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Karina Davidson, PhD; Bruce S. Jonas, PhD; Kim E. Dixon, RN, MBA; Jerome H. Markovitz, MD, MPH

Arch Intern Med. 2000;160:1495-1500.

Background  Hypertension has been linked to several psychological factors, including depression, but the relation between hypertension incidence and depressive symptoms has not been adequately examined.

Objective  To determine if depressive symptoms independently predict hypertension incidence.

Design and Setting  A prospective, multicenter, epidemiological cohort of young adults (aged 23-35 years at study entry) from the general community without hypertension followed up for 5 years.

Subjects  A sample of 3343 adults from 4 urban areas stratified for race (black and white) from the CARDIA (Coronary Artery Risk Development in Young Adults) study.

Main Outcome Measure  Hypertension incidence, which was defined as blood pressure higher than 160/95 mm Hg (assessed on a single occasion) or the use of prescribed antihypertensive medication.

Results  Participants with high scores (16) on the Center for Epidemiological Studies Depression (CES-D) Scale were at significant risk for hypertension incidence compared with those with low CES-D scores (7; odds ratio, 2.10; 95% confidence interval, 1.22-3.61) after adjustment for other hypertension risk factors (eg, age, resting systolic blood pressure at the 5-year examination, physical activity, daily alcohol use, parental history of hypertension, education, presence of diabetes mellitus or heart disease, sex, and race) in fixed logistic models. Those with intermediate depressive symptoms (CES-D scores 8-15) were also at significant risk (adjusted odds ratio, 1.78; 95% confidence interval, 1.06-2.98). These associations were significant in blacks alone but were not found in whites, who had a lower hypertension incidence (29 [2%] of 1806) than blacks (89 [6%] of 1537).

Conclusions  Depressive symptoms were predictive of later hypertension incidence in young adults, and young blacks with depressive symptoms were at high risk of developing hypertension.

From the Department of Psychology, University of Alabama, Tuscaloosa (Dr Davidson and Ms Dixon); the Centers for Disease Control and Prevention, National Center for Health Statistics, Atlanta, Ga (Dr Jonas); and the Department of Preventive Medicine, University of Alabama, Birmingham (Dr Markovitz). Dr Davidson is now at the Mount Sinai Medical Center, New York, NY.

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