Affective impairment in chronic low blood pressure ☆ Stefan Duschek a, ⁎, Alexandra Hoffmann a , Gustavo A. Reyes del Paso b a UMIT - University of Health Sciences Medical Informatics and Technology, Institute of Psychology, Austria b University of Jaén, Department of Psychology, Spain abstract article info Article history: Received 5 August 2016 Received in revised form 21 November 2016 Accepted 10 December 2016 Available online xxxx Objective: Physical complaints such as faintness, dizziness, cold limbs and headaches have been well-established in chronic low blood pressure (hypotension). This study investigated the occurrence of adverse emotional states and the symptoms of depression in this condition. As autonomic dysregulation, particularly diminished sympa- thetic tone, is believed to be involved in the etiology of hypotension, the impact of different facets of autonomic cardiovascular control on mood and depressive symptoms was also explored. Methods: Forty individuals with chronic hypotension and forty normotensive control persons were presented with the Mood Scale and Beck Depression Inventory. Stroke volume, cardiac output, pre-ejection period, Heather index and aortic peak blood flow velocity were recorded under resting conditions as indices of beta-adrenergic inotropic drive. Respiratory sinus arrhythmia and baroreflex sensitivity were additionally obtained. Results: Hypotensive individuals scored markedly higher on both questionnaire scales than controls, indicating an adversely affected emotional state and more severe depressive symptoms. In the entire sample, cardiac out- put, Heather index, and aortic peak blood flow velocity correlated negatively with the questionnaire scores; ac- cording to regression analysis, the Heather index explained the largest proportion of test score variance. Conclusion: Although hypotension does not constitute a serious medical condition, the findings of an adverse af- fective state and increased burden with depressive symptoms corroborate the view that it can have a consider- able impact on wellbeing and quality of life. The correlations of the beta-adrenergic indices with the questionnaire scales indicate that cardiac sympathetic regulation plays a key role in the psychophysiological me- diation of hypotension-related mood impairment. © 2016 Elsevier Inc. All rights reserved. Keywords: Hypotension Blood pressure Mood Depression Autonomic control 1. Introduction Chronic hypotension is referred to as a persistent state of inappropri- ately low blood pressure independent of the occurrence of other patho- logical conditions [1]. The chronic form is distinguished from orthostatic hypotension (that is, circulatory problems when assuming an upright position) and symptomatic hypotension, which occurs, for example, due to blood loss or medication [2]. According to WHO [3] criteria, hypo- tension is diagnosed when systolic blood pressure falls below 100 mmHg in women and 110 mmHg in men. Chronically low blood pressure is relatively widespread; in the general population its preva- lence has been estimated at 2–3% with younger women being especially affected [4,5]. It is generally the case that in research, as well as in clinical practice, relatively little importance is ascribed to chronic hypotension [5]. In contrast to elevated blood pressure, which constitutes a major risk fac- tor for cardiovascular diseases, chronic hypotension is not regarded as a dangerous medical condition. However, low blood pressure is associat- ed with increased risk in pregnancy [6,7]; and longitudinal studies have revealed associations of hypotension with brain atrophy and cognitive decline in the elderly [8,9]. Typical complaints reported by affected indi- viduals include dizziness, cold limbs, fatigue, reduced drive and concen- tration difficulties [5]. Various studies comparing hypotensive individuals with those with blood pressure in the normotensive range confirmed the increased prevalence of the physical symptoms [10,11]. Furthermore, population-based studies of cases spanning the whole blood pressure spectrum revealed inverse relationships between blood pressure and symptoms like faintness, dizziness and poor appe- tite [12,13]. In the field of psychological symptoms ascribed to chronic hypoten- sion, various studies have confirmed the presence of deficits in attention and memory [14,15]. In contrast, abnormalities in affect-related features have received less attention thus far. In a study on quality of life, con- ducted in 50 years old men drawn from the general population, an in- verse association between systolic and diastolic blood pressure and mental wellbeing was observed [16]. In another study, blood pressure- Journal of Psychosomatic Research 93 (2017) 33–40 ☆ Place of study: Institute of Psychology, UMIT - University of Health Sciences Medical Informatics and Technology. ⁎ Corresponding author at: UMIT - University for Health Sciences, Medical Informatics and Technology, Institute of Psychology, Eduard Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria. E-mail address: stefan.duschek@umit.at (S. Duschek). http://dx.doi.org/10.1016/j.jpsychores.2016.12.008 0022-3999/© 2016 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Psychosomatic Research