Association between depression and hypertension using classic and revised blood pressure thresholds
Dustin S DeMoss1, Kari J Teigen2, Cynthia A Claassen3
1Department of Psychiatry, John Peter Smith Hospital, Fort Worth, TX, USA.
Insights
This study found no clinically meaningful link between treating depression and lowering hypertension (HTN) using new or old guidelines. While older HTN guidelines showed a slight association, it wasn't clinically significant.
Area of Science:
- Cardiology
- Psychiatry
- Primary Care Medicine
Background:
- The relationship between depression treatment and hypertension (HTN) management under revised ACC/AHA HTN guidelines is not well understood in primary care.
- This study investigates this relationship in a primary care setting.
Purpose of the Study:
- To compare the association between changes in depression severity and hypertension (HTN) over time using newly revised versus previous HTN guidelines.
- To determine if revised HTN guidelines impact the observed relationship between depression and HTN management.
Main Methods:
- A retrospective cohort study included 3018 outpatients with depressive symptoms and elevated blood pressure.
- Patients were categorized into 'revised' (≥130/80 mmHg), 'classic' (≥140/90 mmHg), or 'revised-minus-classic' groups.
- Depression severity (PHQ-9) and HTN levels were tracked over 6-18 months, with correlations analyzed using robust regression.
Main Results:
- Depressive symptom change was unrelated to blood pressure change in the revised and revised-minus-classic groups.
- The classic HTN guideline group showed a statistically significant but clinically insignificant change in systolic blood pressure per unit change in PHQ-9 score (β = 0.23, P=0.02).
- Only 41% of subjects had follow-up data for PHQ-9 and HTN.
Conclusions:
- While classic HTN guidelines showed a statistically significant association between reduced HTN and improved depression, it was not clinically meaningful.
- No clinically meaningful association was found between depression treatment and improved HTN levels under either revised or classic guidelines.
Background:
In a primary care population, the relationship between treatment of depression and hypertension (HTN) under the recently revised American College of Cardiology and American Heart Association HTN thresholds for diagnosing HTN is unknown.
Objective:
To compare the association between changes in severity of co-occurring depression and HTN over time using the newly revised versus previous HTN guidelines.
Methods:
In this retrospective cohort study, outpatients ≥18 years (n = 3018) with clinically significant depressive symptoms and elevated blood pressure at baseline were divided into a 'revised' guideline group (baseline blood pressure ≥130/80 mmHg), a 'classic' guideline group (≥140/90 mmHg) and a 'revised-minus-classic' group (≥130/80 and <140/90 mmHg). Depressive symptom change was assessed using the Patient Health Questionnaire-9 (PHQ-9). Correlations between changes in PHQ-9 scores and HTN levels by group over a 6- to 18-month observation period were assessed using robust regression analysis.
Results:
There were demographic and clinical differences between groups. A total of 41% of study subjects (1252/3018) had a visit during the follow-up period where additional PHQ-9 and HTN results were available. Depressive symptom change was unrelated to change in blood pressure in the revised and revised-minus-classic groups. The classic HTN group demonstrated a clinically insignificant change in systolic blood pressure for each unit change in PHQ-9 score (β = 0.23, P-value =0.02).
Conclusions:
Although a statistically significant association between reduced HTN levels and improvement in depressive symptoms was demonstrated under classic HTN guidelines, there was no clinically meaningful association between treatment of depression and improved HTN levels under either guideline.
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