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Association of depression with mortality in an elderly treated hypertensive population

Published online by Cambridge University Press:  13 August 2018

Enayet K. Chowdhury Open the ORCID record for Enayet K. Chowdhury [Opens in a new window] ,
Michael Berk ,
Mark R. Nelson ,
Lindon M. H. Wing  and
Christopher M. Reid
Enayet K. Chowdhury*
Affiliation:
Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
Michael Berk
Affiliation:
Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia Orygen Youth Health Research Centre and the Centre of Youth Mental Health, The Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, University of Melbourne, Parkville, Australia
Mark R. Nelson
Affiliation:
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
Lindon M. H. Wing
Affiliation:
College of Medicine and Public Health, Flinders University, South Australia, Australia
Christopher M. Reid
Affiliation:
Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia School of Public Health, Curtin University, Perth, Western Australia, Australia
*
Correspondence should be addressed to: Enayet Karim Chowdhury, Department of Epidemiology and Preventive Medicine, Monash University, 6th Floor, Alfred Centre, 99 Commercial Rd, Melbourne VIC 3004, Australia. Phone: +61 3 99030524; Fax: +61-3 9903 0556. Email: enayet.chowdhury@monash.edu.
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Abstract

Background:

Both elevated blood pressure and/or depression increase the risk of cardiovascular disease and mortality. This study in treated elderly hypertensive patients explored the incidence of depression, its association (pre-existing and incident) with mortality and predictors of incident depression.

Methods:

Data from 6,083 hypertensive patients aged ≥65 years enrolled in the Second Australian National Blood Pressure study were used. Participants were followed for a median of 10.8 years (including 4.1 years in-trial) and classified into: “no depression,” “pre-existing” and “incident” depression groups based on either being “diagnosed with depressive disorders” and/or “treated with an anti-depressant drug” at baseline or during in-trial period. Further, we redefined “depression” restricted to presence of both conditions for sensitivity analyses. For the current study, end-points were all-cause and any cardiovascular mortality.

Results:

313 (5%) participants had pre-existing depression and a further 916 (15%) participants developed depression during the trial period (incidence 4% per annum). Increased (hazard-ratio, 95% confidence-interval) all-cause mortality was observed among those with either pre-existing (1.23, 1.01–1.50; p = 0.03) or incident (1.26, 1.12–1.41; p < 0.001) depression compared to those without. For cardiovascular mortality, a 24% increased risk (1.24, 1.05–1.47; p = 0.01) was observed among those with incident depression. The sensitivity analyses, using the restricted depression definition showed similar associations. Incident depression was associated with being female, aged ≥75 years, being an active smoker at study entry, and developing new diabetes during the study period.

Conclusions:

This elderly cohort had a high incidence of depression irrespective of their randomised antihypertensive regimen. Both pre-existing and incident depression were associated with increased mortality.

Keywords

angiotensin converting enzyme inhibitorsdepressiondiureticselderlyhypertensionsurvival
Type
Original Research Article
Information
International Psychogeriatrics , Volume 31 , Issue 3: Issue Theme: Caregiving for People with Dementia , March 2019 , pp. 371 - 381
Copyright
Copyright © International Psychogeriatric Association 2018 

