A study from The Johns Hopkins University
School of Nursing
concludes depression may sabotage efforts to control high
blood pressure in urban African-American men. The
researchers found no direct link between depression and
high blood pressure, but the depressed men were five times
more likely to abuse alcohol, leading to behaviors that
counteract efforts to control blood pressure.
The study results, published in Annals of
Behavioral Medicine in July, found that more than
one-fourth of 190 hypertensive black men from inner-city
Baltimore were at high risk for depression. The level of
depression correlated significantly with poor adherence to
high blood pressure treatment, according to Miyong Kim,
lead author and associate professor at the School of
Nursing. The results, she said, demonstrate a need for
interventions that address depression as an essential
component of care for hypertensive patients.
"People who are depressed are more likely to use
alcohol or drugs and less likely to take their medication
or follow a low-salt diet. This greatly impacts
hypertension and can lead to complications and even death,"
Kim said. "Better screening for depression among
hypertensive patients will lead to better treatment of both
conditions as well as an improved quality of life for the
The men in the study were between the ages of 30 and
56 and already enrolled in a Johns Hopkins clinical trial
of a blood pressure control program. The study revealed a
rate of depression among the men that was three times that
of the general population. Low income was found to be the
most significant factor predicting depression; more than
two-thirds of the participants reported an annual income of
less than $10,000.
"Many of the urban black men in this study face a
harsh environment and challenges in accessing health care,
and it's important to acknowledge that substance abuse may
be a way of self-medicating for the depression," Kim said.
"The results of our study warrant further investigation in
order to construct effective means of caring for this
group, but clearly the first step in treating hypertension
is to uncover any underlying depression early on."
The study was supported by grants from the National
Institutes of Health National Institute of Nursing
Research, the NIH-NCRR, OPD-GCRC and Merck & Co. Other
authors are Hae-Ra Han, Martha N. Hill, Linda Rose and Mary
Roary, all from the School of Nursing.