title: Systematic Review: The Association between Late Life Depression and Hypotension.
abstract: Late life depression (LLD), defined as depressive illness in people aged 60 years or older, is more complex than depression presenting in earlier life, with different clinical features and a poorer response to therapy. Different biological factors underlie LLD and hypotension may be an important modifiable risk factor. The aim of this systematic review is to clarify the relationship between hypotension and LLD.
  
  
  
  A systematic search was conducted in PubMed and Embase for articles published up to December 31, 2015. Key search terms were "depression," "depressive disorder," "hypotension," and "blood pressure." Studies were included if they were published as a primary research paper in a peer-reviewed journal, involved participants with a mean age of 60 years or more, and examined the relationship between hypotension and depression.
  
  
  
  The initial combined search retrieved 2268 nonduplicate articles. Of these, 116 full texts were assessed for eligibility, of which 19 were included in this systematic review. Nine cross-sectional studies examined the association between hypotension and LLD, with 8/9 indicating a positive association between the 2. Five cross-sectional studies examined the relationship between orthostatic hypotension (OH) and LLD, with each study finding a positive association between the 2. Five longitudinal studies examined the relationship between hypotension and LLD, with discordant findings between studies. There were no longitudinal studies examining the relationship between OH and LLD.
  
  
  
  This systematic review found that cross-sectional studies demonstrated a consistent relationship between hypotension and LLD, but longitudinal data to date is less consistent, with discordant findings. There are several methodological limitations of published longitudinal data that may explain these differences, including differences in age at enrollment, depression and blood pressure assessment, and controlling for covariates. Further longitudinal studies to clarify the role of these potentially modifiable factors in the development of this complex illness are essential.
authors: The Irish Longitudinal Study on Aging (TILDA), Trinity College Dublin, Dublin, Ireland; Mercer's Institute for Successful Aging, Department of Medical Gerontology, St. James's Hospital, Dublin, Ireland; Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland. Electronic address: briggsr@tcd.ie.
authors: Robert
authors: R
authors: Briggs
authors: The Irish Longitudinal Study on Aging (TILDA), Trinity College Dublin, Dublin, Ireland; Mercer's Institute for Successful Aging, Department of Medical Gerontology, St. James's Hospital, Dublin, Ireland.
authors: Rose Anne
authors: RA
authors: Kenny
authors: The Irish Longitudinal Study on Aging (TILDA), Trinity College Dublin, Dublin, Ireland; Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland.
authors: Sean P
authors: SP
authors: Kennelly
mesh_terms: D000368:Aged; D001794:Blood Pressure; D003863:Depression / Q000209:etiology*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000523:psychology*; D008297:Male; D008875:Middle Aged
keywords: Depression; blood pressure; hypotension; late life depression; orthostatic hypotension