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Treatment and control of blood pressure in Welsh patients with and without depression: A study of whole-population electronic health records

Libby Ellins Orcid Logo, Richard Summers, Carla White, Ann John Orcid Logo, David P.J. Osborn, Keith Lloyd Orcid Logo, Ashley Akbari Orcid Logo, Michael Gravenor Orcid Logo, Julian Halcox Orcid Logo

PLOS One, Volume: 20, Issue: 6, Start page: e0326583

Swansea University Authors: Libby Ellins Orcid Logo, Richard Summers, Carla White, Ann John Orcid Logo, Keith Lloyd Orcid Logo, Ashley Akbari Orcid Logo, Michael Gravenor Orcid Logo, Julian Halcox Orcid Logo

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DOI (Published version): 10.1371/journal.pone.0326583

Abstract

Background: To explore differences in blood pressure treatment and control in patients with and without depression and a diagnosis of hypertension (HTN). Also to examine the possible impact of sex, socio-economic status (deprivation) and location of residence on any differences. Methods: A retrospec...

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ISSN: 1932-6203
Published: Public Library of Science (PLoS) 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa69825
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Also to examine the possible impact of sex, socio-economic status (deprivation) and location of residence on any differences. Methods: A retrospective observational cohort study (2010&#x2013;2019) using individual level linked anonymised routinely-collected electronic health record (EHR) data sources was carried out. Patients with a prior or new diagnosis of hypertension, with and without depression were included. Outcome variables were prescription of antihypertensive therapy (AHT) within one year of entering the study for prior HTN or post for new HTN and documentation of blood pressure &lt;140/90 mmHg. Logistic regression was used to explore the association between depression and outcome variables adjusting for sex, age group, deprivation, location of residence and other risk factors. Results: Depression was associated with higher likelihood of AHT prescription in both prior (OR 1.71 95%CI 1.64&#x2013;1.78 p &lt; 0.001) and new HTN patients (OR 2.67 95%CI 2.38&#x2013;3.00 p &lt; 0.001). Similarly, depression was associated with successful blood pressure control in both prior (OR 1.42 95%CI 1.37&#x2013;1.46 p &lt; 0.001) and new HTN (OR 1.23 95%CI 1.08&#x2013;1.40 p &lt; 0.001). Females were less likely to be prescribed AHT than males, mainly driven by non-depressed females in both HTN groups. Depressed females were the most likely to have controlled blood pressure in both HTN groups. Conclusion: Patients with depression are more likely to be prescribed AHT and have documented blood pressure control. Sex differences existed in treatment and control, indicating opportunities for potential improvements in these areas.</abstract><type>Journal Article</type><journal>PLOS One</journal><volume>20</volume><journalNumber>6</journalNumber><paginationStart>e0326583</paginationStart><paginationEnd/><publisher>Public Library of Science (PLoS)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1932-6203</issnElectronic><keywords/><publishedDay>25</publishedDay><publishedMonth>6</publishedMonth><publishedYear>2025</publishedYear><publishedDate>2025-06-25</publishedDate><doi>10.1371/journal.pone.0326583</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>SU Library paid the OA fee (TA Institutional Deal)</apcterm><funders>British Heart Foundation project grant PG/21/10631</funders><projectreference/><lastEdited>2025-07-10T09:58:39.5164861</lastEdited><Created>2025-06-26T14:47:12.7914545</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Libby</firstname><surname>Ellins</surname><orcid>0000-0001-5164-6416</orcid><order>1</order></author><author><firstname>Richard</firstname><surname>Summers</surname><order>2</order></author><author><firstname>Carla</firstname><surname>White</surname><order>3</order></author><author><firstname>Ann</firstname><surname>John</surname><orcid>0000-0002-5657-6995</orcid><order>4</order></author><author><firstname>David P.J.