Hypertension Centre - Hospital Universitario Austral, Pilar, Argentina
Systemic hypertension and depression are currently considered risk factors for cardio-cerebral-vascular disease and particularly for stroke. The mechanisms how depression increases the risk of stroke have not been fully elucidated. It is also well known that elevated pulse wave velocity (PWV) as evidence of arterial stiffness and target organ damage (TOD) increases risk of cerebral events. Furthermore, autonomic disbalance has been related as a physiopatological mechanism in depression and cardiovascular disease. Based on this unexplored issue, we explored the hyphotesis that the association between hypertension and depression is related to greater PWV increase, and that autonomic disbalance could be one of the pathways involved.
Objective: To evaluate PWV and the autonomic balance in young hipertensive patients with depression.
Methods: We studied 34 consecutive hypertensive patients (39 ± 9,1 years; 68 % men) admitted for TOD assessment. All patients completed voluntarily a sheet with two questions validated for depression screening and validated scales (CES-D/Hamilton) to obtain a severity score of depression. Arterial stiffness was determined by non-invasive PWV measurement and autonomic response by heart rate variability, previously described by others, during stress test recovery period.
Results: This population was analyzed in a 2:1 ratio, classified as depressive (n:11) when at least one question was positive, and non-depressive (n:23) when both were negative. Results were analyzed with chi2 and T-test. There were no significative differences in baseline characteristics. Depressive patients showed a significative higher PWV (11 ± 2,1 vs 9,2 ± 1,6 m/s; p = 0.025). There was also found a difference in stress test recovery period, showing a faster recovery in the same group (p = 0.006).
Conclusions: An association between an increased arterial stiffness, autonomic disbalance and depression was found in the young hypertensive population we evaluated. Further studies would be necessary to identify their contribution to the increased risk of stroke previously reported (MRFIT/WHI). Autonomic disbalance could be a probable physiopathological pathway while arterial stiffness would be a marker of its early atherosclerotic impact.