Gender Differences in Associations of Diurnal Blood Pressure Variation, Awake Physical Activity, and Sleep Quality With Negative Affect

Abstract

Abstract-This study reports on the associations among depression, anxiety, awake physical activity, sleep quality (assessed by nocturnal physical activity), and diurnal blood pressure (BP) variation in a nonpsychiatric sample (The Work Site Blood Pressure Study). We conducted ambulatory BP (ABP) monitoring and actigraphy in 231 working men and women. Depression and anxiety were measured by the Brief Symptom Inventory. There were gender-specific associations between depression or anxiety and ABP parameters. In men, depression was associated positively with the sleep/awake systolic BP (SBP) ratio (rϭ0.24, Pϭ0.006). After controlling for age, body mass index, and awake and sleep activity, depression remained significantly associated with the sleep/awake SBP ratio (rϭ0.25, Pϭ0.005) and was also significantly related to sleep SBP (rϭ0.21, Pϭ0.02). Anxiety, which was related to depression (rϭ0.73, PϽ0.0001), had a similar but slightly weaker pattern of associations with ABP and activity. These associations were not found in women, but there were associations of anxiety with awake SBP (rϭ0.24, Pϭ0.01) and pulse rate (rϭ0.27, Pϭ0.006). In conclusion, depression is associated with disrupted diurnal BP variation independent of ambulatory physical activity in working men, whereas anxiety is associated with awake SBP and pulse rate in women. here is growing evidence that depression is one of the most important psychological predictors of cardiovascular disease. 1 Depression and depressive symptoms are exceedingly common in the general population. 2 A large epidemiological study of Ͼ18 500 persons reported the lifetime prevalence rate of subthreshold depressive symptoms to be 23%. 3 Recent clinical studies have shown that depression and related conditions, such as anxiety, even at subthreshold levels, are independent predictors of hypertension and cardiovascular events (both coronary heart disease and stroke). 1,[3][4][5][6][7][8] In addition to activating the neuroendocrine system (sympathetic activity and hypothalamus-pituitaryadrenal [HPA] axis), major depression has also been reported to disrupt the diurnal rhythm of these neuroendocrine factors, which, in turn, are closely associated with blood pressure (BP). 2,6 There are clear gender differences in the prevalence of depression and related disorders. 9 Depressive symptoms and major depression are more common in women. 9 On the other hand, cardiovascular events and hypertension are less frequent in women, particularly before menopause. 10 Thus, the impact of depression on the cardiovascular system may be different between women and men.Ambulatory BP (ABP) monitoring (ABPM) performed in healthy subjects has shown that BP levels typically decrease during sleep, by 10% to 20% of the mean awake BP. 11 Several studies have recently found that an abnormal diurnal BP variation, characterized by diminished nocturnal BP dipping, is associated with silent and clinical cardiovascular disease. [12][13][14][15][16][17] This diminished nocturnal BP dipping is hypothesized to be cause...

Impact of outdoor temperature on prewaking morning surge and nocturnal decline in blood pressure in a Japanese population

“…This finding may reflect higher levels of awake BP on the cold day than that measured on the warm day. Previous studies showed that the level of physical activity, 21 sleep activity 22 and psychological factors 23 are known to affect the magnitude of nocturnal decline in BP. Outdoor temperature may also be a determining factor in the magnitude of nocturnal decline in BP.…”

Depression Predicts Increased Incidence of Adverse Health Outcomes in Older Mexican Americans With Type 2 Diabetes

“…The increased risk of negative diabetic outcomes may also be the result of biologic changes that occur as a result of depression, including neurohormonal or neurotransmitter abnormalities (25), or lowered immune functioning, or inhibited cortisol release, which in turn increase vulnerability to diabetes (26,27). It may also be possible that both depression and diabetes share common pathogenesis, such as actions of the autonomic or sympathetic nervous systems (28,29), polymorphism of genes associated with obesity, insulin resistance, and sensitivity to stress (30), reduction of glucose use and increased insulin resistance (31), common neuroendocrine pathways (32), or the disruption of the hypothalamicpituitary-adrenal axis (33). The link between depression and diabetes may also be the direct or indirect result of risk factors common to both conditions, such as obesity, inactivity, medication use, and other preexisting psychological and physical conditions (34).…”

Anxiety Disorder Is Associated With Nocturnal and Early Morning Hypertension With or Without Morning Surge

“…First, we investigated a relatively small number of patients. It has been reported that sex differences are associated with effects on BP, 43 but investigation of sex differences was not done in this study. Future studies with larger numbers of patients are needed.…”