Influence of Depressive State on Levels of Homocysteine and Thyroid Hormone in Patients with Hypertension

J Int Transl Med, 2015, 3(4): 263-266; doi: 10.11910/2227-6394.2015.03.04.07

Research Article Open Access

Influence of Depressive State on Levels of

Homocysteine and Thyroid Hormone in Patients
with Hypertension
WANG Wei-wei1*, WANG Yan-ling2
1. Department of Internal Medicine, Community Health Center of Zhangkuan Subdistrict Office in Qiaoxi District, Xingtai, Hebei,
054000, China;
2. Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China

ABSTRACT
Objective: To explore the influence of depressive state on the levels of homocysteine (Hcy) and
thyroid hormone in patients with hypertension.
Methods: Totally 179 patients with primary hypertension were selected and divided into
depression group (n=97) and non-depression group (n=82) according to whether to be complicated
with depressive disorder. The venous blood was drawn for detecting the level of Hcy in 2 groups
by enzymatic cycling assay, and serum free triiodothyronine (FT3), free thyroxine (FT4) and
thyrotropic hormone (TSH) by chemiluminiscence. The correlation between Hamilton depression
scale (HAMD) scores and levels of plasma Hcy and serum FT3, FT4 and TSH was analyzed.
Results: Compared with non-depression group, the level of plasma Hcy increased and the levels
of FT3 and FT4 decreased in depression group (P<0.05), but there was no statistical difference
Key words: between 2 groups (P>0.05). HAMD scores in depression group had a positive correlation with the
Hypertension level of plasma Hcy (r=0.593, P=0.024), a negative correlation with the level of serum FT3 (r=-
Depressive disorder 0.421, P=0.011), and no relationships with the levels of serum FT4 and TSH (r=-0.137, P=0.334;
Homocysteine r=0.058, P=0.576).
Triiodothyronine Conclusion: Hypertensive patients complicated with depression have abnormal level of Hcy and
Thyroxine thyroid hormones. Moreover, the depressive degree of patients is positively correlated with the
Thyrotropic hormone level of Hcy and negatively with the level of FT3.

Introduction
Hypertension is one of the most common chronic diseases, and
its major risk factors include age, history of hypertension, high-
sodium low-potassium diet, excessive drinking, overweight and
obesity, long-term psychentonia and anxiety, etc.. In addition,
a large number of clinical data showed the occurrence and
development of hypertension is associated with psychosocial
factors, and individual personality traits[1]. Due to long-term
course and instability of the disease and discomfort caused
by the disease, hypertensive patients are especially prone to
adverse psychological symptoms manifested by emotional
disorders, such as anxiety, stress, anger and depression. And
strong negative emotions, in turn, become the inducement which
further affects blood pressure[2].

*Corresponding Author:
WANG Wei-wei, E-mail: wangww2015@sina.com

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J Int Transl Med, 2015, 3(4): 263-266
A study in recent years has shown that high homocysteine (Hcy)
level is an important risk factor for hypertension that influences
the occurrence and development of hypertension by participating
in vascular endothelial cell damage, smooth muscle cell
[3]
proliferation and blood coagulability . High Hcy level is also
an independent risk factor for depression. Some patients with
severe non-thyroidal illness had the decreased level of thyroid
hormones and normal level of thyroid stimulating hormone
(TSH) in circulating blood, but no manifestation of thyroid
hypofunction in clinic, which is called normal thyroidal sick
syndrome or non-thyroidal illness syndrome (NTIS). Scholars
have pointed out in their reports related to cardiovascular
diseases that the abnormal thyroxine level, which often exists
in patients with hypertension, acute myocardial infarction,
congestive heart-failure, heart transplantation, coronary
artery surgery, cardiac sudden death, etc., in most cases, is
[4]
accompanied with depressive symptoms . Therefore, this study
was intended to compare the levels of plasma Hcy and thyroxine
hornome between hypertensive patients with depression and
hypertensive patients with non-depression so as to explore their
relationship with hypertension and depressive disorder, learn the
influence of depressive state on the levels of Hcy and thyroxine
hormone. The report was presented as follows.
Materials and Methods
Study objects
Totally 179 patients with primary hypertension admitted in
Community Health Center of Zhangkuan Subdistrict Office and
Xuanwu Hospital from Sep., 2013 to May, 2015 were selected
and all of them confirmed to the Guidelines for Prevention
and Treatment of Hypertension in China (2010) [5-6], and had
hemodynamic stability. Exclusion criteria: (1) Patients with
severe liver and kidney dysfunction; (2) Patients with malignant
tumors; (3) Patients with history of mental illness; (4) Patients
with no ability of independent behavior; (5) Patients using
antidepressant drugs, folic acid and multivitamin recently.
According to whether complicated with depressive disorder, the
patients were divided into depression group (n=97) and non-
depression group (n=82). This study was approved by Ethics
Committee of Xuanwu Hospital Hospital and all patients and
their family members signed the informed consent forms.
Diagnostic criteria for depressive
disorder
Hamilton depression scale (HAMD) was conducted by
264
two operators who were trained through conversation and
observation. After that, patients were evaluated by two operators
independently according to their observation on patients,
patients’ oral account and weight records as well as data from
family members and medical staff. (1) Normal state: total
HAMD points <7; (2) Depression (possible): total HAMD
points between 7-17; (3) Depression (definite): total HAMD
points between l7-24; (4) Severe depression: total HAMD points
>24. The clinical manifestations within 3 months confirmed
to Chinese Classification and Diagnostic Criteria for Mental
Disorder (the 3rd revised edition, CCMD-3)[7] and HAMD >17
points were determined as depressive disorder.
Methods
Fasting venous blood (FBG, 10 mL) was drawn in the morning
and half was infused into test tube containing 100 μL 2%
ethylene diamine tetraacetic acid (EDTA) and centrifuged
for separation of plasma. OLYMPUS AU2700 automatic
biochemical analyzer and its accessory kit were used for
detecting the level of Hcy by enzymatic cycling assay. The rest
of venous blood was centrifuged for separation of plasma after
it was placed for 1 h. Bayer ADVIA Centaur Immunoassay
Analyzer and its accessory kit were used for detecting the levels of
serum free triiodothyronine (FT3), free thyroxine (FT4) and TSH.
Statistical analysis
SAS 9.3 software package was applied for data analysis. The
measurement data were presented as ( x ± s ), the comparison of
2 groups was used by independent-samples t test. Enumeration
data were presented as percentage, and analyzed by chi-square
test. Correlation was analyzed by Pearson correlation analysis. A
value of P<0.05 was considered to be statistically significant.
Results
Demographic characteristic and baseline
characteristics of 2 groups
There was no statistical difference between 2 groups in gender,
age, constitutional index, course of disease, hypertension
grading, fasting blood-glucose (FBG) (P>0.05) (Table 1).
Comparison of levels of plasma Hcy and
serum thyroid hormones of 2 groups
Compared with non-depression group, the level of plasma Hcy
increased obviously in depression group (P<0.05), and the levels
of FT3 and FT4 decreased obviously (P<0.05). There was no
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 J Int Transl Med, 2015, 3(4): 263-266

