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Major Depression as a Risk Factor for High Blood Pressure: Epidemiologic Evidence From a National Longitudinal Study

From the Department of Community Health Sciences (S.B.P., J.V.A.W., D.H.L., M.E.), Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Departments of Medicine and Pharmacology and Therapeutics (N.R.C.C.), Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; and the Department of Psychology (T.S.C.), Faculty of Social Sciences, University of Calgary, Calgary, Alberta, Canada.

Address correspondence and reprint requests to Scott Patten, Department of Community Health Sciences, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1. E-mail: patten{at}ucalgary.ca

Objective: To determine whether major depression (MD) leads to an increased risk of new-onset high blood pressure diagnoses.

Methods: The data source was the Canadian National Population Health Survey (NPHS). The NPHS included a short-form version of the Composite International Diagnostic Interview (CIDI-SF) to assess MD and collected self-report data about professionally diagnosed high blood pressure and the use of antihypertensive medications. The analysis included 12,270 respondents who did not report high blood pressure or the use of antihypertensive medications at a baseline interview conducted in 1994. Proportional hazards models were used to compare the incidence of high blood pressure in respondents with and without MD during 10 years of subsequent follow-up.

Results: After adjustment for age, the risk of developing high blood pressure was elevated in those with MD. The hazard ratio was 1.6 (95% Confidence Interval = 1.2–2.1), p = .001, indicating a 60% increase in risk. Adjustment for additional covariates did not alter the association.

Conclusions: MD may be a risk factor for new-onset high blood pressure. Epidemiologic data cannot definitely confirm a causal role, and the association may be due to shared etiologic factors. However, the increased risk may warrant closer monitoring of blood pressure in people with depressive disorders.

Key Words: depressive disorders • major depressive episode • high blood pressure • epidemiologic studies • longitudinal studies • risk factors

Abbreviations: MD = major depression; HR = hazard ratio; CI = Confidence Interval; NPHS = National Population Health Survey; OR = odds ratio; CARDIA Study = Coronary Artery Risk Development in Young Adults; CES-D = Center for Epidemiologic Studies Depression Rating Scale; CIDI-SF = Composite International Diagnostic Interview Short Form.