Original Article

Evaluation of the Relationship Between Depression, Anxiety, and Stress with Hypertension: Results of a Health Study in Yazd, Iran

Abstract

Background and Aim: Over the past few decades, different epidemiological studies have been conducted on the relationship between mental disorders and hypertension. However, conflicting results have been reported. This research aimed to evaluate the relationship between symptoms of depression, anxiety and stress with hypertension in a large population.
Materials and Methods: This cross-sectional analytic study was conducted using the results of in Yazd Health Study, Iran (N=9340). In addition, DASS-21 questionnaire was asked from the participants to assess depression, anxiety, and stress. Moreover, logistic regression was used to evaluate the relationship between symptoms of depression, anxiety and stress with hypertension.
Results: A negative association was observed between systolic and diastolic blood pressure and symptoms of depression, anxiety, and stress, which were independent from other variables. Regarding systolic blood pressure, a significant and reverse relationship was found in individuals with moderate stress (OR: 0.81, 95% CI: 0.69-0.95) and mild depression (OR: 0.82, 95% CI: 0.68-0.99). In terms of diastolic blood pressure, subjects with moderate stress had a lower blood pressure, compared to healthy individuals (OR: 0.86, 95% CI: 0.750.99). Furthermore, participants with depression had a lower chance of being diagnosed with hypertension, compared to healthy individuals.
Conclusion: The present research did not confirm the previous assumptions about the relationship between depression, anxiety and stress with hypertension. Our findings showed that symptoms of depression, anxiety, and stress are correlated with a low blood pressure.

