairment in chronic low blood pressure. Journal of Psychosomatic Research, 93, 33–40. https://doi.org/10.1016/j.jpsychores.2016.12.008
(2005). Essential hypotension is accompanied by deficits in attention and working memory. Behavioral Medicine, 30, 149–158.
(1979). Baroreceptor activation reduces reactivity to noxious stimulation: Implications for hypertension. Science, 205, 1299–1301. https://doi.org/10.1126/science.472749
(Erdmann E. (Ed.). (2009). Klinische Kardiologie
[Clinical cardiology] . Heidelberg, Germany: Springer.2013). Regression. Berlin, Germany: Springer.
(2001). Multivariate statistical modelling based on generalized linear models. New York, NY: Springer.
(1988). Cardiovascular effects of the standard tricyclic antidepressants. Clinical Chemistry, 34, 856–858.
(2004). Screening psychischer Störungen mit dem Gesundheitsfragebogen für Patienten (PHQ-D)
([Screening for psychiatric disorders with the Patient Health Questionnaire (PHQ)] . Diagnostica, 50, 171–181. https://doi.org/10.1026/0012-1924.50.4.1711986). The fallacy of employing standardized regression coefficients and correlations as measures of effect. American Journal of Epidemiology, 123, 203–208.
(2007). Depression and risk of cardiovascular diseases among males aged 25–64 (WHO MONICA-Psychosocial). Alaska Medicine, 49(2 Suppl), 255–258.
(2010). MCMC methods for multi-response generalized linear mixed models: The MCMCglmm R package. Journal of Statistical Software, 33, 1–22.
(2015). Association between chronic stress and blood pressure. Psychosomatic Medicine, 77, 575–582. https://doi.org/10.1097/psy.0000000000000183
(2008). Effect of anxiety and depression on blood pressure: 11-year longitudinal population study. The British Journal of Psychiatry, 193, 108–113. https://doi.org/10.1192/bjp.bp.107.045013
(2011). Anxiety and depression lowers blood pressure: 22-year follow-up of the population based HUNT study, Norway. BMC Public Health, 11. https://doi.org/10.1186/1471-2458-11-601
(2000). The corticosteroid receptor hypothesis of depression. Neuropsychopharmacology, 23, 477–501. https://doi.org/10.1016/s0893-133x(00)00159-7
(2005). Why most published research findings are false. PLoS Medicine, 2, e124. https://doi.org/10.1371/journal.pmed.0020124
(1997). 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. Archives of Family Medicine, 6, 43–49.
(2001). Association of hypotension with positive and negative affect and depressive symptoms in the elderly. British Journal of Psychiatry, 178, 553–555. https://doi.org/10.1192/bjp.178.6.553
(2018). Association of low blood pressure with suicidal ideation: A cross-sectional study of 10,708 adults with normal or low blood pressure in Korea. BMC Public Health, 18. https://doi.org/10.1186/s12889-018-5106-5
(2010). Impact of depression and antidepressant treatment on heart rate variability: A review and meta-analysis. Biological Psychiatry, 67, 1067–1074. https://doi.org/10.1016/j.biopsych.2009.12.012
(2002). Toward a comprehensive developmental model for major depression in women. American Journal of Psychiatry, 159, 1133–1145. https://doi.org/10.1176/appi.ajp.159.7.1133
(2006). Toward a comprehensive developmental model for major depression in men. American Journal of Psychiatry, 163, 115–124. https://doi.org/10.1176/appi.ajp.163.1.115
(1990). Hypertension: Cognitive and behavioral considerations. Neuropsychology Review, 1, 31–73. https://doi.org/10.1007/BF01108858
(2001). The PHQ-9. Journal of General Internal Medicine, 16, 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
(1995). Emotion: Clues from the brain. Annual Review of Psychology, 46, 209–235. https://doi.org/10.1146/annurev.ps.46.020195.001233
(2008). Relationship between blood pressure and depression in the elderly. The three-city study. Journal of Hypertension, 26, 1765–1772. https://doi.org/10.1097/hjh.0b013e3283088d1f
(2009). Depression is associated with decreased blood pressure, but antidepressant use increases the risk for hypertension. Hypertension, 53, 631–638. https://doi.org/10.1161/hypertensionaha.108.126698
(2013). Emotional dampening in persons with elevated blood pressure: Affect dysregulation and risk for hypertension. Annals of Behavioral Medicine, 47, 111–119. https://doi.org/10.1007/s12160-013-9526-2
(2011). Cardiovascular-emotional dampening. Psychosomatic Medicine, 73, 743–750. https://doi.org/10.1097/psy.0b013e318235ed55
(2014). Blood pressure values and depression in hypertensive individuals at high cardiovascular risk. BMC Cardiovascular Disorders, 14. https://doi.org/10.1186/1471–2261-14–109
