Longitudinal Association Between Depression and Incident Hypertension-an Updated Systematic Review and Meta-Analysis

Abstract

Objective: Background: The association between depression and cardiovascular disease (CVD) is well documented. However, depression has also been proposed to be involved in the pathological pathways linking the main risk factors of CVDs. Several studies including one meta-analysis have suggested that depression may be an independent risk factor for hypertension. Objective:To evaluate the relationship between depression and incident hypertension Design and method: Bibliographic databases Medline, EMBASE, Web of Science and PsycINFO without language restrictions were searched from 2005 up to 2019. We included prospective cohort studies, involving normotensive subjects at baseline with diagnosis of depression measured using clinical evaluation or a standardised psychometric tool and recorded as a dichotomous variable. Outcome was new-onset hypertension. We excluded studies that enrolled participants with a history of antihypertensive medication at the time of study initiation. Methodological quality was assessed using the Newcastle-Ottawa Scale. Pooled hazard ratios (HR) were calculated using inverse variance method in random effects models. Results: We identified five studies with a total of 201,886 participants and an average follow-up of 7.52 years. Out of the five studies, only two reported a positive association between depression and incident hypertension. The pooled effect of three studies included in the meta-analysis showed that depression was associated with 20% increased risk of hypertension (HR = 1.20, 95%CI 1.01–1.43) but with a substantial heterogeneity (I2 = 70%). One study reported a null result for a dose-response relationship between depressive symptoms and incident hypertension. Quality analysis showed increased risk of bias notably in the ascertainment of the outcome as most studies relied on self-report and/or prescription of antihypertensive medication as a proxy for hypertension. Conclusions: Our findings indicate a possible increased risk of hypertension with depressive symptoms, but this result is limited by heterogeneity and ascertainment bias in the studies included.

Sex and age differentials among people living with hypertension across the life course: evidence from a national survey in Bangladesh

“…Some studies showed that anxiety and depression may be related to the rise of BP while other studies showed a transient sympathetic mediated rise in BP due to stress (72)(73)(74)(75). Though more studies are required to undoubtedly establish a direct relationship between stress, anxiety, and depression with hypertension, stress-whether emotional, social, cultural, or occupational-may lead to several illnesses including the development of hypertension (76).…”