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References

Adamis, D. and Ball, C. (2000). Physical morbidity in elderly psychiatric inpatients: prevalence and possible relations between the major mental disorders and physical illness. International Journal of Geriatric Psychiatry, 15, 248–253.Google Scholar
Ancelin, M. L., Carriere, I., Scali, J., Ritchie, K., Chaudieu, I. and Ryan, J. (2013). Angiotensin-converting enzyme gene variants are associated with both cortisol secretion and late-life depression. Translational Psychiatry, 3, e322.Google Scholar
Anderson, R. J., Freedland, K. E., Clouse, R. E. and Lustman, P. J. (2001). The prevalence of comorbid depression in adults with diabetes. Diabetes Care, 24, 1069.Google Scholar
Australian Bureau of Statistics (1998). Mental Health and Wellbeing: Profile of Adults, Australia 1997. ABS Catalogue No. 4326.0. Canberra: ABS.: Australian Bureau of Statistics.Google Scholar
Australian Bureau of Statistics (2008). National Survey of Mental Health and Wellbeing: Summary of Results, 2007. Cat. no. (4326.0). Canberra: ABS.: Australian Bureau of Statistics.Google Scholar
Axon, R. N., Zhao, Y. M. and Egede, L. E. (2010). Association of depressive symptoms with all-cause and ischemic heart disease mortality in adults with self-reported hypertension. American Journal of Hypertension, 23, 30–37.Google Scholar
Baldwin, R. C. (2008). Depressive disorders. In Jacoby, R., Oppenheimer, C., Dening, T. and Thomas, A. (eds.), Oxford Textbook of Old Age Psychiatry (pp. 529–556). Oxford, UK: Oxford University Press.Google Scholar
Boal, A. H. et al. (2016). Monotherapy with major antihypertensive drug classes and risk of hospital admissions for mood disorders. Hypertension, 68, 1132–1138.Google Scholar
Bonnet, F., Irving, K., Terra, J.-L., Nony, P., Berthezène, F. and Moulin, P. (2005). Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease. Atherosclerosis, 178, 339–344.Google Scholar
Brownstein, D. J. et al. (2018). Blockade of the angiotensin system improves mental health domain of quality of life: a meta-analysis of randomized clinical trials. Australian & New Zealand Journal of Psychiatry, 52, 24–38.Google Scholar
Chowdhury, E. K., Ademi, Z., Moss, J. R., Wing, L. M. H., Reid, C. M. and on behalf of the Second Australian National Blood Pressure Study Management Committee (2015). Cost–utility of angiotensin-converting enzyme inhibitor-based treatment compared with thiazide diuretic-based treatment for hypertension in elderly australians considering diabetes as comorbidity. Medicine, 94, e590.Google Scholar
Cole, M. G. and Dendukuri, N. (2003). Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. American Journal of Psychiatry, 160, 1147–1156.Google Scholar
Davidson, K., Jonas, B. S., Dixon, K. E. and Markovitz, J. H. (2000). Do depression symptoms predict early hypertension incidence in young adults in the cardia study?. Archives of Internal Medicine, 160, 1495–1500.Google Scholar
Egan, B. M., Zhao, Y. and Axon, R. (2010). Us trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA, 303, 2043–2050.Google Scholar
Golden, S. H. et al. (2017). The prevalence and specificity of depression diagnosis in a clinic-based population of adults with type 2 diabetes mellitus. Psychosomatics, 58, 28–37.Google Scholar
Grant, B. F., Hasin, D. S., Chou, S., Stinson, F. S. and Dawson, D. A. (2004). Nicotine dependence and psychiatric disorders in the united states: Results from the national epidemiologic survey on alcohol and related conditions. Archives of General Psychiatry, 61, 1107–1115.Google Scholar
Hamer, M., Batty, G. D., Stamatakis, E. and Kivimaki, M. (2010). The combined influence of hypertension and common mental disorder on all-cause and cardiovascular disease mortality. Journal of Hypertension, 28, 2401–2406.Google Scholar
Johansen, A., Holmen, J., Stewart, R. and Bjerkeset, O. (2012). Anxiety and depression symptoms in arterial hypertension: the influence of antihypertensive treatment. The hunt study, Norway. European Journal of Epidemiology, 27, 63–72.Google Scholar
Kendrick, T., King, F., Albertella, L. and Smith, P. W. F. (2005). GP treatment decisions for patients with depression: an observational study. The British Journal of General Practice, 55, 280–286.Google Scholar
King, M. et al. (2008). Development and validation of an international risk prediction algorithm for episodes of major depression in general practice attendees: The predicted study. Archives of General Psychiatry, 65, 1368–1376.Google Scholar
