Abstract WP153: Depressive Symptom Trajectories Are Associated With Blood Pressure Reduction Among Stroke Survivors

Abstract

Little is known about the longitudinal course of post-stroke depression and its impact on vascular risk reduction, a key secondary prevention strategy. Data for this study came from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial of a skills-based intervention to reduce vascular risk in 552 mild/moderate stroke/TIA patients. Depressive symptom severity was measured pre-discharge and at 6 and 12 months post-discharge as the total score on the Center for Epidemiologic Studies - Depression (CES-D) scale (range 0-60). Discrete mixture models identified distinct trajectories of depressive symptom severity over time and assigned patients to trajectory groups. Poisson models with linear and quadratic parameters were run to select the best-fitting model based on Bayesian information criterion and interpretability. The outcome, systolic blood pressure (BP) reduction, was defined as the difference between BP at baseline and 12 months post-discharge (mmHg). The association between trajectory group membership and BP reduction was examined using ANOVA and multinomial logistic regression adjusted for trial arm, baseline BP, sex, age, race/ethnicity, marital status, and NIH Stroke Scale score. A total of 465 individuals completed at least 1 depression assessment. A model was selected with four distinct trajectories: 1) resistance - low depressive symptom levels at all waves (35% of patients); 2) recovery - clinically significant baseline symptom levels (CES-D>16), dropping to low levels at subsequent waves (32%); 3) delayed - low levels at baseline, increasing to clinically significant levels (20%); 4) chronic - high levels at all waves (13%). Mean BP reduction was significantly higher in the resistance group compared to the other trajectory groups (10.7 vs. 2.3 in recovery group, 2.3 in delayed group, 4.5 in chronic group, p=0.017) and remained significantly higher compared to each of the other trajectory groups in the adjusted model (betas = 5.0-5.5 mmHg, all p<0.05). Mean BP reduction did not differ significantly between other trajectory groups. Rapid reduction of depressive symptoms and prevention of symptom onset following stroke may be important targets for helping stroke survivors reduce vascular risk.