Unraveling the Combined Influence of Hypertension and Common Mental Disorders on All-Cause and Cardiovascular Disease Mortality

Abstract

Background: Cardiovascular disease (CVD) and mental health disorders constitute significant global health challenges, with their interplay presenting a complex and often understudied intersection. Hypertension, a prevalent cardiovascular risk factor, has been associated with adverse outcomes, including CVD mortality.

Objective: This study aimed to investigate the association between hypertensive status, common mental disorder, and the risk of cardiovascular disease (CVD) mortality. Additionally, the study examined the impact of the co-occurrence of hypertension and common mental disorder on CVD mortality risk.

Methodology: A total of 150 participants were recruited from general clinics in Karachi, Pakistan. Blood pressure (BP) measurements were obtained using an electronic BP monitor during a check-up visit. Hypertension was defined according to established criteria. Information on physician-diagnosed CVD, other medical conditions, antihypertensive medication, and demographic factors was collected. Mental health was assessed using the General Health Questionnaire (GHQ-12). Participants were followed up for mortality, with cause of death determined through death certificates and additional information provided by certifying doctors. Cox proportional hazards models were utilized to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for various covariates.

Results: Of the initial sample, 150 participants (mean age: 52.5 ± 12.5 years; 45.7% men) were included in the final analysis. The prevalence of common mental disorder varied across hypertensive status categories. The risk of CVD death was higher in participants with controlled hypertension (HR: 1.63, 95% CI: 1.26-2.12), uncontrolled hypertension (HR: 1.57, 95% CI: 1.08-2.27), and undiagnosed hypertension (HR: 1.37, 95% CI: 0.98-1.91) compared to normotensive participants. Similar associations were observed for all-cause mortality. Common mental disorder was associated with an increased risk of CVD death (HR: 1.60, 95% CI: 1.35-1.90) and all-cause mortality. Participants with both hypertension and common mental disorder had the highest risk of CVD mortality, particularly those with controlled (HR: 2.32, 95% CI: 1.70-3.17) and uncontrolled hypertension (HR: 1.90, 95% CI: 1.18-3.05).

Conclusion: This study highlights the elevated risk of CVD mortality associated with hypertension and common mental disorder. Individuals with controlled and uncontrolled hypertension, as well as those with undiagnosed hypertension, were at increased risk compared to normotensive individuals. The coexistence of hypertension and common mental disorder further amplified the risk of CVD mortality. These findings underscore the importance of integrating mental health screening and management into hypertension care to improve cardiovascular outcomes.