Advertisement

Systematic Review: The Association between Late Life Depression and Hypotension

  • Robert Briggs
    Correspondence
    Address correspondence to Robert Briggs, MD, The Irish Longitudinal Study on Aging (TILDA), Trinity College Dublin, Dublin 2, Ireland.
    Affiliations
    The Irish Longitudinal Study on Aging (TILDA), Trinity College Dublin, Dublin, Ireland

    Mercer's Institute for Successful Aging, Department of Medical Gerontology, St. James's Hospital, Dublin, Ireland

    Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland
    Search for articles by this author
  • Rose Anne Kenny
    Affiliations
    The Irish Longitudinal Study on Aging (TILDA), Trinity College Dublin, Dublin, Ireland

    Mercer's Institute for Successful Aging, Department of Medical Gerontology, St. James's Hospital, Dublin, Ireland
    Search for articles by this author
  • Sean P. Kennelly
    Affiliations
    The Irish Longitudinal Study on Aging (TILDA), Trinity College Dublin, Dublin, Ireland

    Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland
    Search for articles by this author
Published:August 11, 2016DOI:https://doi.org/10.1016/j.jamda.2016.06.027

      Abstract

      Background

      Late life depression (LLD), defined as depressive illness in people aged 60 years or older, is more complex than depression presenting in earlier life, with different clinical features and a poorer response to therapy. Different biological factors underlie LLD and hypotension may be an important modifiable risk factor. The aim of this systematic review is to clarify the relationship between hypotension and LLD.

      Methods

      A systematic search was conducted in PubMed and Embase for articles published up to December 31, 2015. Key search terms were “depression,” “depressive disorder,” “hypotension,” and “blood pressure.” Studies were included if they were published as a primary research paper in a peer-reviewed journal, involved participants with a mean age of 60 years or more, and examined the relationship between hypotension and depression.

      Results

      The initial combined search retrieved 2268 nonduplicate articles. Of these, 116 full texts were assessed for eligibility, of which 19 were included in this systematic review.
      Nine cross-sectional studies examined the association between hypotension and LLD, with 8/9 indicating a positive association between the 2. Five cross-sectional studies examined the relationship between orthostatic hypotension (OH) and LLD, with each study finding a positive association between the 2. Five longitudinal studies examined the relationship between hypotension and LLD, with discordant findings between studies. There were no longitudinal studies examining the relationship between OH and LLD.

      Discussion

      This systematic review found that cross-sectional studies demonstrated a consistent relationship between hypotension and LLD, but longitudinal data to date is less consistent, with discordant findings. There are several methodological limitations of published longitudinal data that may explain these differences, including differences in age at enrollment, depression and blood pressure assessment, and controlling for covariates.
      Further longitudinal studies to clarify the role of these potentially modifiable factors in the development of this complex illness are essential.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. World Population Ageing 2013. United Nations, New York. December 2013. Available at: http://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2013.pdf. Accessed on May 23, 2016.

