IJCS | Volume 32, Nº4, July/August 2019

356 Araújo et al. Depression and hypertension in elders Int J Cardiovasc Sci. 2019;32(4):355-361 Original Article Hypertension is recognized as a multifactorial clinical condition, with lifestyle- related factors, such as smoking, high sodium intake, sedentary lifestyle, among others, widely associated with this condition. However, recent studies have pointed to a close relationship between hypertension and depression, 4 which becomes evenmore worrying when considering the elderly people, due to the known association between depression and aging. 5 Depressive disorder is common among the elderly; it is a multi-causal condition, whose etiology may vary from depressive disorders, observed in young adults, to those associated with chronic age-related processes (cardiovascular, inflammatory, endocrine, autoimmune processes), continuous use of some medications, psychological adversity, and cognitive deficits. 6 Approximately 10% of individuals over 60 years old require therapeutic intervention for depressive disorder, and the prevalence of depressionmay be greater than 40% among elders living in geriatric institutions. 7 Changes in autonomic nervous system control, characterized by worse vagal control and increased heart rate, are observed in depressive subjects and are pointed out as factors that may explain the predisposition to hypertension. 8 In addition, it is known that, among elders, the association between depression and hypertension seems to be influenced by obesity. 9 The study by Long et al., 9 raises an important perspective in the understanding of the relationship between depression and hypertension among elders. In fact, Meng al., 10 had already reported that variables such as gender, race, smoking, physical activity level, obesity / body mass index (BMI), DM and other psychological factors are potentially confounding variables in the relationship between depression and hypertension. In this context, the present study aimed to analyze the association between depression and hypertension in community-dwelling elders, as well as to analyze the influence of confounding variables that are potentially capable to influence this association. Material and methods Sample All community-dwelling old adults (≥ 60 years old) from Aiquara, Bahia, Brazil were invited to take part in this survey study. Two hundred eighty-nine subjects were screened, all of them answered an extensive health questionnaire, and were submitted to clinical and physical examinations. Bedridden individuals and/or those with severe cognitive impairment (n=20) were excluded. Cognitive status was assessed using the translated and validated version of theMini-Mental State Examination (MMSE). 11 The cutoff points for cognitive impairment was set as: 13 points for no schooling, 18 points for schooling from 1 to 11 years, and 26 points for more than 11 years of schooling. 11 Additionally, 38 elders had technical problems during data recording, which limited their inclusion in the analysis. Data were collected between January and July 2015. Ethical aspects The individuals included in this study were informed about all the procedures and provided written informed consent to participate. This study was approved by the ethics committee of the institution (CAAE: 10786212.3.0000.0055) and abides by the CONEP resolution 466/2012. Definition of hypertension and depression The stratification of hypertensive and normotensive elderly subjectswas based on previous diagnosis reported by the elders, while the stratification of depressive and non-depressive elders was based on the Geriatric Depression Scale (GDS), which was validated to the Brazilian population. 12 The cut-off score for depression was set as 6 positive items. 13 The most commonly used psychotropic medications among depressive elders were tricyclic and selective serotonin-reuptake-inhibitors, benzodiazepines and muscle-relaxation drugs. Adjustment variables The dichotomous variables sex (male or female), race (white or non-white), smoking habit (yes or not), physical activity level (sufficiently active or insufficiently active), and self-reported diagnostic of DM (yes or no), and the continuous variables age and body mass index (BMI, Kg/m 2 ) was used as adjustment variables. Physical activity level was obtained using the International Physical ActivityQuestionnaire (IPAQ) and the results were dichotomized according to the proposed cut-point of ≥ 150 min/week of moderate and vigorous activity (i.e., ≥ 150 min/wk, sufficiently active; < 150 min/week, insufficiently active). 14