</firstname><surname>Osborn</surname><order>5</order></author><author><firstname>Keith</firstname><surname>Lloyd</surname><orcid>0000-0002-1440-4124</orcid><order>6</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>7</order></author><author><firstname>Michael</firstname><surname>Gravenor</surname><orcid>0000-0003-0710-0947</orcid><order>8</order></author><author><firstname>Julian</firstname><surname>Halcox</surname><orcid>0000-0001-6926-2947</orcid><order>9</order></author></authors><documents><document><filename>69825__34596__eb7b47f923d546feb7dc6c8a5023e10a.pdf</filename><originalFilename>pone.0326583.pdf</originalFilename><uploaded>2025-06-26T14:47:12.7910554</uploaded><type>Output</type><contentLength>644998</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2025 Ellins et al. 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spelling 2025-07-10T09:58:39.5164861 v2 69825 2025-06-26 Treatment and control of blood pressure in Welsh patients with and without depression: A study of whole-population electronic health records 553ce2abe05a6396e7dd6eadb6b90a6d 0000-0001-5164-6416 Libby Ellins Libby Ellins true false 7159dc658c1697cfda7c760a5d494d86 Richard Summers Richard Summers true false 10ad33360d095c9ac6bb4889fd086213 Carla White Carla White true false ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false a13aaa0df9045c205e82ed3b95d18c10 0000-0002-1440-4124 Keith Lloyd Keith Lloyd true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 70a544476ce62ba78502ce463c2500d6 0000-0003-0710-0947 Michael Gravenor Michael Gravenor true false 3676f695eeda169d0f8c618adf27c04b 0000-0001-6926-2947 Julian Halcox Julian Halcox true false 2025-06-26 MEDS Background: To explore differences in blood pressure treatment and control in patients with and without depression and a diagnosis of hypertension (HTN). Also to examine the possible impact of sex, socio-economic status (deprivation) and location of residence on any differences. Methods: A retrospective observational cohort study (2010–2019) using individual level linked anonymised routinely-collected electronic health record (EHR) data sources was carried out. Patients with a prior or new diagnosis of hypertension, with and without depression were included. Outcome variables were prescription of antihypertensive therapy (AHT) within one year of entering the study for prior HTN or post for new HTN and documentation of blood pressure <140/90 mmHg. Logistic regression was used to explore the association between depression and outcome variables adjusting for sex, age group, deprivation, location of residence and other risk factors. Results: Depression was associated with higher likelihood of AHT prescription in both prior (OR 1.71 95%CI 1.64–1.78 p < 0.001) and new HTN patients (OR 2.67 95%CI 2.38–3.00 p < 0.001). Similarly, depression was associated with successful blood pressure control in both prior (OR 1.42 95%CI 1.37–1.46 p < 0.001) and new HTN (OR 1.23 95%CI 1.08–1.40 p < 0.001). Females were less likely to be prescribed AHT than males, mainly driven by non-depressed females in both HTN groups. Depressed females were the most likely to have controlled blood pressure in both HTN groups. Conclusion: Patients with depression are more likely to be prescribed AHT and have documented blood pressure control. Sex differences existed in treatment and control, indicating opportunities for potential improvements in these areas. Journal Article PLOS One 20 6 e0326583 Public Library of Science (PLoS) 1932-6203 25 6 2025 2025-06-25 10.1371/journal.pone.0326583 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University SU Library paid the OA fee (TA Institutional Deal) British Heart Foundation project grant PG/21/10631 2025-07-10T09:58:39.5164861 2025-06-26T14:47:12.7914545 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Libby Ellins 0000-0001-5164-6416 1 Richard Summers 2 Carla White 3 Ann John 0000-0002-5657-6995 4 David P.J. Osborn 5 Keith Lloyd 0000-0002-1440-4124 6 Ashley Akbari 0000-0003-0814-0801 7 Michael Gravenor 0000-0003-0710-0947 8 Julian Halcox 0000-0001-6926-2947 9 69825__34596__eb7b47f923d546feb7dc6c8a5023e10a.pdf pone.0326583.pdf 2025-06-26T14:47:12.7910554 Output 644998 application/pdf Version of Record true © 2025 Ellins et al. This is an open access article distributed under the terms of the Creative Commons Attribution License. true eng http://creativecommons.org/licenses/by/4.0/
