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@ARTICLE{Schaare:911397,
      author       = {Schaare, H. Lina and Blöchl, Maria and Kumral, Deniz and
                      Uhlig, Marie and Lemcke, Lorenz and Valk, Sofie L. and
                      Villringer, Arno},
      title        = {{M}ental health, blood pressure and the development of
                      hypertension},
      reportid     = {FZJ-2022-04680},
      year         = {2022},
      abstract     = {Hypertension (HTN) has been associated with a greater risk
                      of affective disorders. Paradoxically, several studies have
                      shown the opposite effect in which high blood pressure
                      relates to less depressive symptoms and greater well-being.
                      Here we dissolve this paradox and clarify the relationship
                      between mental health, blood pressure and the development of
                      HTN using the UK Biobank. In adjusted multiple linear
                      regression models, we found that the presence of a HTN
                      diagnosis was associated with impaired mental health (i.e.
                      more depressive symptoms (N = 303,771; β = 0.043; $95\%$ CI
                      [0.039, 0.047]; p<0.001) and lower well-being scores (N =
                      129,876; β = -0.057; $95\%$ CI [-0.064, - 0.050]; p<0.001))
                      at baseline, whereas higher systolic blood pressure (SBP)
                      was associated with fewer depressive symptoms (N = 303,771;
                      β = -0.063; $95\%$ CI [-0.067, -0.060]; p<0.001) and higher
                      well-being scores (N = 129,876; β = 0.057; $95\%$ CI
                      [0.051, 0.063]; p<0.001). These effects persisted until
                      follow-up (∼10 years later). To explore a potential link
                      between the mental health-blood pressure association and the
                      development of HTN, we compared participants who were
                      normotensive at baseline and developed HTN until follow-up
                      with those who stayed normotensive. Notably, the adjusted
                      model showed impaired mental health already at baseline in
                      HTN developers (i.e., before HTN diagnosis; depressive
                      symptoms: β = 0.060; $95\%$ CI [0.045, 0.076]; p<0.001;
                      well-being: β = -0.043; $95\%$ CI [-0.068, -0.017];
                      p<0.001), indicating that people who develop HTN might
                      require higher blood pressure levels for the same mental
                      health outcomes as normotensives. In addition, the negative
                      association between SBP and depressive symptoms at baseline
                      was moderated by HTN development (β = -0.014; $95\%$ CI
                      [-0.026, -0.003]; p=0.015), suggesting that the negative
                      relationship between mental health and blood pressure was
                      accentuated in people developing HTN several years before
                      receiving their HTN diagnosis. We further observed that
                      higher SBP was associated with lower emotion-related brain
                      activity from functional magnetic resonance imaging (fMRI;
                      β = -0.032 $95\%$ CI [-0.045, -0.019]; p<0.001). This
                      effect was also moderated by HTN diagnosis, suggesting an
                      impact of SBP and HTN on the central nervous processing of
                      emotions. Possible mechanisms are discussed, including
                      regulatory baroreceptor circuits linking arterial blood
                      pressure to neural processing of emotions. Overall, our
                      results show an interrelation between mental health and
                      blood pressure that may be involved in the development of
                      HTN. In people who develop HTN, this relationship seems to
                      be altered, such that higher blood pressure is required to
                      sustain mental health, potentially offering a novel
                      perspective for developing preventive and therapeutic
                      measures.},
      cin          = {INM-7},
      cid          = {I:(DE-Juel1)INM-7-20090406},
      pnm          = {5251 - Multilevel Brain Organization and Variability
                      (POF4-525)},
      pid          = {G:(DE-HGF)POF4-5251},
      typ          = {PUB:(DE-HGF)25},
      doi          = {10.1101/2022.11.04.22281936},
      url          = {https://juser.fz-juelich.de/record/911397},
}