Low blood pressure and risk of depression in the elderly

Paterniti, Sabrina; Verdier-Taillefer, M.-H.; Geneste, Catherine; Bisserbe, J.C.; Alpérovitch, Annick

doi:10.1192/bjp.176.5.464

Cited by 91 publications

(68 citation statements)

References 22 publications

(20 reference statements)

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“…30,[33][34][35] The findings suggest significant associations between hypotension and increased incidence of depression, 30,[36][37][38][39][40][41][42] anxiety, 38,39 unexplained tiredness, 30,33 and poor perception of well-being. 34 In addition to adverse mood changes, hypotension is also associated with cognitive dysfunction: compared to matched-normotensive controls, individuals with hypotension are reported to have slowed cognitive speed, 43 fewer word recall, 44 decreased accuracy of response, 31 limited attention, 44 and reduced memory and concentration capacity.…”

Section: Discussionmentioning

confidence: 90%

A retrospective chart review of heart rate and blood pressure abnormalities in veterans with spinal cord injury

Zhu

Galea

Livote

et al. 2013

The Journal of Spinal Cord Medicine

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Objective: Autonomic impairment may lead to increased prevalence of heart rate (HR) and blood pressure (BP) abnormalities in veterans with spinal cord injury (SCI). In addition, comorbid medical conditions and prescription medication use may influence these abnormalities, including bradycardia, and tachycardia, hypotension, hypertension as well as autonomic dysreflexia (AD), and orthostatic hypotension (OH). Design: A retrospective review of clinical and administrative datasets in veterans with SCI and compared the prevalence rates between clinical values and ICD-9 diagnostic codes in individuals with tetraplegia (T: C1-C8), high paraplegia (HP: T1-T6), and low paraplegia (LP: T7 and below). Results: The prevalence of clinical values indicative of a HR ≥ 80 beats per minute was higher in the HP compared to the LP and T groups. A systolic BP (SBP) ≤ 110 mmHg was more common in the T compared to the HP and LP groups, whereas the prevalence of a SBP ≥ 140 mmHg was increased in the LP compared to the HP and T groups. Diagnosis of hypertension was 39-60% whereas the diagnosis of hypotension was less than 1%. Diagnosis of AD and OH was highest in the T group, but remained below 10%, regardless of categorical lesion level. Antihypertensive medications were commonly prescribed (55%), and patients on these medications were less likely to have high BP. The odds ratio of higher SBP and DBP increased with age and body mass index (BMI). Conclusion: In veterans with SCI, the prevalence of HR and BP abnormalities varied depending on level of lesion, age, BMI, and prescription medication use.

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Section: Discussionmentioning

confidence: 90%

A retrospective chart review of heart rate and blood pressure abnormalities in veterans with spinal cord injury

Zhu

Galea

Livote

et al. 2013

The Journal of Spinal Cord Medicine

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“…Depression will be measured using the Center for Epidemiological Studies-Depression Scale (CES-D), an inventory shown to be valid and responsive to differences in physiological parameters [99]. The evidence of a relation of cholesterol to depression in published studies has been mixed and appears to be substantially less consistent than the relation of cholesterol to behavior, including suicide [23,100,101].…”

Section: Mood Personality Sleep and Quality Of Life Measuresmentioning

confidence: 99%

The UCSD Statin Study: a randomized controlled trial assessing the impact of statins on selected noncardiac outcomes