        • Blazer D.G.
        Depression in late life: Review and commentary.
        J Gerontol A Biol Sci Med Sci. 2003; 58: 249-265
        • Noël P.H.H.
        • Williams J.W.
        • Unützer J.
        • et al.
        Depression and comorbid illness in elderly primary care patients: Impact on multiple domains of health status and well-being.
        Ann Fam Med. 2004; 2: 555-562
        • Lenze E.J.
        • Schulz R.
        • Martire L.M.
        • et al.
        The course of functional decline in older people with persistently elevated depressive symptoms: Longitudinal findings from the Cardiovascular Health Study.
        J Am Geriatr Soc. 2005; 53: 569-575
        • Schulz R.
        • Beach S.R.
        • Ives D.G.
        • et al.
        Association between depression and mortality in older adults: The Cardiovascular Health Study.
        Arch Intern Med. 2000; 160: 1761-1768
        • Penninx B.W.
        • Guralnik J.M.
        • Ferrucci L.
        • et al.
        Depressive symptoms and physical decline in community-dwelling older persons.
        JAMA. 1998; 279: 1720-1726
        • Büchtemann D.
        • Luppa M.
        • Bramesfeld A.
        • Riedel-Heller S.
        Incidence of late-life depression: A systematic review.
        J Affect Disord. 2012; 142: 172-179
        • Gottfries C.G.
        Late life depression.
        Eur Arch Psychiatry Clin Neurosci. 2001; 251: II57-61
        • Regan C.O.
        • Kearney P.M.
        • Savva G.M.
        • et al.
        Age and sex differences in prevalence and clinical correlates of depression: First results from the Irish Longitudinal Study on Ageing.
        Int J Geriatr Psychiatry. 2013; 28: 1280-1287
        • Fiske A.
        • Wetherell J.L.L.
        • Gatz M.
        Depression in older adults.
        Annu Rev Clin Psychol. 2009; 5: 363-389
        • Pimontel M.A.
        • Culang-Reinlieb M.E.
        • Morimoto S.S.
        • Sneed J.R.
        Executive dysfunction and treatment response in late-life depression.
        Int J Geriatr Psychiatry. 2012; 27: 893-899
        • Cole M.G.
        • Bellavance F.
        • Mansour A.
        Prognosis of depression in elderly community and primary care populations: A systematic review and meta-analysis.
        Am J Geriatr Psychiatry. 1999; 156: 1182-1189
        • Schoevers R.A.
        • Beekman A.T.
        • Deeg D.J.
        • et al.
        The natural history of late-life depression: Results from the Amsterdam Study of the Elderly (AMSTEL).
        J Affect Disord. 2003; 76: 5-14
        • Krishnan K.R.
        • McDonald W.M.
        Arteriosclerotic depression.
        Med Hypotheses. 1995; 44: 111-115
        • Hopkins Tanne J.
        US guidelines say blood pressure of 120/80 mm Hg is not “normal.”.
        BMJ. 2003; 326: 1104
        • Denker M.G.
        • Cohen D.L.
        What is an appropriate blood pressure goal for the elderly: Review of recent studies and practical recommendations.
        Clin Interv Aging. 2013; 8: 1505-1517
        • Wright J.T.
        • Williamson J.D.
        • et al.
        • SPRINT Research Group
        A Randomized Trial of Intensive versus Standard Blood-Pressure Control.
        N Engl J Med. 2015; 373: 2103-2116
        • Cohen D.L.
        • Townsend R.R.
        Which patients does the SPRINT study not apply to and what are the appropriate blood pressure goals in these populations?.
        J Clin Hypertens. 2016; 18: 477-478
        • Fedorowski A.
        • Melander O.
        Syndromes of orthostatic intolerance: A hidden danger.
        J Intern Med. 2013; 273: 322-335
        • Jansen R.W.M.M.
        Postprandial hypotension: Simple treatment but difficulties with the diagnosis.
        J Gerontol A Biol Sci Med Sci. 2005; 60: 1268-1270
        • O'Mara G.
        • Lyons D.
        Postprandial hypotension.
        Clin Geriatr Med. 2002; 18: 307-321
        • Nitzan M.
        • Adar Y.
        • Hoffman E.
        • et al.
        Comparison of systolic blood pressure values obtained by photoplethysmography and by Korotkoff sounds.
        Sensors (Basel). 2013; 13: 14797-14812
        • Nietert P.J.
        • Wessell A.M.
        • Feifer C.
        • Ornstein S.M.
        Effect of terminal digit preference on blood pressure measurement and treatment in primary care.
        Am J Hypertens. 2006; 19: 147-152
        • Alpert B.S.
        • Quinn D.
        • Gallick D.
        Oscillometric blood pressure: A review for clinicians.
        J Am Soc Hypertens. 2014; 8: 930-938
        • van Montfrans G.A.
        Oscillometric blood pressure measurement: Progress and problems.
        Blood Press Monit. 2001; 6: 287-290
        • Stergiou G.S.
        • Kollias A.
        • Destounis A.
        • Tzamouranis D.
        Automated blood pressure measurement in atrial fibrillation: A systematic review and meta-analysis.
        J Hypertens. 2012; 30: 2074-2082
        • Pickering T.G.
        • Hall J.E.
        • Appel L.J.
        • et al.
        Recommendations for blood pressure measurement in humans and experimental animals.
        Circulation. 2005; 111: 697-716
        • Truijen J.
        • van Lieshout J.J.
        • Wesselink W.A.
        • Westerhof B.E.
        Noninvasive continuous hemodynamic monitoring.
        J Clin Monit Comput. 2012; 26: 267-278
        • Langewouters G.J.
        • Settels J.J.
        • Roelandt R.
        • Wesseling K.H.
        Why use Finapres or Portapres rather than intra-arterial or intermittent noninvasive techniques of blood pressure measurement?.
        J Med Eng Technol. 1998; 22: 37-43
        • Wesseling K.H.
        Finger arterial pressure measurement with Finapres.
        Z Kardiol. 1996; 85: 38-44
        • Schutte A.E.
        • Huisman H.W.
        • van Rooyen J.M.
        • et al.
        Validation of the Finometer device for measurement of blood pressure in black women.
        J Hum Hypertens. 2004; 18: 79-84
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration.
        BMJ. 2009; 339: b2700
      2. National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. Available at: http://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/cohort. Accessed on May 23, 2016.