1.Grimsrud A, Stein DJ, Seedat S, Williams D, Myer L. The association between hypertension and depression and anxiety disorders: results from a nationallyrepresentative sample of South African adults. PloS one 2009;4(5):e5552.
2.World health organization(WHO). Strengthening mental health promotion: mental health is not just the absence of mental disorder 2001.
3.Bagalman E, Napili A. Prevalence of mental illness in theUnited States: Data sources and estimates. Congressional Research Service; 2014.
4.Noorbala AA, Faghihzadeh S, Kamali K, Bagheri Yazdi SA, Hajebi A, Mousavi MT, et al. Mental Health Survey of the Iranian Adult Population in 2015. Arch Iran Med 2017;20(3): 128-134.
5.Ghaffari S, Pourafkari L, Tajlil A, Sahebihagh MH, Mohammadpoorasl A, Tabrizi JS, et al. The prevalence, awareness and control rate of hypertension among elderly in northwest of Iran. J Cardiovasc Thorac Res 2016;8(4):176-182.
6.world health organization(WHO). Global Status Report on Noncommunicable Diseases, Geneva, Switzerland. World Health Organization. 2014.
7.Aghaei- Meybodi HR, Khashayar P, Rezai Homami M, Heshmat R, Larijani B, Prevalence of hypertension in an Iranian population. Ren Fail, 2014; 36(1): 87–91.
8.Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. Jama 2010;303(20):2043-50.
9.Cheung BM, Au T, Chan S, Lam C, Lau S, Lee R, et al. The relationship between hypertension and anxiety or depression in Hong Kong Chinese. Exp Clin Cardiol 2005;10(1):21-24.
10.Pan Y, Cai W, Cheng Q, Dong W, An T, Yan J. Association between anxiety and hypertension: a systematic review and metaanalysis of epidemiological studies. Neuropsychiatr Dis Treat 2015;11:11211130.
11.Hildrum B, Mykletun A, Stordal E, Bjelland I, Dahl AA, Holmen J. Association of low blood pressure with anxiety and depression: the Nord-Trøndelag Health Study. J Epidemiol Community Health 2007;61(1):53-58.
12.Hildrum B, Romild U, HolmenJ. Anxiety and depression lowers blood pressure: 22-year follow-up of the population based HUNT study, Norway. BMC Public Health 2011;11(1):601.
13.Mirzaei M, Salehi-Abargouei A, Mirzaei M, Mohsenpour MA. Cohort Profile: The Yazd Health Study (YaHS): apopulationbased study of adults aged 20–70 years (study design and baseline population data). Int J Epidemiol 2017;47(3):697-8h.
14.Whelton P, Carey R, Aronow W, Casey Jr D, Collins K, Dennison Himmelfarb C, etal. Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018; 71(6): 12691324.
15.Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995;33(3):335343.
16.Silva HAd, Passos MHPd, Oliveira VMAd, Palmeira AC, Pitangui ACR, Araújo RCd. Short version of the Depression Anxiety Stress Scale-21: is it valid for Brazilian adolescents? Einstein (Sao Paulo) 2016;14(4):486-493.
17.Ng T-P, Feng L, Niti M, Yap K-B. Low blood pressure and depressive symptoms among Chinese older subjects: a populationbased study. Am J Med 2010;123(4):342-349.
18.Stroup‐Benham CA, Markides KS, Black SA, Goodwin JS. Relationship between low blood pressure and depressive symptomatology in older people. J Am Geriatr Soc 2000;48(3):250-255.
19.Hamer M, Batty GD, Stamatakis E, Kivimaki M. Hypertension awareness and psychological distress. Hypertension 2010;56(3):547-550.
20.Ho AK, Thorpe CT, Pandhi N, Palta M, Smith MA, Johnson HM. Association ofAnxiety and Depression with Hypertension Control: A US Multi-Disciplinary Group Practice Observational Study. J Hypertens. 2015;33(11):2215-2222.
21.Maatouk I, Herzog W, Böhlen F, Quinzler R, Löwe B, Saum K-U, et al. Association of hypertension with depression and generalized anxiety symptoms in a large population-based sample of older adults. J Hypertens 2016;34(9):1711-1720.
22.Licht CM, De Geus EJ, Seldenrijk A, Van Hout HP, Zitman FG, Van Dyck R, et al. Depression is associated with decreased blood pressure, but antidepressant use increases the risk for hypertension. Hypertension 2009;53(4):631-638.
23.Guilleminault C, Faul JL, Stoohs R. Sleepdisordered breathing and hypotension. Am J Respir Crit Care Med 2001;164(7):12421247.
24.Verghese J, Lipton R, Hall C, Kuslansky G, Katz M. Low blood pressure and the risk of dementia in very old individuals. Neurology 2003;61(12):1667-1672.
25.Lucas KE, Rowe PC, Coresh J, Klag MJ, Meoni LA, Ford DE. Prospective association between hypotension and idiopathic chronic fatigue. J Hypertens 2004;22(4):691-695.
26.Hildrum B, Mykletun A, Holmen J, Dahl AA. Effect of anxiety and depression on blood pressure: 11-year longitudinal population study. Br J Psychiatry 2008;193(2):108-113.
27.Holmes A, Heilig M, Rupniak NM, Steckler T, Griebel G. Neuropeptide systems as novel therapeutic targets for depression and anxiety disorders. Trends Pharmacol Sci 2003;24(11):580-588.
8.Michalkiewicz M, Knestaut KM, Bytchkova EY, Michalkiewicz T. Hypotension and reduced catecholamines in neuropeptide Y transgenic rats. Hypertension 2003;41(5):1056-1062.
29.Herva A, Räsänen P, Miettunen J, Timonen M, Läksy K, Veijola J, et al. Co-occurrence of metabolic syndrome with depression and anxiety in young adults: the Northern Finland 1966 Birth Cohort Study. Psychosom Med 2006;68(2):213-216.
Files
IssueVol 5 No 3 (2019) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jbe.v5i3.3621
Keywords
Hypertension; Depression; Anxiety; Stress
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Khajeh M, Mirzaei M, Nadjarzadeh A. Evaluation of the Relationship Between Depression, Anxiety, and Stress with Hypertension: Results of a Health Study in Yazd, Iran. JBE. 2020;5(3):236-245.