Abstract P331: Does Depression Status Impact Recognition, Treatment, or Control of Hypertension?
Background: Depression may delay the identification, treatment or control of hypertension (HT) due to competing demands on provider’s time and attention, or the impact of depression on patient adherence to lifestyle treatment or pharmacotherapy for HT.
Objective: To test whether incident HT patients with depression had worse HT control, recognition and treatment initiation than patients without depression.
Methods: Insured patients 19 years of age and older with HT onset were identified from three large health systems from January 1, 2003 to December 31, 2008 based on combinations of elevated blood pressure readings (≥ 140/90 mmHg or ≥ 130/80 mmHg if diabetes or chronic kidney disease), HT diagnosis codes, and anti-HT prescription fills. Depression was ascertained based on combinations of outpatient and inpatient diagnosis codes and depression medication fills. HT recognition is the 1st use of HT diagnosis codes on or after HT onset. HT treatment initiation is the date of the 1st anti-HT medication fill on or after HT onset. HT control is the date of the 2nd BP value of 2+ consecutive readings with the BP < 140/90mm or < 130/80 for diabetes or chronic kidney disease. HT relapse is the 2nd BP value of 2+ consecutive elevated readings after a patient has achieved HT control. We examined 12-month cumulative incidence rates for HT recognition, treatment initiation, control, and relapse. General linear models and Poisson regression models were used to examine the covariate adjusted relationship between depression and HT-related outcomes.
Results: We identified 132,609 HT patients of whom 10,622 (8%) had depression prior to HT onset. Those with depression were more likely to be female (73% vs 54%), White (66% vs 52%), smokers (27% vs 18%), and have more visits/year (4.9 vs 3.7). Average patient follow-up was 3.9 years. At 12 months, persons with depression had better HT control (54% vs 48%) although worse HT recognition (24% vs 31%) and treatment initiation (29% vs 35%). HT relapse was similar at 12 months. Patients with depression had better HT control at 1-year (RR=1.13; 95% CI 1.11-1.15) and were less likely to relapse within 5 years.
Conclusion: In our study population, patients with depression prior to HT onset had better HT control than patients without depression, even after adjusting for potential confounders including the number of medical encounters. In this study, 80% of patients with depression had evidence of being treated for depression. It is possible that patients with adequate depression control also maintain adequate control of other chronic conditions.
- © 2013 by American Heart Association, Inc.