Association between depressive symptoms and hypertension care cascade in the Peruvian population

Background Depressive symptoms are common among individuals with cardiovascular risk factors and may influence engagement across the hypertension care continuum. However, their association with the hypertension care cascade has not been well characterized in large population-based studies from Latin America. Purpose To evaluate the association between depressive symptoms and the hypertension care cascade in a nationally representative sample of Peruvian adults. Methods We conducted a cross-sectional analysis of 84,986 adults from the Peruvian Demographic and Family Health Survey. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9) and categorized as none/minimal, mild, moderate, or severe. Hypertension prevalence, awareness, treatment, and control were defined using standardized criteria. Poisson regression models were fitted to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Results Hypertension prevalence was 22.8% and increased with depressive symptom severity (20.0% to 26.7%; p<0.001). Hypertension awareness was 62.9% and increased across depressive symptom categories (52.4% to 70.4%; p<0.001). In adjusted models, moderate (aPR 1.07, 95% CI 1.01–1.14) and severe depressive symptoms (aPR 1.15, 95% CI 1.09–1.22) were associated with higher hypertension prevalence. For awareness, adjusted PRs were 1.20 (95% CI 1.12–1.27) for moderate and 1.25 (95% CI 1.18–1.32) for severe symptoms. Treatment (68.8%) and control (55.4%) did not differ significantly across depressive symptom categories. Awareness showed significant effect modification by age and sex, with stronger associations in younger adults and men. Conclusion Depressive symptom severity was associated with higher hypertension prevalence and awareness but not with improved treatment or blood pressure control. These findings support the need for integrated strategies that address both mental health and cardiovascular risk in primary care.