Relationship Between Blood Pressure Values, Depressive Symptoms, and Cardiovascular Outcomes in Patients With
Bhautesh Dinesh Jani1, Jonathan Cavanagh2, Sarah J E Barry3
1General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
Insights
High blood pressure and depression significantly increase cardiovascular risk in patients with cardiometabolic disease. Combining these conditions elevates the risk of major adverse cardiovascular events (MACE).
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Cardiovascular disease remains a leading cause of mortality globally.
- Comorbid depression is prevalent in patients with cardiometabolic conditions.
- The combined impact of blood pressure and depression on cardiovascular risk is not fully elucidated.
Purpose of the Study:
- To investigate the joint effect of systolic blood pressure (BP) and depression on major adverse cardiovascular events (MACE) in patients with established cardiometabolic disease.
- To determine if depression modifies the association between BP and cardiovascular risk.
Main Methods:
- A cohort of 35,537 patients with coronary heart disease, diabetes, or stroke was analyzed.
- Baseline systolic BP and depression status were recorded concurrently.
- Cox proportional hazards models were used to assess the 4-year risk of MACE (myocardial infarction, heart failure, stroke, or cardiovascular death).
Main Results:
- 11% of patients experienced a MACE within 4 years.
- Very high systolic BP (160-240 mm Hg) and depression were independently associated with significantly higher adjusted MACE risk.
- A significant interaction between depression and systolic BP was observed (P=.03).
- Patients with both high systolic BP and depression faced an 83% higher adjusted risk of MACE compared to those with normal BP and no depression.
Conclusions:
- Comorbid depression significantly amplifies the cardiovascular risk associated with high systolic BP in patients with cardiometabolic disease.
- Closer monitoring of systolic BP in cardiometabolic patients with comorbid depression is warranted.
- This highlights the importance of integrated care for cardiovascular and mental health.
Abstract:
The authors studied the joint effect of blood pressure (BP) and depression on the risk of major adverse cardiovascular outcome in patients with existing cardiometabolic disease. A cohort of 35,537 patients with coronary heart disease, diabetes, or stroke underwent depression screening and BP measurement recorded concurrently. The authors used Cox's proportional hazards to calculate risk of major adverse cardiovascular event (MACE; myocardial infarction/heart failure/stroke or cardiovascular death) over 4 years associated with baseline BP and depression. A total of 11% (3939) had experienced a MACE within 4 years. Patients with very high systolic BP (160-240 mm Hg; hazard ratio, 1.28) and depression (hazard ratio, 1.22) at baseline had significantly higher adjusted risk. Depression had a significant interaction with systolic BP in risk prediction (P=.03). Patients with a combination of high systolic BP and depression at baseline had 83% higher adjusted risk of MACE, as compared with patients with reference systolic BP without depression. Patients with cardiometabolic disease and comorbid depression may benefit from closer monitoring of systolic BP.
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