Association of depressive symptoms with non-fatal cardiovascular disease in middle-aged and elderly patients with hypertension: a cohort study from China

Objective Our study explored the association between depressive symptoms and non-fatal cardiovascular disease, as well as other significant risk factors for non-fatal cardiovascular disease, in middle-aged and elderly patients with hypertension in China. Design Prospective cohort study. Setting Data were sourced from the China Health and Retirement Longitudinal Study (CHARLS) database over a 9-year period (2011–2020). Participants Middle-aged and elderly patients with hypertension aged 45 and above in China. Outcome measures Non-fatal cardiovascular disease was ascertained based on self-reported, physician-diagnosed heart disease. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale-10. Results A total of 1755 participants were enrolled in the prospective cohort study. The incidence of non-fatal cardiovascular diseases among patients with hypertension was 5 per 1000 person-months. There was a positive linear correlation between depressive symptoms and the risk of non-fatal cardiovascular diseases (p non-linear =0.625). Meanwhile, an inverted U-shaped relationship was identified between baseline duration of hypertension and risk of non-fatal cardiovascular diseases; those experiencing hypertension for 15 years had the highest risk, with the risk decreasing for durations above or below this value (p non-linear <0.001). Other risk factors identified were female gender (HR 1.19, 95% CI 1.01 to 1.40), health education (HR 0.81, 95% CI 0.70 to 0.95), comorbidity of diabetes (HR 1.60, 95% CI 1.30 to 1.97) and age (HR 1.01, 95% CI 1.01 to 1.02). Conclusions This study demonstrates graded associations between depression severity and incident non-fatal cardiovascular disease in middle-aged and elderly patients with hypertension in China. The multivariable analysis identified five modifiable risk determinants: inadequate health education, advanced age, female gender, diabetes comorbidity and hypertension exposure duration of 7–21 years. These findings necessitate precision prevention strategies combining psychocardiological interventions with risk factor modification in high-risk subgroups.