Abstract: P1374
Blood Pressure control, presence of depressive symptoms and clinical outcomes at 4 years in patients with cardiometabolic disease

B. Jani1, S. Barry1, J. Cavanagh1, G. Der1, N. Sattar2, F. Mair1, 1University of Glasgow, Institute of Health and Wellbeing - Glasgow - United Kingdom, 2University of Glasgow, Institute of Cardiovascular and Medical Sciences - Glasgow - United Kingdom,

Hypertension, diet, other
European Heart Journal ( 2015 ) 36 ( Abstract Supplement ), 204

Background: The health hazards of uncontrolled Blood Pressure (BP) as well as tightly controlled BP have been extensively studied for high cardiovascular risk patients (Coronary Heart Disease (CHD), Diabetes, previous stroke)-“J-shaped phenomenon”. Comorbid depression is common in these patients and associated with poor prognosis; with substantial evidence that depression may be associated with lower BP values. The relationship between BP control and depression in predicting outcomes in cardiometabolic disease patients remains unknown.

Purpose and methods: The aim of this project is to study interaction between depression and BP control in predicting adverse outcomes at 4 years in a primary care cohort (N=355537) of cardiometabolic disease patients (CHD/Diabetes/Stroke). Patients underwent depression screening using the hospital anxiety and depression score (HADS-D) in 2008–09. Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) were recorded concurrently and classified into uncontrolled (SBP≥140, DBP≥90); normal control (SBP 130–139, DBP 80–89); and tightly controlled (SBP<130, DBP<80). We recorded subsequent vascular events (myocardial infarction/stroke) and used Cox's proportional hazards for survival analysis.

Results: Out of 35537 patients, 2068 (5.8%) had at least one vascular event during 4 years of follow-up. Depression (defined as HADS-D>7) had a significant interaction with SBP (p=0.04) and DBP (p=0.01) in predicting a new vascular event. In the sub-group analysis based on SBP control categories, patients with uncontrolled SBP and depression had a higher risk of a new vascular event (Hazard Ratio HR 1.38; 95% Confidence Interval (CI) 1.14–1.67, p<0.001) compared to those with uncontrolled SBP but without depression. Similarly, patients with tightly controlled SBP and depression had a higher risk of subsequent vascular event (HR 1.42; 95% CI 1.17–1.71) compared to those with tightly controlled SBP and without depression. In DBP sub-group analysis, patients with uncontrolled DBP and depression were at a higher risk of a new vascular event (HR 2.14; 95% CI 1.41–3.25), as compared to those with uncontrolled DBP without depression. All results were adjusted for age, gender, socioeconomic status, number of comorbid conditions, total cholesterol values, body mass index and antidepressant initiation.

Conclusion: There may be potential benefits from closer monitoring of BP in those with cardiometabolic disease and comorbid depression. Further research is needed to understand the relationship between BP control and depressive symptoms in patients with existing cardiometabolic disease.