Golomb

Criqui

White

et al. 2004

Controlled Clinical Trials

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There has been persistent controversy regarding possible favorable or adverse effects of statins or of cholesterol reduction on cognition, mood and behavior (including aggressive or violent behavior), muscle function, and quality of life. The UCSD Statin Study seeks to ascertain the beneficial or adverse effects of statin cholesterol-lowering drugs on a set of noncardiac endpoints, including cognition, behavior, and serotonin biochemistry. The study will enroll 1000 subjects (minimum 20% female) of mixed ethnicity from San Diego. Subjects must be age 20 and older, postmenopausal if female, without known cardiovascular disease or diabetes, and with LDLcholesterol between 115 and 190 mg/dl. Subjects will be randomized to a double-blind, placebocontrolled trial with assignment 1/3, 1/3, 1/3 to placebo, simvastatin 20 mg, or pravastatin 40 mg (equipotent LDL-cholesterol-lowering doses for drug arms with simvastatin and pravastatin chosen to represent the extremes of the lipophilicity spectrum) for 6 months of treatment followed by 2 months postcessation follow-up. Primary outcomes are cognition (cognitive battery), irritability/aggression (behavior measure), and serotonin (gauged by whole blood serotonin), assessed as the difference between baseline and 6 months, judging combined statin groups vs. placebo. Secondary outcomes include mood (CES-D and Wakefield depression inventory), quality of life (SF-12V), sleep (Leeds sleep scale, modified), and secondary aggression measures (Conflict Tactics Scale; Overt Aggression Scale, Modified). Cardiovascular reactivity will be examined in a 10% subset. As additional secondary endpoints, primary and selected secondary outcomes will be assessed by statin assignment (lipophilic simvastatin vs. hydrophilic pravastatin). "Reversibility" of changes, if any, at 2 months postcessation will be determined. If effects (favorable or unfavorable) are identified, we will seek to ascertain whether there are baseline variables that predict who will be most susceptible to these favorable or adverse noncardiac effects (i.e., effect modification). NIH Public Access BackgroundStatins are important and widely prescribed drugs, with well-documented and incontrovertible cardiac benefits. However, controversy remains regarding the existence and impact of noncardiac effects, including central nervous system (CNS) effects. The University of California-San Diego (UCSD) Statin Study, a National Institutes of Health/ National Heart Lung and Blood Institute-funded double-blind, placebo-controlled study, seeks to address these issues through a complex battery of tests assessing noncardiac outcomes pertaining to cognition, behavior, quality of life, and biochemistry, among other endpoints. This paper provides the general methodology employed and addresses certain theoretical issues in study design.Statin cholesterol-lowering drugs (HMG-CoA reductase inhibitors) are the most prescribed drugs in the United States and the world and contributed substantially to prescription drug cost increases in 200...

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“…24 In the 1990s the British Medical Journal published a series of articles describing the association between low BP and mood disorders in the general population. 8,9,25,26 The findings indicate that individuals with chronic hypotension have significantly increased incidence of depression, 8,[27][28][29][30][31][32][33] anxiety, 28, 29 unexplained tiredness, 8,9 and poor perception of well-being compared to matched-normotensive controls. 25 More recently we conducted focus group sessions in individuals with SCI and clinical care providers and found that both patients and clinicians were able to ascribe adverse effects of persistent asymptomatic hypotension on health related quality of life in those with SCI.…”

Section: Discussionmentioning

confidence: 86%

Orthostatic responses to anticholinesterase inhibition in spinal cord injury

et al. 2015

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Acetylcholine (Ach) is the pre-synaptic neurotransmitter of the sympathetic nervous system. Increased pre-synaptic Ach may augment post-synaptic release of norepinephrine thereby increasing systemic blood pressure (BP). The primary objective of this investigation was to determine the hemodynamic effect of pyridostigmine bromide (PYRIDO: 60 mg), an Ach inhibitor (AchI), compared to no-drug (NO-D) during head-up tilt (HUT) in individuals with spinal cord injury (SCI). Secondarily we aimed to determine the effects of PYRIDO compared to NO-D on symptoms of orthostatic intolerance (OI) and adverse event reporting (AE). Ten individuals with SCI (C4-C7) were studied on 2 occasions: visit 1) NO-D and visit 2) PYRIDO. On each visit subjects underwent a progressive HUT maneuver to 15°, 25°, 35° for 5 minutes at each angle and 45 minutes at 45°. Supine and orthostatic heart rate (HR), systolic and diastolic BP (SBP & DBP) were monitored and symptoms of OI and AE recorded. Supine hemodynamics did not differ between the trials. The significant fall in SBP during the NO-D trial was diminished with PYRIDO and five subjects had an increased DBP during HUT with PYRIDO compared to the NO-D trial. Individuals that responded to PYRIDO with an increase in orthostatic BP had significantly lower resting HR than non-responders (p<0.01), which suggests increased levels of pre-synaptic Ach. Subjective symptoms of OI and AE reporting did not differ between the two trials. These preliminary data suggest that PYRIDO is safe and may be effective at ameliorating the orthostatic fall in BP in select individuals with SCI.

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Low blood pressure and risk of depression in the elderly

Abstract: In our study, low blood pressure was a risk factor for, but not a consequence of, high depressive symptomatology.

Cited by 91 publications

References 22 publications

A retrospective chart review of heart rate and blood pressure abnormalities in veterans with spinal cord injury

A retrospective chart review of heart rate and blood pressure abnormalities in veterans with spinal cord injury

The UCSD Statin Study: a randomized controlled trial assessing the impact of statins on selected noncardiac outcomes

Orthostatic responses to anticholinesterase inhibition in spinal cord injury

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