Associations between mental health, blood pressure and the development of hypertension

Nature Communications · 7 authors, 11 centres

AI SUMMARY

POPULATIONMiddle-aged and older adults from the UK Biobank (N=502,494 at baseline; median age 58 years, range 37-73; 54.4% female)

INTERVENTIONNot applicable (observational study). Exposures: systolic blood pressure (SBP), hypertension diagnosis (HTN), number of antihypertensive medications.

COMPARISONParticipants with higher vs. lower SBP; participants with vs. without HTN diagnosis; participants who developed HTN at follow-up vs. those who stayed normotensive.

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TL;DR

This large UK Biobank study (N>500,000) found that higher systolic blood pressure was associated with fewer depressive symptoms and greater well-being, while a diagnosis of hypertension was paradoxically linked to worse mental health. Notably, individuals who later developed hypertension already showed poorer mental health years before diagnosis, and the mood-lifting effect of higher blood pressure was stronger in those who eventually became hypertensive. These findings suggest that the complex interplay between blood pressure and mental health, possibly mediated by baroreceptor mechanisms, may contribute to the development of hypertension over time.

Full summary

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{"Background": "Both hypertension (HTN) and affective disorders such as depression frequently co-occur and are established risk factors for cardiovascular disease. Previous studies have reported contradictory findings: some show that higher blood pressure relates to better mood and well-being, while others link HTN to worse mental health. Baroreceptor mechanisms\u2014whereby blood pressure elevations phasically adjust pain sensitivity, emotional processing, and cortical excitability\u2014have been proposed as a potential neuro-behavioural component in the development of essential hypertension. The authors aimed to systematically dissect these associations using the large, deeply phenotyped UK Biobank cohort, hypothesizing that higher SBP would relate to fewer depressive symptoms and greater well-being both cross-sectionally and longitudinally.", "Methods": "Data from 502,494 UK Biobank participants (273,378 women, 54.4%) were analyzed. Baseline assessment occurred between 2006-2010, with an online mental health follow-up at ~5 years and an imaging follow-up at ~10 years (mean 8.9 years, range 3.8-13.8 years). Current depressive symptoms were assessed via a 4-point Likert scale (depressed mood, unenthusiasm, tenseness, tiredness); well-being via 7 questions on a 6-point Likert scale. SBP was the mean of two automated readings (Omron 705 IT). HTN diagnosis was self-reported (doctor-diagnosed). Number of antihypertensive medications was coded from nurse interviews. Covariates included age, gender, BMI, resting heart rate, diabetes, angina, myocardial infarction, and lifetime depression. Cross-sectional and longitudinal multiple linear regression models were used. Moderation analyses tested whether the BP-mental health relationship differed by later HTN status. fMRI analyses used the Hariri emotional faces task (BOLD contrast, faces > shapes) in amygdala and whole-brain masks. Sensitivity analyses included multiple imputation, E-values, hospital records (HES), and subgroup analyses by medication/disease status.", "Key Results": "Cross-sectionally (N=303,771 for depressive symptoms; N=129,876 for well-being), higher SBP was associated with fewer depressive symptoms (\u03b2=-0.063; 95% CI [-0.067, -0.060]; p<0.001) and greater well-being (\u03b2=0.057; 95% CI [0.051, 0.063]; p<0.001). Conversely, HTN diagnosis was associated with more depressive symptoms (\u03b2=0.043; 95% CI [0.039, 0.047]; p<0.001) and lower well-being (\u03b2=-0.057; 95% CI [-0.064, -0.050]; p<0.001). Longitudinally (N=28,021 for depressive symptoms; N=29,966 for well-being), baseline SBP predicted fewer depressive symptoms at ~10-year follow-up (\u03b2=-0.042; 95% CI [-0.055, -0.029]; p<0.001) and higher well-being (\u03b2=0.033; 95% CI [0.020, 0.046]; p<0.001). Baseline HTN predicted more depressive symptoms (\u03b2=0.029; 95% CI [0.014, 0.044]; p<0.001) and lower well-being (\u03b2=-0.032; 95% CI [-0.047, -0.017]; p<0.001) at follow-up. In the moderation analysis (N=25,991 non-hypertensive at baseline), participants who later developed HTN already had higher baseline SBP (mean 148 mmHg vs. 130 mmHg). In unadjusted models, no baseline mental health differences existed between groups, but after adjusting for SBP, those who later developed HTN had significantly more depressive symptoms (\u03b2=0.060; 95% CI [0.045, 0.076]; p<0.001) and lower well-being (\u03b2=-0.043; 95% CI [-0.068, -0.017]; p<0.001). The negative SBP-depressive symptoms association was steeper in those who later developed HTN (interaction \u03b2=-0.014; 95% CI [-0.026, -0.003]; p=0.015). fMRI analyses (N=26,697) showed lower BOLD activity to emotional faces in HTN vs. normotensive participants (amygdala: HTN z=1.134, no HTN z=1.249; t=9.797; p<0.001; whole-brain: HTN z=2.322, no HTN z=2.592; t=14.528; p<0.001). Higher SBP was negatively associated with BOLD activity (amygdala: \u03b2=-0.041; 95% CI [-0.054, -0.028]; p<0.001; whole-brain: \u03b2=-0.032; 95% CI [-0.045, -0.019]; p<0.001). The negative SBP-BOLD association was less pronounced in HTN participants (whole-brain interaction \u03b2=0.015; 95% CI [0.003, 0.028]; p=0.014). Results were robust across extensive sensitivity analyses including multiple imputation, E-values (E=1.25-1.32), hospital records, and subgroup analyses by medication and disease status.", "Clinical Implications": "This study resolves apparent contradictions in the literature by demonstrating that higher blood pressure per se is associated with better mental health, while a diagnosis of hypertension is linked to worse mental health\u2014an effect detectable years before clinical diagnosis. The findings support the 'learned hypertension' hypothesis, whereby baroreceptor-mediated mood-lifting effects of blood pressure elevations may positively reinforce behaviours that increase blood pressure over time, contributing to hypertension development. The altered BP-mental health relationship and reduced emotional brain reactivity in pre-hypertensive individuals suggest that central nervous system adaptations may precede and potentially contribute to hypertension. While effect sizes were small (\u2206adj. R\u00b2=0.001-0.004) and not directly applicable to individual patient care, the epidemiological relevance is substantial given the high prevalence of hypertension and sub-clinically elevated blood pressure. The results highlight the need for prospective longitudinal studies with repeated BP monitoring and mental health assessments, and suggest that blood pressure-mental health interactions should be considered in the management of individuals at risk for hypertension."}

