Gender Differences in the Association Between Depression, Anxiety and Cardiovascular Mortality in Hypertensive...

Hypertension is a primary risk factor for cardiovascular mortality and frequently co-occurs with depression and anxiety, though their combined impact remains inadequately characterized in this high-risk population.

This study aimed to investigate the associations of depression and anxiety with cardiovascular mortality specifically in adults with hypertension.

We analyzed data from the National Health and Nutrition Examination Survey (NHANES). Depression was assessed using the PHQ-9 questionnaire, while anxiety was measured through self-reported days. The associations were evaluated using weighted multivariable cox regression and restricted cubic spline (RCS) models.

A total of 3728 participants were included, with a mean follow-up of 9.2 years and 285 cardiovascular deaths. In Model3, depression (PHQ-9) was positively associated with cardiovascular mortality (Hazard ratio (HR) [95% CI] 1.07 [1.03-1.10], P < 0.001). When PHQ-9 was categorized into quartiles, the greatest HR in men was observed in Q3 (2.65 [1.09-6.44], P = 0.032) but that for women was in Q4 (3.94 [1.39-11.2], P = 0.01). RCS curve revealed linear positive association between depression and cardiovascular mortality (P-overall < 0.001; P-nonlinear > 0.05). No interaction was observed in the stratified analyses (P > 0.05). Sensitivity analyses showed the HR of Q4 was attenuated in the overall population but remained stable in women (3.97 [1.29-12.2], P = 0.019). No significant association was found between anxiety and cardiovascular mortality (P > 0.05).

Depression, but not self-reported anxious days, was positively associated with cardiovascular mortality in hypertensive patients, with a stronger association observed in women.