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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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