Changes in depressive symptoms over 12 months in hypertensive African Americans cared for in a primary care based setting

INTRODUCTION: Depression is a chronic condition that has been associated with hypertension. Prospective studies are needed to clarify the association between these two chronic diseases. Depression is characterized by the dynamic nature of depressive symptoms. An important limitation of available prospective studies studying the association between depression and hypertension is the assessment of depressive symptoms using a cross-sectional design.;MANUSCRIPT I -- Changes in Depressive Symptoms Over 12 Months In Hypertensive African Americans Cared For In A Primary Care Based Setting..;Background. In cohort studies that have evaluated the association between depression and hypertension, depressive symptoms are typically assessed at only one time-point. The purpose of this analysis was to create a profile of the 12-month course of depressive symptoms, using the Patient Health Questionnaire Depression Module (PHQ-9), in 661 hypertensive African Americans followed in community health centers (CHCs).;Methods. This secondary analysis was performed using data from a clinical trial that evaluated the effect of a multi-level intervention versus usual care, on blood pressure (BP) control among hypertensive African Americans who receive care in CHCs in the New York Metropolitan area. Patients completed the PHQ-9 at 2 weeks and 12 months post-baseline. Patients with PHQ-9 score ≥ 10 were categorized as depressed.;Results. Analysis was conducted on a total of 661 patients who had complete data at the 2 weeks and 12 month visits. Their mean age was 57.6 +/- 11.9 years; majority earned < ;Discussion. Findings from this study reflect the dynamic nature of depressive symptoms in hypertensive African Americans over time. This important characteristic of depressive symptoms should be reflected in longitudinal studies in order to more accurately describe the association between depressive status and hypertension.;MANUSCRIPT II - Resistant Hypertension and Sleep Apnea: Pathophysiologic Insights and Strategic Management..;Background. Resistant hypertension is common among adults with hypertension affecting up to 30% of patients. The treatment of resistant hypertension is important because suboptimal blood pressure control is the leading preventable cause of death worldwide. A frequent comorbid condition in patients with resistant hypertension is obstructive sleep apnea (OSA). The pathophysiology of sleep apnea associated hypertension is characterized by sustained adrenergic activation and volume retention often posing treatment challenges in patients with resistant hypertension. This review will address some of the epidemiological data associating apnea with the pathogenesis of resistant hypertension. Diagnosis and management of apnea and its associated hypertension will also be considered.;Methodology. We conducted a systematic review of the literature including online databases, clinical guidelines, and current textbooks.;Results. Sleep apnea has been demonstrated in prospective and cross-sectional studies to be related to development of hypertension. The prevalence of sleep apnea in patients with resistant hypertension is high often making the management of hypertension in this population difficult. Pathophysiology of sleep apnea induced hypertension is dominated by an adrenergic drive that results in multi-system maladaptive processes and is characterized by volume retention and primary hyperaldosteronism.;Discussion. Diuretic use is essential and use of an aldosterone antagonistic diuretic should be considered as an adjunct. The therapeutic efficacy of CPAP is variable, but appears especially beneficial when used properly and in appropriate populations.;OVERALL CONCLUSIONS: This thesis stresses that our measurement of depressive symptoms must be designed to reflect the dynamic nature of symptoms. The current method of assessing depressive symptoms in prospective studies focused on hypertension is frequently limited by its cross-sectional design. We also need to screen for obstructive sleep apnea when evaluating a patient with resistant hypertension. Treatment of obstructive sleep apnea may be reflected in the improvement of hypertension. Future studies should investigate whether sleep apnea may be a common factor in hypertensive patients with depression.