Depressive symptoms are not associated with clinically important levels of digital home blood pressure in the electronic Framingham Heart Study

Q: What are the key findings of this study?

Depressive symptoms had a small, clinically insubstantial association with home SBP (β 0.87 mm Hg per 1 SD CES-D, P=.014) and no significant association when dichotomized at CES-D ≥16 (P>.2).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Depressive symptoms and home blood pressure in community-dwelling adults (n=883). Intervention: Depressive symptoms measured by the Center for Epidemiological Studies Depression Scale (CES-D, continuous per 1 SD and dichotomous ≥16) vs. Absence of depressive symptoms (CES-D <16) or lower continuous CES-D score. Primary outcome: Repeated digital home systolic blood pressure (SBP) and diastolic blood pressure (DBP) (MD 0.87 mm Hg (SBP per 1 SD higher CES-D), 95% CI 0.18-1.56, p=0.014).

Q: What does this research mean for the field?

Depressive symptoms are associated with only small, clinically insubstantial increases in digital home blood pressure and show no significant relationship when evaluated as a dichotomous condition. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jasmine Lee; Xuzhi Wang; Chunyu Liu; Chathurangi H Pathiravasan; Emelia J. Benjamin; David D. McManus; Joanne M. Murabito

doi:10.1016/j.cvdhj.2024.01.001

February 2, 2024Cardiovascular Digital Health JournalOpen Access

Depressive symptoms are not associated with clinically important levels of digital home blood pressure in the electronic Framingham Heart Study

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Key result

Depressive symptoms link to a clinically negligible ~0.9-mm Hg higher home SBP per SD.

MD 0.87 mm Hg (SBP per 1 SD higher CES-D)
95% CI 0.18-1.56
P=0.014
n=883

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Why the study?

Studies evaluating the association between depressive symptoms and blood pressure have yielded inconsistent results, and home blood pressure monitoring may provide clearer insight.

Are depressive symptoms (measured by CES-D) associated with higher digital home blood pressure over 1 year in community-dwelling middle-aged and older adults?

Key Points

To investigate the association between depressive symptoms and digital home blood pressure among community-dwelling adults in the electronic Framingham Heart Study.
Participants from the electronic Framingham Heart Study (N=883; mean age 54 years; 59% women) were provided a smartphone app and digital blood pressure cuff, completing ≥3 weeks of home measurements over 1 year.
Depressive symptoms were evaluated using the Center for Epidemiological Studies Depression Scale (CES-D) both as a continuous score and dichotomously (CES-D ≥16).
Multivariable linear mixed models tested associations with digital home systolic and diastolic blood pressure, adjusting for age, sex, cohort, time since baseline, lifestyle factors, diabetes, and cardiovascular disease.
A 1 SD higher continuous CES-D score was associated with a 0.9 mm Hg higher home systolic blood pressure (95% CI: 0.18–1.56, P = .01) and a 0.6 mm Hg higher diastolic blood pressure (95% CI: 0.06–1.07, P = .03).
Dichotomous depressive symptoms (CES-D ≥16) showed no significant association with home systolic or diastolic blood pressure (P > .2), whether or not antidepressant use was included.
Neither continuous nor dichotomous depressive symptoms were significantly associated with the prevalence of home hypertension (OR = 1.16, 95% CI: 0.89–1.51 for 1 SD increase in CES-D; OR = 1.77, 95% CI: 0.72–4.36 for CES-D ≥16).

Study Design

Type

Cohort (n=883)

Multicenter

No

Structured PICO

Are depressive symptoms (measured by CES-D) associated with higher digital home blood pressure over 1 year in community-dwelling middle-aged and older adults?

P

Population

883 community-dwelling middle-aged adults in the electronic Framingham Heart Study (mean age 54 years, 58.7% female, 91.5% White, 47.6% with hypertension) who transmitted ≥3 weeks of digital home blood pressure measurements over up to 1 year.

E

Exposure

Depressive symptoms measured at research exam 3 using the Center for Epidemiological Studies Depression Scale (CES-D, continuous score 0–60 and dichotomous cut-off ≥16, with or without self-reported antidepressant medication use such as sertraline, fluoxetine, and citalopram)

C

Comparator

Absence of depressive symptoms (CES-D <16, with or without absence of antidepressant medication use) or lower continuous CES-D score

O

Outcome

Repeated home systolic blood pressure (SBP) and repeated home diastolic blood pressure (DBP) measured weekly for up to 1 year using a wireless Nokia Withings digital BP cuffsurrogate

Main Result

Mean Difference: 0.87 (95% CI 0.18–1.56)

p-value: p=0.014

In middle-aged community-dwelling adults, depressive symptoms showed only a very small, clinically unsubstantial positive association with digital home blood pressure over 1 year, and dichotomous depression was not significantly associated with home blood pressure or hypertension.