        • Radloff L.S.
        The CES-D Scale.
        Appl Psychol Meas. 1977; 1: 385-401
        • Yesavage J.A.
        • Brink T.L.
        • Rose T.L.
        • et al.
        Development and validation of a geriatric depression screening scale: A preliminary report.
        J Psychiatr Res. 1982; 17: 37-49
        • Gould C.E.
        • Beaudreau S.A.
        Association between depression and anxiety on blood pressure dysregulation and pulse in the Health and Retirement Study.
        Int J Geriatr Psychiatry. 2013; 28: 1045-1053
        • Rosset I.
        • Rodrigues R.P.P.
        • Rizzi L.
        • et al.
        Inverse relationship between depressive symptoms and arterial blood pressure in community-dwelling oldest-old Brazilians.
        J Am Geriatr Soc. 2013; 61: 465-467
        • Imai H.
        • Okumiya K.
        • Wada T.
        • et al.
        Relationship between depression and blood pressure in community-dwelling oldest-old adults in Japan.
        J Am Geriatr Soc. 2013; 61: 2241-2242
        • Ng T.P.P.
        • Feng L.
        • Niti M.
        • Yap K.B.B.
        Low blood pressure and depressive symptoms among Chinese older subjects: A population-based study.
        Am J Med. 2010; 123: 342-349
        • Lenoir H.
        • Lacombe J.M.M.
        • Dufouil C.
        • et al.
        Relationship between blood pressure and depression in the elderly. The Three-City Study.
        J Hypertens. 2008; 26: 1765-1772
        • Kim B.S.S.
        • Bae J.N.N.
        • Cho M.J.J.
        Depressive symptoms in elderly adults with hypotension: Different associations with positive and negative affect.
        J Affect Disord. 2010; 127: 359-364
        • Jorm A.F.
        Association of hypotension with positive and negative affect and depressive symptoms in the elderly.
        Br J Psychiatry. 2001; 178: 553-555
        • Stroup-Benham C.A.
        • Markides K.S.
        • Black S.A.
        • Goodwin J.S.
        Relationship between low blood pressure and depressive symptomatology in older people.
        J Am Geriatr Soc. 2000; 48: 250-255
        • Barrett-Connor E.
        • Palinkas L.A.
        Low blood pressure and depression in older men: A population-based study.
        BMJ. 1994; 308: 446-449
        • Richardson J.
        • Kerr S.R.
        • Shaw F.
        • et al.
        A study of orthostatic hypotension in late-life depression.
        Am J Geriatr Psychiatry. 2009; 17: 996-999
        • Vasudev A.
        • O'Brien J.T.
        • Tan M.P.P.
        • et al.
        A study of orthostatic hypotension, heart rate variability and baroreflex sensitivity in late-life depression.
        J Affect Disord. 2011; 131: 374-378
        • Regan C.O.
        • Kearney P.M.
        • Cronin H.
        • et al.
        Oscillometric measure of blood pressure detects association between orthostatic hypotension and depression in population based study of older adults.
        BMC Psychiatry. 2013; 13: 266
        • Colloby S.J.
        • Vasudev A.
        • O'Brien J.T.
        • et al.
        Relationship of orthostatic blood pressure to white matter hyperintensities and subcortical volumes in late-life depression.
        Br J Psychiatry. 2011; 199: 404-410
        • Schwartz S.
        • Feller A.
        • Perlmuter L.C.
        Postprandial systolic blood pressure and subsyndromal depression.
        Exp Aging Res. 2001; 27: 309-318
        • Paterniti S.
        • Verdier-Taillefer M.H.
        • Geneste C.
        • et al.
        Low blood pressure and risk of depression in the elderly. A prospective community-based study.
        Br J Psychiatry. 2000; 176: 464-467
        • Gilmore C.
        • Green B.H.
        • Copeland J.R.
        • et al.
        Blood pressure as a risk factor for depression in elderly people: A prospective study.
        Acta Psychiatr Scand. 1995; 91: 126-129
        • Siennicki-Lantz A.
        • André-Petersson L.
        • Elmståhl S.
        Decreasing blood pressure over time is the strongest predictor of depressive symptoms in octogenarian men.
        Am J Hypertens. 2013; 21: 863-871
        • Tikhonoff V.
        • Hardy R.
        • Deanfield J.
        • et al.
        Symptoms of anxiety and depression across adulthood and blood pressure in late middle age: The 1946 British birth cohort.
