Centre for Mental Health Research, Australian National University, Canberra 0200, Australia. Tel: +61 2 61252741; Fax: +61 2 61250733
Correspondence: e-mail: Anthony.Jorm{at}anu.edu.au
Declaration of interest Funding was provided by the National Health and Medical Research Council and the Australian Rotary Health Research Fund.
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ABSTRACT |
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Aims To examine the association of hypotension with depressive symptoms, negative affect and positive affect.
Method Community survey of 340 elderly persons aged 77-99 years.
Results Diastolic hypotension had a weak association with depression, no association with negative affect and a strong inverse association with positive affect. Systolic hypertension was associated with positive affect. Use of antihypertensive medication was independently associated with lower positive affect.
Conclusions Diastolic hypotension shows a specific association with low positive affect. This association may explain the weak and inconsistent results of earlier studies relating hypotension to depression.
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INTRODUCTION |
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Depression and affective systems
One interpretation is that the positive associations in the literature are
simply due to selective reporting of Type I errors
(Donner-Banzhoff et al,
1997). However, another possibility is that depression scales are
only weakly tapping the psychological characteristics associated with
hypotension. Research into the psychology of emotion has distinguished two
independent affective systems, involving positive and negative affect. Whereas
anxiety involves the negative affect system, depression involves both high
negative affect and (to a lesser degree) low positive affect
(Watson et al, 1988;
Clark et al, 1994).
According to Watson et al
(1988), high positive affect
is "a state of high energy, full concentration, and pleasurable
engagement, whereas low [positive affect] is characterized by sadness and
lethargy" (p. 1063). The same authors describe negative affect as
"a general dimension of subjective distress and unpleasurable engagement
that subsumes a variety of aversive mood states, including anger, contempt,
disgust, guilt, fear, and nervousness, with low [negative affect] being a
state of calmness and serenity" (p. 1063). The present study assessed
the association of hypotension with measures of depression, anxiety, positive
affect and negative affect.
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METHOD |
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Multiple linear regression analyses were carried out to predict the affect score from hypotension and hypertension (dichotomous variables). To control for potential confounders, additional regression analyses were carried out with the confounders entered as simultaneous predictors.
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RESULTS |
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To control for possible confounders, a multiple linear regression analysis was carried out to predict the positive affect from hypotension, hypertension, use of antihypertensive medication, age, gender, education, marital status and a range of physical health and cognitive measures (see Korten et al, 1999, for details). Controlling for these factors, positive affect was related to diastolic hypotension (unstandardised ß= -2.18, P=0.031) and the use of antihypertensive medication (ß=-2.61, P=0.004). Antihypertensive medication was being taken by 39% of the sample. Among those on medication, 24% had diastolic hypotension and 5% had systolic hypotension.
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DISCUSSION |
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Effect of antihypertensive medication
Diastolic hypotension was found in a quarter of users of antihypertensive
medication, suggesting that treatment might be leading to hypotension in some
cases. Furthermore, the use of antihypertensive medication was found to be
associated with low positive affect when blood pressure status was
statistically controlled. As previous studies have done, we defined
hypotension based on a single measurement occasion (although measured twice),
which would have involved some unreliability. Whether or not a participant
uses anti-hypertensive medication may be an independent predictor because it
gives additional reliable information about blood pressure status.
Unfortunately, we did not collect data on type of medication, so we could not
explore whether the association is a general one or specific to particular
classes of medication.
Limitations
Other limitations of this study must be acknowledged. A cross-sectional
study such as this one cannot distinguish whether hypotension is a cause or
effect of low positive affect, or whether there is a common cause of both.
Although the present study had longitudinal data on blood pressure, positive
affect was measured only at Wave 3. Another limitation is that the use of
psychotropic medication, which is another potential confounding variable, was
not measured. The association of hypotension with lower positive affect
requires further research in longitudinal studies and in controlled trials of
antihypertensive treatment.
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Clinical Implications and Limitations |
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LIMITATIONS
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ACKNOWLEDGMENTS |
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REFERENCES |
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Received for publication June 16, 2000. Revision received December 22, 2000. Accepted for publication December 22, 2000.