OBJECTIVES: Presence of comorbid depression in patients with hypertension is associated with adverse healthcare consequences including increased mortality, morbidity, and disability. Given the change in the guidelines for hypertension diagnosis by ACC in 2017, it's imperative to study its impact on the prevalence of depression in this population. Hence, the primary objective of this research study was to evaluate the change in the prevalence of depression among hypertensive (DAH) between the JNC 7 and the 2017 ACC/AHA guidelines using NHANES data.

METHODS: A cohort study was conducted using NHANES data from 2008-2016. The PHQ-9 questionnaire in NHANES was used to measure depression. JNC 7 and ACC/AHA 2017 guidelines were used to define hypertension. Descriptive statistics and survey linear regressions were used to analyze prevalence of DAH using the different guidelines controlling for race and sex. Predictors of depression were analyzed using survey logistic regression models.

RESULTS: Preliminary analysis shows that the overall unadjusted prevalence of DAH was 62.8%. The unadjusted prevalence of DAH was found to be 64% using the JNC 7 guideline and 62% using the 2017 ACC/AHA guideline. Further analysis and adjusting for age, race/ethnicity and sex shows that the prevalence of DAH is significantly lower in the 2017 ACC/AHA guideline compared to the JNC 7 guideline by nearly 2.15%. There was also a decrease in the unadjusted and adjusted prevalence of DAH after applying the guidelines among all race/ethnicities and by sex, with the use of older guideline resulting in a greater prevalence of depression.

CONCLUSIONS: With the change in the guidelines for measurement and diagnosis of hypertension, there was significant decrease in the prevalence of DAH. The distribution of the prevalence of DAH between hypertension categories also changed with the current guidelines. Further research into effective screening and management for depression, and future longitudinal follow-up of this population is needed.