Between Depression and Risk of Hypertension: A Systematic Review and Meta-Analysis

Abstract

Background

Hypertension and depression are major global health concerns, with increasing evidence suggesting a potential bidirectional relationship between the two conditions. While previous studies have explored this association, the findings remain inconsistent, necessitating a comprehensive evaluation. This systematic review and meta-analysis aimed to assess the association between depression and the risk of developing hypertension by synthesizing evidence from observational studies.

Methods

A systematic search of PubMed, Embase, and Web of Science databases was conducted up to December 20, 2024. Observational studies that examined depression as an exposure and hypertension as an outcome were included. Random-effects meta-analysis was performed to estimate pooled odds ratios (ORs) and hazard ratios (HRs). Subgroup and sensitivity analyses were conducted to explore heterogeneity and assess the robustness of findings. Publication bias was evaluated using Egger test and funnel plots.

Results

A total of 36 studies were included, comprising cross-sectional, cohort, and case-control designs. The pooled analysis indicated a significant positive association between depression and hypertension (pooled OR = 1.198, 95% CI: 1.086–1.321), with substantial heterogeneity (I² = 68%, p < 0.001). Longitudinal studies yielded a pooled HR of 1.277 (95% CI: 1.159–1.408) with no significant heterogeneity (I² = 0%). Subgroup analyses revealed stronger associations in cross-sectional studies compared to cohort studies. Sensitivity analyses confirmed the robustness of findings, while publication bias was detected.

Conclusion

This study provides evidence supporting a positive association between depression and an increased risk of hypertension. The findings underscore the importance of integrating mental health screening in cardiovascular care and adopting multidisciplinary strategies to address both conditions. Further research is needed to clarify causal pathways and explore targeted interventions.