Psychiatric correlates of blood pressure variability in the elderly: The Three City cohort study

Background: The modifiable factors associated with blood pressure variability (BPV) are still being established and their clinical relevance is poorly understood. Generalized anxiety disorder (GAD) and depression have been implicated with higher BPV in the short term (e.g. hours, days) however their effects on BPV over longer periods are unknown.

Methods: In a prospective cohort study, 1454 elderly participants (age 78.5 ± 3.78 years, 59% women) underwent structured interview for GAD and major depression. Participants performed home blood pressure monitoring (HBPM) over 3 consecutive days and underwent serial clinic BP measures on 4 separate follow-ups over an 8 year period. Systolic and diastolic BPV was calculated using the coefficient of variation (CV) and standard deviation method. Generalized linear models assessed the association between GAD and depression with BPV over an 8 year period.

Results: GAD was associated with significantly increased systolic BPV over 8 years in age, sex and mean systolic BP (β = 0.25, SE = 0.09; p = 0.007) and fully adjusted models (β = 0.23, SE = 0.10; p = 0.017). BPV from HBPM was strongly associated with 8 year systolic BPV in age-sex (β = 3.10, SE = 0.82; p < 0.001) and fully adjusted models (β = 3.09, SE = 0.84; p < 0.001). The association between GAD and longer term BPV was consistent when analyzing morning and evening HBPM measures of BPV. There was no association between diastolic BPV over 8 years with GAD or depression.

Conclusions: GAD but not depression was associated with increased systolic BPV over an 8 year period controlling for HBPM. GAD has clinical relevance for control of systolic BPV in elderly participants.