Impact of depression on masked hypertension and variability in home blood pressure in treated hypertensive patients
Impact of depression on masked hypertension and variability in home blood pressure in treated hypertensive patients
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DOI：
10.1038/hr.2015.75
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发表时间：
2015-11-01
影响因子：
5.4
通讯作者：
Kobayashi, Youichi
中科院分区：
文献类型：
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作者：
Kayano, Hiroyuki;Koba, Shinji;Kobayashi, Youichi
本研究旨在确定与其他类型的高血压相比，抑郁和/或失眠对隐匿性高血压 (MHT) 的影响，以及对家庭测量血压 (HBP) 和诊所血压 (CBP) 变异性的影响。根据 CBP (140/90mmHg) 和早晨 HBP (135/85mmHg) 测量结果，将 328 名年龄 68 +/- 10 岁的高血压患者（132 名女性）分为四种血压类型：控制性 HT (CHT)、白大衣 HT、MHT 和持续性 HT (SHT)。分数为.流行病学研究中心抑郁量表（CES-D）中16分被定义为抑郁症。平均值和标准差血压值是根据 CES-D 评估前连续 14 天的测量值计算得出的。与CHT组相比，SHT组患抑郁症的风险高出2.77倍，MHT组则更高（7.02倍）。抑郁症与 MHT 之间的关联在失眠的情况下会增强，并且在女性中更为强烈。 MHT 的 HBP 变异指数（定义为早晨和夜间的 s.d./平均血压）显着高于其他 BP 类型，而 CBP 则不然。抑郁症患者的早晨和夜间 HBP 变异性均显着高于非抑郁症患者。这些表明抑郁症与 MHT 相关，并且会增加早晨和夜间的 HBP 变异性，但不会增加 CBP 变异性。医生在制定昼夜周期血压控制策略时，应注意高血压患者的精神压力，例如抑郁症。
This study was conducted to determine the effects of depression and/or insomnia on masked hypertension (MHT) compared with other types of HT and on variability in home-measured blood pressure (HBP) and clinic BP (CBP). Three hundred and twentyeight hypertensives (132 women) aged 68 +/- 10 years were classified into four BP types: controlled HT (CHT), white-coat HT, MHT and sustained HT (SHT), based on CBP (140/90mmHg) and morning HBP (135/85mmHg) measurements. A score of. 16 on the Center for Epidemiologic Studies Depression Scale (CES-D) was defined as depression. The mean values and s.d. of BP were calculated from measurements taken during the 14 consecutive days just before the CES-D evaluation. Compared with the CHT group, the risk of depression was 2.77-fold higher in the SHT group and even higher in the MHT group (7.02-fold). The association between depression and MHT was augmented in the presence of insomnia and was somewhat stronger in women. A HBP variability index defined as s.d./mean BPs in both morning and night time was significantly higher in MHT than in the other BP types, whereas that of CBP was not. Both morning and night-time HBP variability were significantly higher in depressive patients than in non-depressives. These suggest that depression is associated with MHT and that increases both morning and night-time HBP variability but not CBP variability. Physicians should be mindful of mental stresses such as depression in their hypertensive patients when forming strategies to control BP over the diurnal cycle.