Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland.
University of Basel, Basel, Switzerland.
Sci Rep. 2022 Apr 1;12(1):5516. doi: 10.1038/s41598-022-09396-2.
Depression and cardiovascular disease (CVD) are main contributors to the global disease burden and are linked. Pathophysiological pathways through increased blood pressure (BP) are a common focus in studies aiming to explain the relationship. However, studies to date have not differentiated between the predictive effect of depression on the course of BP versus hypertension diagnosis. Hence, we aimed to elucidate this relationship by incorporating these novel aspects in the context of a cohort study. We included initially normotensive participants (n = 3214) from the second (2001-2003), third (2009-2011), and fourth (2016-2018) waves of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA). We defined depression based on physician diagnosis, depression treatment and/or SF-36 Mental Health score < 50. The prospective association between depression and BP change was quantified using multivariable censored regression models, and logistic regression for the association between depression and incident hypertension diagnosis. All models used clustered robust standard errors to account for repeat measurements. The age-related increase in systolic BP was slightly lower among people with depression at baseline (β = - 2.08 mmHg/10 years, 95% CI - 4.09 to - 0.07) compared to non-depressed. A similar trend was observed with diastolic BP (β = - 0.88 mmHg/10 years, 95% CI - 2.15 to 0.39), albeit weaker and not statistically significant. Depression predicted the incidence of hypertension diagnosis (OR 1.86, 95% CI 1.33 to 2.60). Our findings do not support the hypothesis that depression leads to CVD by increasing BP. Future research on the role of depression in the pathway to hypertension and CVD is warranted in larger cohorts, taking into account healthcare utilization as well as medication for depression and hypertension.
抑郁和心血管疾病（CVD）是全球疾病负担的主要贡献者，而且二者之间存在关联。通过增加血压（BP）来解释这种关系的病理生理途径是研究的一个共同焦点。然而，迄今为止的研究并未区分抑郁对 BP 病程的预测作用与高血压诊断之间的差异。因此，我们旨在通过在队列研究中纳入这些新的方面来阐明这种关系。我们纳入了来自瑞士成人空气污染与肺部和心脏疾病队列研究（SAPALDIA）第二波（2001-2003 年）、第三波（2009-2011 年）和第四波（2016-2018 年）的最初血压正常的参与者（n=3214）。我们根据医生诊断、抑郁治疗和/或 SF-36 心理健康评分<50 来定义抑郁。使用多变量截尾回归模型和逻辑回归来定量评估抑郁与 BP 变化之间的前瞻性关联，以及抑郁与新发高血压诊断之间的关联。所有模型均使用聚类稳健标准误差来解释重复测量。与非抑郁者相比，基线时患有抑郁的人收缩压的年龄相关性升高幅度略低（β= -2.08mmHg/10 年，95%CI -4.09 至 -0.07）。舒张压也观察到类似的趋势（β= -0.88mmHg/10 年，95%CI -2.15 至 0.39），尽管幅度较弱且无统计学意义。抑郁预测高血压诊断的发生率（OR 1.86，95%CI 1.33 至 2.60）。我们的研究结果不支持抑郁通过增加 BP 导致 CVD 的假设。未来需要在更大的队列中研究抑郁在高血压和 CVD 发病机制中的作用，同时考虑医疗保健的利用以及抑郁和高血压的药物治疗。