Kuo, P.-L. and Pu, C. (2011). The contribution of depression to mortality among elderly with self-reported hypertension: analysis using a national representative longitudinal survey. Journal of Hypertension, 29, 2084–2090.Google Scholar
Lim, S. S. et al. (2012). A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380, 2224–2260.Google Scholar
Maatouk, I. et al. (2016). Association of hypertension with depression and generalized anxiety symptoms in a large population-based sample of older adults. Journal of Hypertension, 34, 1711–1720.Google Scholar
Maes, M., Fišar, Z., Medina, M., Scapagnini, G., Nowak, G. and Berk, M. (2012). New drug targets in depression: inflammatory, cell-mediated immune, oxidative and nitrosative stress, mitochondrial, antioxidant, and neuroprogressive pathways. And new drug candidates—Nrf2 activators and GSK-3 inhibitors. Inflammopharmacology, 20, 127–150.Google Scholar
Meng, L., Chen, D., Yang, Y., Zheng, Y. and Hui, R. (2012). Depression increases the risk of hypertension incidence: a meta-analysis of prospective cohort studies. Journal of Hypertension, 30, 842–851.Google Scholar
Moylan, S. et al. (2014). Oxidative & nitrosative stress in depression: why so much stress?. Neuroscience and Biobehavioral Reviews, 45, 46–62.Google Scholar
Moylan, S., Eyre, H. A., Maes, M., Baune, B. T., Jacka, F. N. and Berk, M. (2013). Exercising the worry away: how inflammation, oxidative and nitrogen stress mediates the beneficial effect of physical activity on anxiety disorder symptoms and behaviours. Neuroscience & Biobehavioral Reviews, 37, 573–584.Google Scholar
Mühlig, Y., Antel, J., Föcker, M. and Hebebrand, J. (2016). Are bidirectional associations of obesity and depression already apparent in childhood and adolescence as based on high-quality studies? A systematic review. Obesity Reviews, 17, 235–249.Google Scholar
Musselman, D. L., Evans, D. L. and Nemeroff, C. B. (1998). The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment. Archives of General Psychiatry, 55, 580–592.Google Scholar
O'Connor, D. W. (2006). Do older Australians truly have low rates of anxiety and depression? A critique of the 1997 national survey of mental health and wellbeing. Australian & New Zealand Journal of Psychiatry, 40, 623–631.Google Scholar
Rait, G., Walters, K., Griffin, M., Buszewicz, M., Petersen, I. and Nazareth, I. (2009). Recent trends in the incidence of recorded depression in primary care. The British Journal of Psychiatry, 195, 520.Google Scholar
Sandström, Y. K., Ljunggren, G., Wändell, P., Wahlström, L. and Carlsson, A. C. (2016). Psychiatric comorbidities in patients with hypertension – a study of registered diagnoses 2009–2013 in the total population in Stockholm County, Sweden. Journal of Hypertension, 34, 414–420.Google Scholar
Seymour, J. and Benning, T. B. (2009). Depression, cardiac mortality and all-cause mortality. Advances in Psychiatric Treatment, 15, 107–113.Google Scholar
Sherwood, A., Hinderliter, A. L., Watkins, L. L., Waugh, R. A. and Blumenthal, J. A. (2005). Impaired endothelial function in coronary heart disease patients with depressive symptomatology. Journal of the American College of Cardiology, 46, 656–659.Google Scholar
Strawbridge, W. J., Deleger, S., Roberts, R. E. and Kaplan, G. A. (2002). Physical activity reduces the risk of subsequent depression for older adults. American Journal of Epidemiology, 156, 328–334.Google Scholar
Strine, Tara W. et al. (2008). Depression and anxiety in the United States: findings from the 2006 behavioral risk factor surveillance system. Psychiatric Services, 59, 1383–1390.Google Scholar
Taylor, W. D. et al. (2012). AGTR1 gene variation: association with depression and frontotemporal morphology. Psychiatry Research, 202, 104–109.Google Scholar
Taylor, W. D. et al. (2013). Fiber tract-specific white matter lesion severity findings in late-life depression and by AGTR1 A1166C genotype. Human Brain Mapping, 34, 295–303.Google Scholar
Vian, J. et al. (2017). The renin–angiotensin system: a possible new target for depression. BMC Medicine, 15, 144.Google Scholar
Williams, L. J., Pasco, J. A., Kessing, L. V., Quirk, S. E., Fernandes, B. S. and Berk, M. (2016). Angiotensin converting enzyme inhibitors and risk of mood disorders. Psychotherapy and Psychosomatics, 85, 250–252.Google Scholar
Wing, L. M. H. et al. (2003). A comparison of outcomes with angiotensin-converting–enzyme inhibitors and diuretics for hypertension in the elderly. New England Journal of Medicine, 348, 583–592.Google Scholar
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