Blood Pressure and Depressive Symptoms

doi:10.4236/ojd.2013.24009

Paper Menu >>

Journal Menu >>

Open Journal of Depression

2013. Vol.2, No.4, 43-44

Published Online November 2013 in SciRes (http://www.scirp.org/journal/ojd) http://dx.doi.org/10.4236/ojd.2013.24009

Open Access 43

Blood Pressure and Depressive Symptoms

Yongpin Mu1*, Yongqing Gao2*, Wenjie Sun2,3#

1Department of Clinical Laboratory Centre, The Affiliated People’s Hospital of Inner Mongolia Medical

University, Hohhot, China

2School of Food Science, G uan gdo ng Ph armaceutical University , Gua ngzho u, China

3School of Public Health and Tropical M edicine, Tulane University, New Orleans, USA

Email: #[email protected]

Received August 7th, 2013; revised Septe mber 8 th, 2013; accepted Octob e r 10th, 2013

tribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the

original work is properly cited.

The topic of blood pressure and depression is an old question.

Depression is common in the elderly population (Sun, School-

ing, Chan, Ho, & Lam, 2011). Although several epidemiologic

studies have assessed the relationship between low blood pres-

sure and depressive symptoms in geriatric populations, the

results have been inconsistent. Depressive symptoms used to be

been considered a risk factor associated with development of

hypertension (Hildrum, Romild, & Holmen, 2011). Recently,

additional evidence showed that depressive symptoms are asso-

ciated with low blood pressure (Licht et al., 2009; Scuteri et al.,

2009). These results suggest a complicated association between

blood pressure and depression. It is po ssi bl y a “U” s ha ped r e-

sponse, with to o low or too hig h sy stolic blood pressu re both

associated with depression (Barrett-Connor & Palinkas,

1994).

This relationship leads to the question: does depression cause

the reduced blood pressure or does a reduced blood pressure

cause the depression? It is plausible that low blood pressure

results in depressive symptoms in the elderly. A prospective

community-based study found that low blood pressure can pre-

dict the depression (Siennicki-Lantz, Andre-Petersson, & Elm-

stahl, 2013). Depressive symptoms could be predicted by hy-

pertension earlier in life, and were strongly associated with

decreasing Systolic blood pressure (SBP) during the last decade

(Siennicki-Lantz, Andre-Petersson, & Elmstahl, 2013). How-

ever, the link between blood pressure and depression could be

reversed (Heckbert et al., 2010; Hildrum, Mykletun, Holmen, &

Dahl, 2008; Lenoir et al., 2008). Moreover, Paterniti et al. point

out that low blood pressure was a risk factor for, but not a con-

sequence of, increasing depressive symptoms (Paterniti, Ver-

dier-Taillefer, Geneste, Bisserbe, & Alperovitch, 2000). One

plausible mechanism to explain this correlation is that there is

one gene from the ancestor that affects both blood pressure and

depression.

There are many confounding factors that can affect the cor-

relation in depression and blood pressure. The relationship also

can be explained by other factor such as the health status, pre-

vious diseases, and post-traumatic stress (Kamphuis et al., 2008;

Scuteri, 2008; Signorelli, Costanzo, Cinconze, & Concerto,

2013). Pre-existing diseases like cardiovascular disease, espe-

cially heart diseases such as stroke, may affect both blood

pressure and depression. In this hypothesis blood pressure and

depression are both related to another factor. New research has

found that frontal-striatal white matter integrity may be the

anatomical region through which blood pressure confers vul-

nerability to depression (Hoptman et al., 2008). There is a neg-

ative relationship between SBP and depression in the group of

people whose functional ability is normal, but no relationship

exists in people with moderately or severely damaged white

matter.

Functional changes in this region from pre-existing diseases

can affect the relationship between blood pressure and depres-

sion.

Without a large sample size community-based perspective

study, it is not easy to draw a conclusion on the relationship

between blood pressure and depression. As Mark Twain said,

“supposing is good, but finding out is better”. In order to figure

out the relationship, further research will be required to clarify

causal pathways, in particular: 1) whether low blood pressure

and depression are both secondary to previous diseases; and/or

2) whether low blood pressure is a marker for other, more psy-

chological risk factors for depression, such as the impact of

poor physical health and functional limitation (Stewart, 2000).

REFERENCES

Barrett-Connor, E., & Palinkas, L. A. (1994). Low blood pressure and

depression in older men: A population based study. BMJ, 308, 446-

449.