PICO

PPOPULATION

Middle-aged and older adults from the UK Biobank (N=502,494 at baseline; median age 58 years, range 37-73; 54.4% female)

IINTERVENTION

Not applicable (observational study). Exposures: systolic blood pressure (SBP), hypertension diagnosis (HTN), number of antihypertensive medications.

OOUTCOME

Current depressive symptoms (4-point Likert scale), well-being (6-point Likert scale), BOLD fMRI response to emotional faces (Hariri task).

STUDY TYPE

cohort

SPECIALTY

cardiology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

Not run

ORIGINAL PAPER

PMC10082210

Associations between mental health, blood pressure and the development of hypertension

Nature Communications

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ABSTRACT

Multiple studies have reported a link between mental health and high blood pressure with mixed or even contradictory findings. Here, we resolve those contradictions and further dissect the cross-sectional and longitudinal relationship between mental health, systolic blood pressure, and hypertension using extensive psychological, medical and neuroimaging data from the UK Biobank. We show that higher systolic blood pressure is associated with fewer depressive symptoms, greater well-being, and lower emotion-related brain activity. Interestingly, impending hypertension is associated with poorer mental health years before HTN is diagnosed. In addition, a stronger baseline association between systolic blood pressure and better mental health was observed in individuals who develop hypertension until follow-up. Overall, our findings offer insights on the complex relationship between mental health, blood pressure, and hypertension, suggesting that—via baroreceptor mechanisms and reinforcement learning—the association of higher blood pressure with better mental health may ultimately contribute to the development of hypertension.

CITATION EXPORT

H. Lina Schaare, Maria Blöchl, Deniz Kumral et al.. Associations between mental health, blood pressure and the development of hypertension. Nature Communications. (2023). https://doi.org/10.1038/s41467-023-37579-6

AUTHORS

7 · 11 CENTRES

H. Lina Schaare, Maria Blöchl, Deniz Kumral, Marie Uhlig, Lorenz Lemcke, Sofie L. Valk, Arno Villringer

1grid.419524.f0000 0001 0041 5028Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
2grid.419524.f0000 0001 0041 5028Otto-Hahn-Group Cognitive Neurogenetics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
3grid.8385.60000 0001 2297 375XInstitute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Jülich, Jülich, Germany
4grid.411327.20000 0001 2176 9917Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
5grid.9647.c0000 0004 7669 9786Institute for Psychology, Leipzig University, Leipzig, Germany
6grid.5963.9Institute of Psychology, Neuropsychology, University of Freiburg, Freiburg, Germany
7grid.5963.9Institute of Psychology, Clinical Psychology and Psychotherapy Unit, University of Freiburg, Freiburg, Germany
8grid.419524.f0000 0001 0041 5028Nuclear Magnetic Resonance Unit, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
9grid.7468.d0000 0001 2248 7639MindBrainBody Institute, Berlin School of Mind and Brain, Berlin, Germany
10grid.9647.c0000 0004 7669 9786Clinic of Cognitive Neurology, Leipzig University, Leipzig, Germany
11grid.6363.00000 0001 2218 4662Charité University Medicine Berlin, Berlin, Germany