Independent and joint associations of hypertension and depression with cardiovascular diseases and all-cause mortality: a population-based cohort study

Hypertension frequently co-exists with depression, leading to adverse health outcomes. This study aimed to examine the individual and joint effects of hypertension and depression on the risks of new-onset cardiovascular disease (CVD) and all-cause mortality among the middle-aged and older Chinese individuals. Data from the China Health and Retirement Longitudinal Study (CHARLS) during 2011-2020 were used. Participants were divided into four groups for comparison: hypertension alone, depression alone, both conditions, neither condition. Multivariate logistic regression models were established to compare the risks of all-cause mortality and CVD among the four groups. A total of 9178 participants without pre-existing CVD were included and followed for nine years. Compared with individuals with neither condition, the risk of all-cause mortality increased among individuals with hypertension alone (adjusted odds ratio [aOR]: 1.414, 95% confidence interval [CI]: 1.133-1.764), depression alone (aOR: 1.023, 95% CI: 0.795-1.317) and comorbid hypertension and depression (aOR: 1.524, 95% CI: 1.180-1.968). The aORs for CVD events in individuals with both conditions, hypertension alone, and depression only were 2.207 (95% CI: 1.885-2.584), 1.945 (95% CI: 1.702-2.222) and 1.572 (95% CI: 1.365-1.809), respectively. Furthermore, those with severe depressive symptoms were at higher risks of all-cause mortality and CVD, regardless of having hypertension. Hypertension with comorbid depression leads to higher risks of CVD and all-cause mortality than either condition alone. Screening and management of depression among individuals with hypertension are essential for the primary prevention of CVD and premature death.