The relationship between depressive symptomatology and high blood pressure in Hispanic elderly

American Journal of Health Studies,  Summer-Fall, 2005  by Jose R. Rodriguez,  Priscille Joglar,  Mariel G. Davila

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Abstract: The main purpose of this research was to examine the relationship between depressive symptomatology and the development of heart disease in Hispanic Puerto Rican elderly individuals and also to assess the validity of the Spanish translation of the Beck Depression Inventory (BDI-II) for this population. A probabilistic sample of 410 Hispanic men and women ages 65years and older was drawn from all of the residents in independent residential housing projects for elderly individuals in Puerto Rico. Our results suggest that depression alone is not associated with an increased risk for high blood pressure in Puerto Rican elderly living in independent residential housing projects.

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A positive relationship between poor physical health and mental disorders, especially depression, has been established by many studies (Canino, Bird, Rubio-Stipec, & Bravo, 1997; Davidson, Jonas, Dixon, & Markovitz, 2000; Glassman & Shapiro, 1998; Jonas & Lando, 2000; Wells et al., 1989). This shows evidence of how mental and physical health are intimately related and complement each other. Many physical changes occur with the advancement of age that can lead to poorer health. These factors include decreases in mental and physical activity, negative cultural interpretations of aging, un-availability of medical resources and economic hardship factors. A pioneer research study was performed in Puerto Rico in 1997 using a probabilistic sample of older adults living in residential housing projects to assess their health status. The Rodriguez (1997) study found that 590/0 of the sample reported cardiovascular diseases and 60% of the elderly individuals report some form of depressive symptomatology. These findings suggest the need for in-depth exploration of the relationship between physical and mental health within elderly populations.

One of the physical conditions that can adversely affect elderly health is high blood pressure (HBP). According to the guidelines provided by the National Institutes of Health (NIH) and the National Heart, Lung and Blood Institute, hypertension is defined as systolic blood pressure of 140 mm Hg or greater; diastolic blood pressure of 90 mm Hg or greater; or taking antihypertensive medication (NIH, 1990). Hypertension is common in the elderly (NIH, 1990). Among Americans age 60 and older examined in the NHANES III, HBP was found in 60% of non-Hispanic whites and 61% of Mexican Americans (NIH, 1990). Systolic blood pressure is a better predictor of events like heart disease and mortality than is diastolic blood pressure, especially in older persons (NIH, 1990). Health statistics demonstrate that more than 50% of elderly individuals are at high risk to develop hypertension, or are suffering from it. Factors that affect hypertension include stressful life conditions, obesity, inadequate nutrition, smoking and lack of physical exercise; all of these factors promote poor physical health and makes elders prone to developing heart disease (Harris, 1991; Kart, Metress, & Metress, 1988).

Depression and heart disease are often companions. Numerous studies have demonstrated how one may affect the other, as well as multiple risk factors (Glassman & Shapiro, 1998; Mussleman, Evans, & Nemeroff, 1998; NIH, 1997). However, a clear and specific relationship between depression and HBP has not been established. Elderly individuals with depression and HBP have nearly twice the risk of having heart failure as people who had HBP alone (Abramson, Berger, Krumholz, & Viccarino, 2001).

The elderly population (65 and older) in Puerto Rico constitutes approximately 14% of the total population in the year 2000, and is expected to continue increasing at an alarming rate (U.S. Bureau of the Census, 2000). This fact will continue to have many implications for the island's public health care system and the prevalence of medical and psychological disorders. For example, the elderly report more mayor physical and mental health conditions than younger groups (Alsina & Rodriguez, 1995). Puerto Rican elderly are not only at the highest risk for committing suicide; they also have the highest rate of actual suicide prevalence rate on the island (Alsina & Rodriguez, 1995; Bravo, 2000; Rodriguez, 1997; Rodriguez & Collazo, 2003). Despite these alarming statistics, the most significant epidemiological research in this area that has been performed on the island is very limited and does not include any study of the prevalence, comorbidity and relationship between physical and psychological conditions in the elderly.

Moreover, there is extensive literature regarding depression as a risk factor for coronary heart disease, health problems, mortality and hypertension. (Barefoot & Schroll, 1996; Glassman & Shapiro, 1998; Jonas & Lando, 2000). However, there appears to be contradictory findings and results on the specific aspects of this issue. Some studies report a relationship between depression and hypertension (Aromaa et al., 1994; Frasure-Smith, Lesperance, & Talajic, 1995; Jonas, Franks, & Ingram, 1997; Reiff, Schwartz, & Northridge, 2001) while others report that they are not related (Paterniti, Alperovitch, Ducimetiere, Dealberto, Lepine, & Bisserbe, 1999; Raikkonen, Mathews, & Kuller, 2001; Shin, Poston, Kimball, St Jeor, Foreyt, 2001). An extensive review of the literature spanning 10 years reveal only one study that has statistically established a significant relationship between those two factors (Calvo, Dial, Ojeda, Ramal, & Aleman, 2001). Hence, this research attempts to elucidate the discrepancies found in the literature related to the role of depression and its influence on high blood pressure. It also provides valuable information concerning health disparities in the clinical and research arena.