title: Impact of depression on masked hypertension and variability in home blood pressure in treated hypertensive patients.
abstract: This study was conducted to determine the effects of depression and/or insomnia on masked hypertension (MHT) compared with other types of HT and on variability in home-measured blood pressure (HBP) and clinic BP (CBP). Three hundred and twenty-eight hypertensives (132 women) aged 68±10 years were classified into four BP types: controlled HT (CHT), white-coat HT, MHT and sustained HT (SHT), based on CBP (140/90 mm Hg) and morning HBP (135/85 mm Hg) measurements. A score of ⩾16 on the Center for Epidemiologic Studies Depression Scale (CES-D) was defined as depression. The mean values and s.d. of BP were calculated from measurements taken during the 14 consecutive days just before the CES-D evaluation. Compared with the CHT group, the risk of depression was 2.77-fold higher in the SHT group and even higher in the MHT group (7.02-fold). The association between depression and MHT was augmented in the presence of insomnia and was somewhat stronger in women. A HBP variability index defined as s.d./mean BPs in both morning and night time was significantly higher in MHT than in the other BP types, whereas that of CBP was not. Both morning and night-time HBP variability were significantly higher in depressive patients than in non-depressives. These suggest that depression is associated with MHT and that increases both morning and night-time HBP variability but not CBP variability. Physicians should be mindful of mental stresses such as depression in their hypertensive patients when forming strategies to control BP over the diurnal cycle.
authors.affiliation: Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kayano
authors.affiliation: Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Koba
authors.affiliation: Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Taiju
authors.initials: T
authors.lastname: Matsui
authors.affiliation: Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Fukuoka
authors.affiliation: Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Kyouichi
authors.initials: K
authors.lastname: Kaneko
authors.affiliation: Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Shoji
authors.affiliation: Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Toshida
authors.affiliation: Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Norikazu
authors.initials: N
authors.lastname: Watanabe
authors.affiliation: Department of Internal Medicine, Showa University School of Nursing and Rehabilitation Sciences, Yokohama, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Geshi
authors.affiliation: Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D001795:Blood Pressure Determination; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007564:Japan / Q000453:epidemiology; D008297:Male; D059468:Masked Hypertension / Q000150:complications / Q000523:psychology*; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications*