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
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Article info
Publication history
Published online: August 11, 2016
Identification
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© 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
