Prevalence of Depression among Patients with Hypertension and Its Association with Cardiovascular Risk Factors: A Multicenter Cross-Sectional Study

Abstract

Objective: To determine the prevalence of depressive symptoms among patients with hypertension and examine their association with cardiovascular risk factors in tertiary-care hospitals across Punjab, Pakistan.

Methods: This multicenter cross-sectional study included 410 adults with hypertension who attended three tertiary-care hospitals between January 2024 and June 2025 in Punjab, Pakistan. Participants were enrolled consecutively. Depressive symptoms were assessed using the nine-item Patient Health Questionnaire, with a score of ≥10 indicating clinically relevant symptoms. Sociodemographic characteristics, hypertension duration, medication adherence, smoking, physical activity, body mass index, blood pressure, diabetes mellitus and dyslipidaemia were recorded. Independent factors associated with depression were identified using multivariable logistic regression.

Results: The mean age was 56.2±10.8 years, and 224 (54.6%) participants were women. Clinically relevant depressive symptoms were present in 159 patients, giving a prevalence of 38.8% (95% CI: 34.1–43.7%). Depression was more frequent among women and among patients with uncontrolled blood pressure, diabetes, obesity, physical inactivity and poor medication adherence. Female sex (AOR=1.78), uncontrolled hypertension (AOR=2.06), diabetes (AOR=1.69), obesity (AOR=1.74), physical inactivity (AOR=1.81) and poor medication adherence (AOR=2.28) remained independently associated with depression.

Conclusion: More than one-third of patients receiving treatment for hypertension experienced clinically relevant depressive symptoms. Integrating brief depression screening and appropriate referral into routine hypertension care may help identify vulnerable patients and improve both psychological and cardiovascular care.