Background:
Hispanic women have higher rates of depressive symptoms compared to other racial/ethnic groups. Depression has been associated with incident hypertension in multiple prior studies with mixed results. However, prior studies were limited by small numbers of Hispanic women, short followup and limited information on possible confounders.
Methods:
We evaluated baseline depression and incident hypertension at three years follow-up among 4,680 postmenopausal Hispanic women enrolled in the Women’s Health Initiative observational study and clinical trial. Depression was measured at baseline using the Burnam 8-item scale (combines 6 items from the Center for Epidemiological Studies Depression Scale and 2 items from the Diagnostic Interview Schedule). This scale assesses both current depressive symptoms and past depression history. Women with a calculated Burnam score ≥ 0.06 were considered to have symptoms of depression. Multinomial logistic regression was used to estimate odds of hypertension at baseline in relation to depression. We used logistic regression to estimate odds ratios and 95% confidence intervals for the association between depression and incident hypertension at three years of follow-up. All models were adjusted for multiple demographic, clinical, and behavioral covariates.
Results:
Of 4, 680 Hispanic women, 32% met current depression criteria at baseline. In an age-adjusted model, women with depression were more likely to be hypertensive (OR=1.25; 95% CI 1.04-1.51), although results were attenuated when adjusting for multiple covariates. Further adjustment for antidepressant use at baseline made no important differences to the estimates. Depression at baseline in normotensive Hispanic women was associated with incident hypertension at year 3 follow-up (OR=1.29; 95% CI 1.02-1.63) after adjustment for age, education, insurance, body mass index, diabetes status, hypercholesterolemia, family history of diabetes and cardiovascular disease, and participant history of CVD. Further adjustment for behavior covariates (smoking, physical activity and alcohol intake) did not attenuate the association significantly.
Conclusion:
In the largest study to date of older Hispanic women, baseline depression is associated with incident hypertension at three years of followup. Early detection and management of depression in older Hispanic women is essential to preventing cardiovascular sequelae.
Associations of Stressful Life Events and Social Strain With Incident Cardiovascular Disease in the Women's Health Initiative