Abstract 9244: Depressive Symptoms and Related Health Behaviors May Contribute to Uncontrolled Hypertension

Abstract

Introduction: Depression has considerable support as a risk factor for hypertension and for blood pressure remaining uncontrolled even when treated; however, the pathways for depression's effect on hypertension are not well understood. One proposed mechanism is health behavior, including poor medication adherence, diet, physical activity, alcohol intake, and smoking, each of which have been related to depressive symptoms. An unanswered question is the extent of the relationship of depressive symptoms to health behavior in patients whose high blood pressure is uncontrolled. Objective: To explore potential links between depressive symptoms and health behaviors that contribute to uncontrolled high blood pressure. Methods: A total of 101 subjects classified as uncontrolled hypertensives by ambulatory blood pressure monitoring (waking mean > 135/85, on at least one antihypertensive drug), measured at baseline in a behavioral RCT for hypertension, completed the Beck Depression Inventory II (BDI), Rapid Eating Assessment for Patients (REAP), health behavior questions from the BRFSS, Pittsburgh Sleep Quality Index (PSQI), and Morisky Medication Adherence Scale (MAS). The relationship between the BDI score and health behavior scales and BMI were evaluated. Results: Depressive symptoms (BDI) correlated significantly with poorer medication adherence (r = 0.331, p = 0.001). Several dietary items often related to higher sodium intake also correlated with BDI scores: 1) consuming > 4 sit down or take-out meals from restaurants (r = 0.218, p = 0.029); 2) trouble being able to cook or shop (r = 0.229, p = 0.003); and 3) skipping breakfast (r = 0.20, p = 0.045). BDI scores were also highly correlated with PSQI items on duration of sleep (r = 0.508, p < 0.001) and dysfunctional sleep causing trouble staying awake, eating meals, engaging in social activities, or maintaining enthusiasm to get things done (r = 0.213, p = 0.037), not surprising as disrupted sleep can be a depressive symptom. BMI, physical activity, alcohol intake, and smoking were not related to BDI scores. Conclusion: Even mild-moderate levels of depressive symptoms (BDI mean = 6.53) affect medication adherence, diet, and sleep that can contribute to uncontrolled hypertension.