Researchers evaluated 31 hypertensive patients on blood pressure medicines but without recorded histories of psychiatric disease. Patients used self-blood pressure measurement devices to register their blood pressure for three days when they awoke, before breakfast, before their main meal - which is about 3 p.m. in Mexico - and at bedtime.
They found that patients with poorly controlled hypertension were more than six times as likely to suffer depression compared to those with good blood pressure control.
"Depressed patients may also have poorly controlled blood pressure because they have lost interest in taking their medication," says lead author Alberto F. Rubio-Guerra, M.D., FACP, an internist and associate investigator in the hypertension clinic, at the Hospital General de Ticoman, in Mexico City. The authors advocate screening all hypertensive patients for depression because depression and uncontrolled hypertension often coexist.
"Patients should be treated in a global way because psychological problems may alter blood pressure control," Rubio-Guerra says.
The self blood pressure measuring devices were used to avoid the possibility of 'white coat' hypertension, which is an artificial high blood pressure level some people have when they get nervous in the doctor's office or hospital setting, he says.
Each participant also was evaluated for depression with a questionnaire that helps clinicians diagnose depression and assess it as mild, moderate or severe. Researchers correlated the findings of the depression screening and blood pressure monitoring.
They found that 13 patients with poor control of their blood pressure had high scores for depression; eight patients with poorly controlled blood pressure did not suffer depression; one patient had depression and poor hypertension control; nine patients had good blood pressure control and no depression.
This study emphasizes that not treating depression might put hypertensive patients at higher risk for poor blood pressure control, he says. He adds that future studies should examine depression in larger populations of hypertensive patients to determine if therapy for depression can improve blood pressure control.
High blood pressure is defined as systolic pressure (the top number in a blood pressure reading) of 140 millimeters of mercury (mm Hg) or higher, or diastolic pressure (bottom number) of 90 mm Hg or higher. High blood pressure, which affects one in five Americans, directly increases the risk of coronary heart disease (which leads to heart attack), heart failure and stroke, especially along with other risk factors, according to the American Heart Association.
Several recent studies have suggested a link between hypertension and depression. Some indicate that people with depression are at high risk for hypertension because hormonal changes in the brains of depressed patients might increase blood pressure.
"What is different about our study is we looked not only at whether both diseases cluster in the some patients but also if their simultaneous occurrence affects blood pressure control," Rubio-Guerra says. "Screening for depression in hypertensive patients may be an easy and cost-effective tool to improve outcomes."
Co-authors are Jose Juan Lozano-Nuevo, M.D.; Leticia Rodriguez-Lopez, M.D.; German Vargas-Ayala, M.D.; and Alberto Juarez-Perez, M.D.
The meeting is also sponsored by the Inter-American Society for Hypertension and the National Heart, Lung, and Blood Institute.
NR03 - 1058 (IASH/Rubio-Guerra)
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