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  Vol. 6 No. 1, January 1997 TABLE OF CONTENTS
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Are Symptoms of Anxiety and Depression Risk Factors for Hypertension?

Longitudinal Evidence From the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study

Bruce S. Jonas, PhD; Peter Franks, MD; Deborah D. Ingram, PhD

Arch Fam Med. 1997;6(1):43-49.


Abstract

Objective
To test the hypothesis that symptoms of anxiety and depression increase the risk of experiencing hypertension, using the National Health and Nutrition Examination I Epidemiologic Follow-up Study.

Design
A cohort of men and women without evidence of hypertension at baseline were followed up for 7 to 16 years. The association between 2 outcome measures (hypertension and treated hypertension) and baseline anxiety and depression was analyzed using Cox proportional hazards regression adjusting for hypertension risk factors (age; sex; education; cigarette smoking; body mass index; alcohol use; history of diabetes, stroke, or coronary heart disease; and baseline systolic blood pressure). Analyses were stratified by race and age (white persons aged 25-44 years and 45-64 years and black persons aged 25-64 years).

Setting
General community.

Participants
A population-based sample of 2992 initially normotensive persons.

Main Outcome Measures
Incident hypertension was defined as blood pressure of 160/95 mm Hg or more, or prescription of antihypertensive medications. Treated hypertension was defined as prescription of antihypertensive medications.

Results
In the multivariate models for whites aged 45 to 64 years, high anxiety (relative risk [RR], 1.82; 95% confidence interval [CI], 1.30-2.53) and high depression (RR, 1.80; 95% CI, 1.16-2.78) remained independent predictors of incident hypertension. The risks associated with treated hypertension were also increased for high anxiety (RR, 2.36; 95% CI, 1.73-3.23) and high depression (RR, 1.89; 95% CI, 1.25-2.85). For blacks aged 25 to 64 years, high anxiety (RR, 2.74; 95% CI, 1.35-5.53) and high depression (RR, 2.99; 95% CI, 1.41-6.33) remained independent predictors of incident hypertension. The risks associated with treated hypertension were also increased for high anxiety (RR, 3.24; 95% CI, 1.59-6.61) and high depression (RR, 2.92; 95% CI, 1.37-6.22). For whites aged 25 to 44 years, intermediate anxiety (RR, 1.62; 95% CI, 1.18-2.22) and intermediate depression (RR, 1.60; 95% CI, 1.17-2.17) remained independent predictors of treated hypertension only.

Conclusion
Anxiety and depression are predictive of later incidence of hypertension and prescription treatment for hypertension.



Author Affiliations

From the National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md (Drs Jonas and Ingram); and the Primary Care Institute, Highland Hospital, and the Department of Family Medicine, University of Rochester, Rochester, NY (Dr Franks).



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