title: Symptoms of anxiety and depression across adulthood and blood pressure in late middle age: the 1946 British birth cohort.
abstract: OBJECTIVE
  Previous studies testing the hypothesis that symptoms of anxiety and depression increase blood pressure (BP) levels show inconsistent and limited findings. We examined the association between those symptoms across adult life and BP in late middle age.
  
  
  METHODS
  Using data from 1683 participants from the MRC NSHD, we investigated associations between affective symptoms at ages 36, 43, 53 and 60-64 years and SBP and DBP at age 60-64. Multivariable linear regression was used to examine the effect on BP of affective symptoms at each age separately and as a categorical cumulative score based on the number of times an individual was classified as a 'case'. Models were adjusted for sex, BMI, educational attainment, socio-economic position, heart rate, lifestyle factors and antihypertensive treatment.
  
  
  RESULTS
  In fully adjusted models, we observed lower SBP in study members with case-level symptoms at one to two time-points [-1.83 mmHg; 95% confidence interval (CI) -3.74 to 0.01] and at three to four time-points (-3.93 mmHg; 95% CI -7.19 to -0.68) compared with those never meeting case criteria suggesting a cumulative inverse impact of affective symptoms on SBP across adulthood (P value for trend 0.022). Sex and BMI had a large impact on the estimates while not other confounders. Potential mediators such as heart rate and lifestyle behaviours had a little impact on the association. SBP at age 36 and behavioural changes across adulthood, as additional covariates, had a little impact on the association. A similar but weaker trend was observed for DBP.
  
  
  CONCLUSIONS
  A cumulative effect of symptoms of anxiety and depression across adulthood results in lower SBP in late middle age that is not explained by lifestyle factors and antihypertensive treatment. Mechanisms by which mood may impact BP should be investigated.
authors.affiliation: aMRC Unit for Lifelong Health and Ageing at University College London bNational Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Science, University College London, London, UK cDepartment of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden dDepartment of Psychological Medicine, Institute of Psychiatry eInstitute of Psychiatry, King's College London, London, UK *Matthew Hotopf and Marcus Richards contributed equally to the writing of this article.
authors.forename: Valérie
authors.initials: V
authors.lastname: Tikhonoff
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hardy
authors.forename: John
authors.initials: J
authors.lastname: Deanfield
authors.forename: Peter
authors.initials: P
authors.lastname: Friberg
authors.forename: Diana
authors.initials: D
authors.lastname: Kuh
authors.forename: Graciela
authors.initials: G
authors.lastname: Muniz
authors.forename: Carmine M
authors.initials: CM
authors.lastname: Pariante
authors.forename: Matthew
authors.initials: M
authors.lastname: Hotopf
authors.forename: Marcus
authors.initials: M
authors.lastname: Richards
mesh_terms: D000328:Adult; D001007:Anxiety / Q000150:complications / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology*; D015331:Cohort Studies; D003863:Depression / Q000150:complications / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012306:Risk; D013599:Systole / Q000502:physiology