title Treatment and control of blood pressure in Welsh patients with and without depression: A study of whole-population electronic health records
spellingShingle Treatment and control of blood pressure in Welsh patients with and without depression: A study of whole-population electronic health records
Libby Ellins
Richard Summers
Carla White
Ann John
Keith Lloyd
Ashley Akbari
Michael Gravenor
Julian Halcox
title_short Treatment and control of blood pressure in Welsh patients with and without depression: A study of whole-population electronic health records
title_full Treatment and control of blood pressure in Welsh patients with and without depression: A study of whole-population electronic health records
title_fullStr Treatment and control of blood pressure in Welsh patients with and without depression: A study of whole-population electronic health records
title_full_unstemmed Treatment and control of blood pressure in Welsh patients with and without depression: A study of whole-population electronic health records
title_sort Treatment and control of blood pressure in Welsh patients with and without depression: A study of whole-population electronic health records
author_id_str_mv 553ce2abe05a6396e7dd6eadb6b90a6d
7159dc658c1697cfda7c760a5d494d86
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ed8a9c37bd7b7235b762d941ef18ee55
a13aaa0df9045c205e82ed3b95d18c10
aa1b025ec0243f708bb5eb0a93d6fb52
70a544476ce62ba78502ce463c2500d6
3676f695eeda169d0f8c618adf27c04b
author_id_fullname_str_mv 553ce2abe05a6396e7dd6eadb6b90a6d_***_Libby Ellins
7159dc658c1697cfda7c760a5d494d86_***_Richard Summers
10ad33360d095c9ac6bb4889fd086213_***_Carla White
ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
a13aaa0df9045c205e82ed3b95d18c10_***_Keith Lloyd
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
70a544476ce62ba78502ce463c2500d6_***_Michael Gravenor
3676f695eeda169d0f8c618adf27c04b_***_Julian Halcox
author Libby Ellins
Richard Summers
Carla White
Ann John
Keith Lloyd
Ashley Akbari
Michael Gravenor
Julian Halcox
author2 Libby Ellins
Richard Summers
Carla White
Ann John
David P.J. Osborn
Keith Lloyd
Ashley Akbari
Michael Gravenor
Julian Halcox
format Journal article
container_title PLOS One
container_volume 20
container_issue 6
container_start_page e0326583
publishDate 2025
institution Swansea University
issn 1932-6203
doi_str_mv 10.1371/journal.pone.0326583
publisher Public Library of Science (PLoS)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description Background: To explore differences in blood pressure treatment and control in patients with and without depression and a diagnosis of hypertension (HTN). Also to examine the possible impact of sex, socio-economic status (deprivation) and location of residence on any differences. Methods: A retrospective observational cohort study (2010–2019) using individual level linked anonymised routinely-collected electronic health record (EHR) data sources was carried out. Patients with a prior or new diagnosis of hypertension, with and without depression were included. Outcome variables were prescription of antihypertensive therapy (AHT) within one year of entering the study for prior HTN or post for new HTN and documentation of blood pressure <140/90 mmHg. Logistic regression was used to explore the association between depression and outcome variables adjusting for sex, age group, deprivation, location of residence and other risk factors. Results: Depression was associated with higher likelihood of AHT prescription in both prior (OR 1.71 95%CI 1.64–1.78 p < 0.001) and new HTN patients (OR 2.67 95%CI 2.38–3.00 p < 0.001). Similarly, depression was associated with successful blood pressure control in both prior (OR 1.42 95%CI 1.37–1.46 p < 0.001) and new HTN (OR 1.23 95%CI 1.08–1.40 p < 0.001). Females were less likely to be prescribed AHT than males, mainly driven by non-depressed females in both HTN groups. Depressed females were the most likely to have controlled blood pressure in both HTN groups. Conclusion: Patients with depression are more likely to be prescribed AHT and have documented blood pressure control. Sex differences existed in treatment and control, indicating opportunities for potential improvements in these areas.
published_date 2025-06-25T05:29:12Z
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