title: Association of depressive symptoms with all-cause and ischemic heart disease mortality in adults with self-reported hypertension.
abstract: BACKGROUND
  Hypertension (HTN) is a prevalent and important risk factor for both cardiovascular and all-cause mortality. Depression is often present in hypertensive patients and has also been associated with increased mortality risk. The aim of this study was to evaluate the association of depressive symptoms with all-cause mortality and ischemic heart disease (IHD) mortality among adults with self-reported HTN.
  
  
  METHODS
  We studied 10,025 participants in the National Health and Nutrition Epidemiologic Follow-up Study (NHANES I) who were alive and interviewed in 1982 and had complete data for the Center for Epidemiologic Studies Depression Scale (CES-D). Four groups were identified based screening status at initial interview: (i) no HTN, no depression (reference group); (ii) HTN, no depression; (iii) no HTN, depression; and (iv) both HTN and depression. Cox proportional hazards regression was used to calculate multivariate-adjusted hazard ratios (HRs) of death for each group.
  
  
  RESULTS
  Over an average of 8 years (83,943 person-years) of follow-up, patients with both self-reported HTN and depressive symptoms had the highest multivariate-adjusted HR for all-cause mortality at 1.39 (95% confidence interval (CI) 1.14, 1.69) as well as for IHD mortality at 1.59 (95% CI 1.08, 2.34). In post hoc analysis, nondepressed hypertensive patients had significantly lower adjusted HR for all-cause mortality compared to depressed hypertensive patients (HR 0.85; 95% CI 0.73-1.00), but the HR for IHD mortality was not significant (HR 0.87, 95% CI 0.63-1.20).
  
  
  CONCLUSIONS
  Comorbid depressive symptoms are associated with increased all-cause mortality in patients with self-reported HTN.
authors.affiliation: Department of Medicine, Division of General Internal Medicine and Geriatrics, The Medical University of South Carolina, Charleston, SC, USA. axon@musc.edu
authors.forename: R Neal
authors.initials: RN
authors.lastname: Axon
authors.forename: Yumin
authors.initials: Y
authors.lastname: Zhao
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
mesh_terms: D015331:Cohort Studies; D003863:Depression / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications* / Q000401:mortality*; D009749:Nutrition Surveys; D016016:Proportional Hazards Models