Sex Differences, Depressive Symptoms, and Early Blood Pressure Control After Hospital Discharge in Cardiovascular...

Psychological distress is common among patients with cardiovascular disease and adversely affects secondary prevention. We investigated whether depressive and anxiety symptoms, identified by guideline-recommended ultra-brief screening instruments, were associated with blood pressure (BP) control after hospital discharge, with particular attention to sex. Data in very high-risk populations remain limited.

In this prospective observational single-center study, 305 consecutive hospitalized cardiovascular patients (mean age 63.9 years, 62.6% men, 79.3% at very high cardiovascular risk) underwent screening for depressive and anxiety symptoms using the Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2). BP control was assessed at discharge and at routine follow-up after a median of 36.0 (32.5-39.5) days using ambulatory or home BP monitoring. Clinical, echocardiographic and psychosocial characteristics were analyzed.

Depressive and anxiety symptoms were identified in 31.1% and 29.2% of patients, respectively. Depressive symptoms were more prevalent in women. BP target achievement declined from 78.4% at discharge to 49.5% during follow-up. PHQ-2 ≥ 3 was independently associated with lower odds of achieving BP targets (OR 0.12, 95% CI 0.06-0.23; p < 0.001), together with overweight/obesity (OR 0.20, 95% CI 0.09-0.42; p < 0.001), while male sex was independently associated with better BP control (OR 2.06, 95% CI 1.12-3.77; p = 0.02). Female sex, overweight/obesity, chronic kidney disease, loneliness, and poor sleep quality were associated with PHQ-2 ≥ 3.

Female sex and depressive symptoms were independently associated with a lower likelihood of achieving guideline-recommended BP targets during early post-discharge follow-up. These findings highlight the potential utility of brief psychological screening to identify patients at increased risk after discharge.