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Depressive Symptoms Are Related to Higher Ambulatory Blood Pressure in People With a Family History of Hypertension

From the Department of Psychiatry (K.M.G., S.S.G., K.C.L.), Department of Psychology (S.S.G., K.C.L.), and Medical School (A.H.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Karen Grewen, PhD, University of North Carolina, Medical Research Building A, CB #7175, Chapel Hill, NC 27599-7175. E-mail: karen_grewen{at}med.unc.edu

OBJECTIVE: We investigated whether parental history of hypertension (FH+) enhances the impact of depressed mood, indexed by Beck Depression Inventory (BDI), on ambulatory blood pressure (ABP).

METHODS: Twenty-four–hour ABP, urinary norepinephrine (NE), and cortisol were obtained in 314 unmedicated normotensive and hypertensive men and women (age 18–64 years) who also completed the BDI.

RESULTS: Subjects with a positive family history of hypertension (N = 177) exhibited significantly greater mean body mass index (BMI) and ABP compared with subjects without (N = 137). Importantly, when covarying for age, BMI, gender, and race, linear regressions revealed significant FH by BDI interactions. Higher BDI scores were significantly associated with higher 24-hour ABP in FH+ subjects, but not in FH- participants. Relationships were significantly stronger in those with two hypertensive parents vs. those with one vs. those with no hypertensive parents. Increases in BDI scores were significantly related to greater heart rate (HR) and 24-hour urinary NE in both FH+ and FH- groups, although no evidence of a mediational role for NE in the effect of BDI score on blood pressure (BP) or HR was seen.

CONCLUSIONS: These findings suggest that depressed mood may be reliably associated with higher BP only among those with an underlying susceptibility to HTN.

Key Words: depression, • ambulatory blood pressure, • family history of hypertension, • norepinephrine.

Abbreviations: ABP = ambulatory blood pressure;; BDI = Beck Depression Inventory;; BMI = body mass index;; BP = blood pressure;; CHD = coronary heart disease;; CVD = cardiovascular disease;; DBP = diastolic blood pressure;; ENRICHD = Enhancing Recovery in Coronary Disease;; FH = family history of hypertension;; HPA = hypothalamic-pituitary-adrenal;; HR = heart rate;; HTN = hypertension;; MI = myocardial infarction;; NE = norepinephrine;; SNS = sympathetic nervous system;; SADHEART = Sertraline Antidepressant Heart Attack Randomized Trial;; SBP = systolic blood pressure.