Limitations

Observational study design does not permit inferences about causality or directionality
Depressive symptoms were captured at only 1 point in time
Study sample is primarily White, well-educated, and healthier than non-enrolled exam attenders, limiting generalizability
eFHS participants who returned sufficient BP measurements had lower levels of depressive symptoms than non-enrollees, potentially underestimating associations
CES-D score is a validated screening tool but not the gold standard for diagnosing clinical depression
Unmeasured confounding from factors such as medication adherence and diet
Substantial sample size reduction (dropout) over the second half of the 1-year follow-up
Study design does not permit inferences about causality or directionality
Study sample is primarily White, well educated, and healthier than all exam attenders, limiting generalizability to more diverse samples
eFHS participants who returned sufficient BP measurements had lower levels of depressive symptoms than FHS participants who did not enroll, potentially underestimating the association
Depressive symptoms were measured by CES-D score, which is not the gold standard for diagnosing clinical depression
Inability to account for other possible confounders, including adherence to medications and diet

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Answers are grounded in this paper and cite their sources.

Implication

Depressive symptoms warrant no adjustment to home BP thresholds; leaves open effects in clinically depressed subgroups.

Abstract

Background Depressive symptoms are common and share many biopsychosocial mechanisms with hypertension. Association studies between depressive symptoms and blood pressure (BP) have been inconsistent. Home BP monitoring may provide insight. Objective To investigate the association between depressive symptoms and digital home BP. Methods Electronic Framingham Heart Study (eFHS) participants were invited to obtain a smartphone app and digital BP cuff at research exam 3 (2016–2019). Participants with ≥3 weeks of home BP measurements within 1 year were included. Depressive symptoms were measured using the Center for Epidemiological Studies Depression Scale (CES-D). Multivariable linear mixed models were used to test the associations of continuous CES-D score and dichotomous depressive symptoms (CES-D ≥16) (independent) with home BP (dependent), adjusting for age, sex, cohort, number of weeks since baseline, lifestyle factors, diabetes, and cardiovascular disease. Results Among 883 participants (mean age 54 years, 59% women, 91% White), the median CES-D score was 4. Depressive symptom prevalence was 7.6%. Mean systolic and diastolic BP at exam 3 were 119 and 76 mm Hg; hypertension prevalence was 48%. A 1 SD higher CES-D score was associated with 0.9 (95% CI: 0.18–1.56, P = .01) and 0.6 (95% CI: 0.06–1.07, P = .03) mm Hg higher home systolic BP and diastolic BP, respectively. Dichotomous depressive symptoms were not significantly associated with home BP ( P > .2). Conclusion Depressive symptoms were not associated with clinically substantive levels of home BP. The association between depression and cardiovascular disease risk factors warrants more data, which may be supported by mobile health measures.

Discussion

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Cite This Study

Lee et al. (2024) conducted a cohort in Depressive symptoms and home blood pressure in community-dwelling adults (n=883). Depressive symptoms measured by the Center for Epidemiological Studies Depression Scale (CES-D, continuous per 1 SD and dichotomous ≥16) vs. Absence of depressive symptoms (CES-D <16) or lower continuous CES-D score was evaluated on Repeated digital home systolic blood pressure (SBP) and diastolic blood pressure (DBP) (MD 0.87 mm Hg (SBP per 1 SD higher CES-D), 95% CI 0.18-1.56, p=0.014). Depressive symptoms had a small, clinically insubstantial association with home SBP (β 0.87 mm Hg per 1 SD CES-D, P=.014) and no significant association when dichotomized at CES-D ≥16 (P>.2).

synapsesocial.com/papers/6a7be1cb84d0f3193c75fe96 https://doi.org/10.1016/j.cvdhj.2024.01.001

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Depressive symptoms are not associated with clinically important levels of digital home blood pressure in the electronic Framingham Heart Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Depressive symptoms are not associated with clinically important levels of digital home blood pressure in the electronic Framingham Heart Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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