RESEARCH REPORT

Association of low blood pressure with anxiety and depression: the Nord-Trøndelag Health Study

Bjørn Hildrum¹, Arnstein Mykletun², Eystein Stordal¹, Ingvar Bjelland³, Alv A Dahl⁴, Jostein Holmen⁵

¹ Department of Psychiatry, Hospital Namsos, Norwegian University of Science and Technology, Namsos, Norway
² Research Centre for Health Promotion, University of Bergen, Bergen, Norway
³ Department of Child and Adolescent Mental Health, Haukeland University Hospital, Bergen, Norway
⁴ Department of Clinical Cancer Research, Rikshospitalet-Radiumhospitalet Trust, University of Oslo, Oslo, Norway
⁵ HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Verdal, Norway

Correspondence to:
Correspondence to:
B Hildrum
Department of Psychiatry, Hospital Namsos, Norwegian University of Science and Technology, N-7800 Namsos, Norway;bjorn.hildrum{at}hnt.no

Background: Low blood pressure has mainly been regarded as ideal, but recent studies have indicated an association with depression in elderly people.

Objective: To investigate whether low blood pressure is associated with anxiety and depression in the general population.

Design: Cross-sectional study.

Setting: Participants in the population-based Nord-Trøndelag Health Study (HUNT-2, 1995–7), Norway.

Participants: 60 799 men and women aged 20–89 years filled in the Hospital Anxiety and Depression Scale as part of a general health study. Systolic and diastolic blood pressure was classified in age-stratified and sex-stratified centile groups.

Main results: Compared with participants with systolic blood pressure within the 41–60 centile (reference) group, the odds ratio for anxiety was 1.31 (95% confidence intervals (CI) 1.16 to 1.49), for depression 1.22 (95% CI 1.03 to 1.46), and for comorbid anxiety and depression 1.44 (95% CI 1.24 to 1.68) in the group with 5 centile systolic blood pressure. Slightly weaker associations were found of low diastolic blood pressure with anxiety and depression. These associations were similar across sex and age groups. Physical impairment, smoking and angina pectoris influenced the associations only marginally, whereas stroke, myocardial infarction, use of drugs for hypertension, body mass index and several other covariates had no influence.

Conclusions: This study represents epidemiological evidence for an association of low blood pressure with anxiety and depression, which is not caused by cardiovascular disease.

Abbreviations: DSM, Diagnostc and Statistical Manual of Mental Disorders; GAM, generalised additive model; HADS, Hospital Anxiety and Depression Scale; HUNT Study, Nord-Trøndelag Health Study

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