Association of hypertension with depression in the community: results from the Gutenberg Health Study

Objective: The literature on the depression-hypertension (HTN) relationship came to conflicting results. Previous studies reported close positive as well as close negative associations between HTN and depression. Against this background, the present study sought to analyze this relationship in a large population-based study. Methods: This cross-sectional population-based study (N = 5000) analyzed the association of depression and HTN in persons with different conditions of HTN (unaware of HTN, controlled HTN, uncontrolled HTN) as compared to persons without HTN. Furthermore, the relationships of depressive symptoms with antihypertensive drugs and blood pressure were examined. Results: A total of 48.6% of participants were classified as 'no HTN', 13.5% had controlled HTN, 23.4% had uncontrolled HTN and 14.2% were unaware of their HTN. Unawareness of HTN was inversely associated with burden of depression. Controlled HTN was positively associated with depression. However, this association was due to generally increased disease burden (e. g. stroke, diabetes). Severity of cognitive symptoms of depression was negatively associated with SBP in persons free of antihypertensive drugs (beta = -0.64, P = 0.0005). Intake of beta-blockers and agents acting on the renin-angiotensin system was associated with severity of somatic symptoms of depression (e.g. fatigue). Conclusion: The competing literature about the relationships between depression and HTN may be the result of the insufficient recognition of multiple pathways of opposite directions linking depressive symptoms with blood pressure, HTN and related medications.