Heckbert, S. R., Rutter, C. M., Oliver, M., Williams, L. H., Ciech-

anowski, P., Lin, E. H., & Von Korff, M. (2010). Depression in rela-

tion to long-term control of glycemia, blood pressure, and lipids in

patients with diabetes. Journal of General Internal Medicine, 25,

524-529. http://dx.doi.org/10.1007/s11606-010-1272-6

Hildrum, B., Mykletun, A., Holmen, J., & Dahl, A. A. (2008). Effect of

anxiety and depression on blood pressure: 11-year longitudinal po-

pulation study. The Briti sh J ou r n al of P sy c h ia t ry , 19 3 , 108-113.

http://dx.doi.org/10.1192/bjp.bp.107.045013

Hildrum, B., Romild, U., & Holmen, J. (2011). Anxiety and depression

lowers blood pressure: 22-year follow-up of the population based

HUNT study, Norway. BMC Public Health, 11, 601.

http://dx.doi.org/10.1186/1471-2458-11-601

Hoptman, M. J., Gunning-Dixon, F. M., Murphy, C. F., Ardekani, B. A. ,

Hrabe, J., Lim, K. O., & Alexopoulos, G. S. (2008). Blood pressure

and white matter integrity in geriatric depression. Journal of Affec-

tive Disorders, 115, 171-176.

Kamphuis, M. H., Geerlings, M. I., Giampaoli, S., Nissinen, A., Grob-

*These authors contributed equally to this work.

#Correspo nding author.

Y. P. MU ET AL.

Open Access

bee, D. E., & Kromhout, D. (2008). The association of depression

with cardiovascular mortality is partly explained by health status.

The FINE study. Journal of Affecti ve Dis order s, 114, 184-192.

Lenoir, H., Lacombe, J. M., Dufouil, C., Ducimetiere, P., Hanon, O.,

Ritchie, K., & Tzourio, C. (2008). Relationship between blood pres-

sure and depression in the elderly. The three-city study. Journal of

Hypertension, 26, 1765-1772.

http://dx.doi.org/10.1097/HJH.0b013e3283088d1f

Licht, C. M., d e Geus, E. J., Seldenri jk, A., van Hout, H. P ., Zitman, F.

G., van Dyck, R., & Penninx, B. W. (2009). Depression is associated

with decreased blood pressure, but antidepressant use increases the

risk for hyper tension. Hypertension, 53, 631- 638.

http://dx.doi.org/10.1161/HYPERTENSIONAHA.108.126698

Paterniti, S., Verdier-Taillefer, M. H., Geneste, C., Bisserbe, J. C., &

Alperovitch, A. (2000). Low blood pressure and risk of depression in

the elderly. A prospective community-based study. The British Jour-

nal of Psychiatry, 176, 464-467.

http://dx.doi.org/10.1192/bjp.176.5.464

Scuteri, A. (2008). Depression and cardiovascular risk: Does blood

pressure play a role? Journal of Hypertension, 26, 1738-1739.

http://dx.doi.org/10.1097/HJH.0b013e32830dfff7

Scuteri, A., Spalletta, G., Cangelosi, M., Gianni, W., Assisi, A., Bran-

cati, A. M., & Volpe, M. (2009). Decreased nocturnal systolic blood

pressure fall in older subjects with depression. Aging Clinical and

Experimental Research, 21, 292-297.

http://dx.doi.org/10.1007/BF03324918

Siennicki-Lantz, A., Andre-Petersson, L., & Elmstahl, S. (2013). De-

creasing blood pressure over time is the strongest predictor of de-

pressive symptoms in octogenarian men. The American Journal of

Geriatric Psychiatry, 21, 863-871.

http://dx.doi.org/10.1016/j.jagp.2012.11.007

Signorelli, M. S., Costanzo, M. C., Cinconze, M., & Concerto, C.

(2013). What kind of diagnosis in a case of mobbing: Post-traumatic

stress disorder or adjustment disorder? BMJ Case Reports.

http://dx.doi.org/10.1136/bcr-2013-010080

Stewart, R. (2000). Low blood pressure and depression in the elderly.

The British Journal of Psychiatr y , 177, 181-182.

http://dx.doi.org/10.1192/bjp.177.2.181-b

Sun, W., Schooling, C. M., Chan, W. M., Ho, K. S., & Lam, T. H.

(2011). The association between depressive symptoms and mortality

among Chinese elderly: A Hong Kong cohort study. The Journals of

Gerontology: Series A, 66, 459-466.

http://dx.doi.org/10.1093/gerona/glq206