(2012). Depression increases the risk of hypertension incidence. Journal of Hypertension, 30, 842–851. https://doi.org/10.1097/hjh.0b013e32835080b7
(2017). Multivariate hierarchical Bayesian models and choice of priors in the analysis of survey data. Journal of Applied Statistics, 44, 3011–3032. https://doi.org/10.1080/02664763.2016.1267120
(2011). Trajectories of depressive episodes and hypertension over 24 years: The Whitehall II Prospective cohort study. Hypertension, 57, 710–716. https://doi.org/10.1161/hypertensionaha.110.164061
(2013). Blutdruck in Deutschland 2008–2011
([Blood pressure in Germany 2008–2011] . Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz, 56, 795–801. https://doi.org/10.1007/s00103-013-1669-62010). Low blood pressure and depressive symptoms among Chinese older subjects: A population-based study. The American Journal of Medicine, 123, 342–349. https://doi.org/10.1016/j.amjmed.2009.09.026
(2006). Depression as an aetiologic and prognostic factor in coronary heart disease: A meta-analysis of 6362 events among 146,538 participants in 54 observational studies. European Heart Journal, 27, 2763–2774. https://doi.org/10.1093/eurheartj/ehl338
(2000). Blood pressure measuring devices: Recommendations of the European Society of Hypertension. British Medical Journal, 322(7285), 531–536.
(1992). Low blood pressure, low mood? British Medical Journal, 304, 75–78.
(2004). Elevated resting blood pressure and dampened emotional response. Psychosomatic Medicine, 66, 583–587. https://doi.org/10.1097/01.psy.0000130490.57706.88
(1977). The CES-D scale. Applied Psychological Measurement, 1, 385–401. https://doi.org/10.1177/014662167700100306
(2001). Trajectory of psychological risk and incident hypertension in middle-aged women. Hypertension, 38, 798–802.
(2001). Psychophysiology of arterial baroreceptors and the etiology of hypertension. Biological Psychology, 57, 179–201. https://doi.org/10.1016/s0301-0511(01)00094-1
(2015). German Health Interview and Examination Survey for Adults (DEGS1). Berlin, Germany: Author. Public Use File 1. https://doi.org/10.7797/16-200812-1-1-1
(2006). Dichotomizing continuous predictors in multiple regression: A bad idea. Statistics in Medicine, 25, 127–141. https://doi.org/10.1002/sim.2331
(2012). German Health Interview and Examination Survey for Adults (DEGS) – design, objectives and implementation of the first data collection wave. BMC Public Health, 12. https://doi.org/10.1186/1471-2458-12-730
(2013). Sex and age differences in the relation of depressive symptoms with blood pressure. American Journal of Hypertension, 26, 1413–1420. https://doi.org/10.1093/ajh/hpt135
(2016). Depression and risk of sudden cardiac death and arrhythmias. Psychosomatic Medicine, 79, 153–161. https://doi.org/10.1097/psy.0000000000000382
(2001). Blood pressure and symptoms of depression and anxiety: A prospective study. American Journal of Hypertension, 14, 660–664. https://doi.org/10.1016/s0895-7061(01)01304-8
(2002). Bayesian measures of model complexity and fit. Journal of the Royal Statistical Society: Series B (Statistical Methodology), 64, 583–639. https://doi.org/10.1111/rssb.12062
(1998). Effects of venlafaxine on blood pressure: A meta-analysis of original data from 3744 depressed patients. Journal of Clinical Psychiatry, 59, 502–508.
(2013). Blood pressure regulation IX: Cerebral autoregulation under blood pressure challenges. European Journal of Applied Physiology, 114, 545–559. https://doi.org/10.1007/s00421-013-2667-y
(2012). Flexible imputation of missing data. Boca Raton, FL: CRC Press.
(2011). Mice: Multivariate imputation by chained equations in R. Journal of Statistical Software, 45, 1–67.
(2008). The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Journal of Clinical Epidemiology, 61, 344–349.
. (2011). Life course trajectories of systolic blood pressure using longitudinal data from eight UK cohorts. PLoS Medicine, 8, e1000440. https://doi.org/10.1371/journal.pmed.1000440
(2011). Deming, data and observational studies. Significance, 8, 116–120. https://doi.org/10.1111/j.1740-9713.2011.00506.x
(2017). A meta-analysis of effects of selective serotonin reuptake inhibitors on blood pressure in depression treatment: Outcomes from placebo and serotonin and noradrenaline reuptake inhibitor controlled trials. Neuropsychiatric Disease and Treatment, 13, 2781–2796. https://doi.org/10.2147/ndt.s141832
(