        J Hypertens. 2014; 32: 1590-1598
        • Gao S.
        • Hendrie H.C.
        • Yang L.
        • et al.
        Increase in blood pressure precedes clinical depression in elderly primary care patients.
        Int J Geriatr Psychiatry. 2013; 28: 1099-1100
        • Stack J.A.
        • Reynolds C.F.
        • Perel J.M.
        • et al.
        Pretreatment systolic orthostatic blood pressure (PSOP) and treatment response in elderly depressed inpatients.
        J Clin Psychopharmacol. 1988; 8: 116-120
        • Schneider L.S.
        • Sloane R.B.
        • Staples F.R.
        • Bender M.
        Pretreatment orthostatic hypotension as a predictor of response to nortriptyline in geriatric depression.
        J Clin Psychopharmacol. 1986; 6: 172-176
        • Roman M.W.
        • Callen B.L.
        Screening instruments for older adult depressive disorders: Updating the evidence-based toolbox.
        Issues Ment Health Nurs. 2008; 29: 924-941
        • Lyness J.M.
        • Noel T.K.
        • Cox C.
        • et al.
        Screening for depression in elderly primary care patients. A comparison of the Center for Epidemiologic Studies-Depression Scale and the Geriatric Depression Scale.
        Arch Intern Med. 1997; 157: 449-454
        • Suija K.
        • Rajala U.
        • Jokelainen J.
        • et al.
        Validation of the Whooley questions and the Beck Depression Inventory in older adults.
        Scand J Prim Health Care. 2012; 30: 259-264
        • Conradsson M.
        • Rosendahl E.
        • Littbrand H.
        • et al.
        Usefulness of the Geriatric Depression Scale 15-item version among very old people with and without cognitive impairment.
        Aging Ment Health. 2013; 17: 638-645
        • Carleton R.N.
        • Thibodeau M.A.
        • Teale M.J.N.
        • et al.
        The Center for Epidemiologic Studies Depression Scale: A review with a theoretical and empirical examination of item content and factor structure.
        PLoS One. 2013; 8: e58067
        • Lawton M.P.
        • Parmelee P.A.
        • Katz I.R.
        • Nesselroade J.
        Affective states in normal and depressed older people.
        J Gerontol B Psychol Sci Soc Sci. 1996; 51: P309-P316
        • Grossman E.
        Ambulatory blood pressure monitoring in the diagnosis and management of hypertension.
        Diabetes Care. 2013; 36: S307-S311
        • Ohkubo T.
        • Hozawa A.
        • Nagai K.
        • et al.
        Prediction of stroke by ambulatory blood pressure monitoring versus screening blood pressure measurements in a general population: The Ohasama study.
        J Hypertens. 2000; 18: 847-854
        • Ohkubo T.
        • Imai Y.
        • Tsuji I.
        • et al.
        Home blood pressure measurement has a stronger predictive power for mortality than does screening blood pressure measurement: A population-based observation in Ohasama, Japan.
        J Hypertens. 1998; 16: 971-975
        • Muntner P.
        • Bowling C.B.
        • Shimbo D.
        Systolic blood pressure goals to reduce cardiovascular disease among older adults.
        Am J Med Sci. 2014; 348: 129-134
        • Mallery L.H.H.
        • Allen M.
        • Fleming I.
        • et al.
        Promoting higher blood pressure targets for frail older adults: A consensus guideline from Canada.
        Cleve Clin J Med. 2014; 81: 427-437
        • Potocka-Plazak K.
        • Plazak W.
        Orthostatic hypotension in elderly women with congestive heart failure.
        Aging (Milano). 2001; 13: 378-384
        • Robertson D.
        • DesJardin J.A.
        • Lichtenstein M.J.
        Distribution and observed associations of orthostatic blood pressure changes in elderly general medicine outpatients.
        Am J Med Sci. 1998; 315: 287-295
        • Huang C.Q.Q.
        • Dong B.R.R.
        • Lu Z.C.C.
        • et al.
        Chronic diseases and risk for depression in old age: A meta-analysis of published literature.
        Ageing Res Rev. 2010; 9: 131-141
        • Stewart R.
        Low blood pressure and depression in the elderly.
        Br J Psychiatry. 2000; 177: 181-182
        • Busby W.J.
        • Campbell A.J.
        • Robertson M.C.
        Low blood pressure is not an independent determinant of survival in an elderly population.
        Age Ageing. 1996; 25: 449-452