difference in the level of TSH between 2 groups (Table 2). HAMD scores in depression group had a positive correlation
with the level of plasma Hcy (r=0.593, P=0.024), a negative
Correlation analysis of HAMD scores correlation with the level of serum FT3 (r=-0.421, P=0.011),
and the levels of plasma Hcy and serum and no relationships with the levels of serum FT4 and TSH (r=-
hormonal readiness 0.137, P=0.334; r=0.058, P=0.576).

Table 1 Comparison of Demographic and Baseline Characteristics of Two Groups

Gender/Male Age Constitutional Course of Hypertension grading [n(%)] FBG

[n(%)] (years) index (kg/m2) disease (years) Ⅰ Ⅱ Ⅲ (mmol/L)

Depression group(n ＝ 97) 63(64.95) 63.92±11.53 23.37±2.02 8.31±5.92 39(40.21) 31(31.96) 27(27.84) 5.91±1.27
Non-depression group(n ＝ 82) 54(65.85) 64.01±12.74 24.01±2.34 8.87±4.18 33(40.24) 27(32.93) 22(26.83) 5.88±1.44
t or χ2 0.02 0.55 1.96 0.72 1.75 0.15
P 0.8991 0.5824 0.0511 0.4735 0.4161 0.8824

Table 2 Comparison of Levels of Plasma Hcy and Serum Thyroid Hormones of Two Groups ( x ±s)
Hcy(μmol/L) FT3(pmol/L) FT4(pmol/L) TSH(mU/L)
Depression group (n ＝ 97) 16.59±2.37 3.02±0.89 15.14±2.10 2.79±1.24
Non-depression group (n ＝ 82) 11.37±1.56 3.81±1.15 15.97±2.68 2.71±1.29
t 17.64 5.18 2.28 0.42
P <0.0001 <0.0001 0.0241 0.6744

Discussion Hcy is a sulfur-containing amino acid which can’t directly take

Hypertension is a kind of cardiovascular syndrome.
Epidemiological surveys have shown that the incidence of
hypertension is up to 24%-60%. At present, there are 200 million
hypertensive patients, taking up 1/5 of the total number of global
[8-9]
hypertension . Hypertension, as a kind of common chronic
diseases, is characterized by long-term course, instability of the
disease, discomfort caused by disease, treatment compliance,
side effects caused by antihypertensive drugs, which makes
patients be prone to adverse psychological symptoms, such as
irritability, anxiety, stress, anger and depression.
Depressive disorder or depression is a group of emotional disorders
caused by various reasons, with obvious and lasting black mood
as the basic characteristic. Psychologic medicine associated
epidemiological investigation is found that the incidence of
depressive symptoms for outpatients is 28%-45%, and the incidence
of inpatients is 20%-57%[10]. A research has showed that the
incidence of hypertensive patients complicated with depression is
20%-35%, and the depressive state, to some extent, can influence
the occurrence, development and prognosis of hypertension[11]. A
large number of clinical data have indicated that hypertension can
induce, even aggravate depressive disorder which, in turn, leads to
the fluctuation of blood pressure and promotes the occurrence and
development of hypertension, thus forming a vicious circle which
jointly influences the overall prognosis of patients[12].
in from the external environment. It is intermediate metabolites
produced by methionine from food. A research in recent years
has reported high level of plasma Hcy causes elevation of
blood pressure through the following approaches[13]: (1) Toxic
effect on vascular endothelial cells; (2) Damaging vascular
endothelial function; (3) Reducing the production of nitric
oxide; (4) Inducing the proliferation of vascular smooth muscle;
(5) Promoting the formation of thrombosis; (6) Participating in
inflammatory reactions. The occurrence risk of hypertension has
an internal relation with the level of plasma Hcy. The larger the
risk is, the higher the level of plasma Hcy is. With the continuous
progress of research on correlation between hypertension and
depressive state or the level of Hcy, the relationship between
depression and the level of Hcy is increasingly paid attention by
a lot of scholars. Beydoun et al.[14] analyzed the cross-sectional
study of 2 524 patients aged 20-85 years and found that patients
with higher level of serum Hcy were more easier to suffer from
depression, and the higher the level of serum Hcy was, the
higher the HAMD score was, indicating that the level of serum
Hcy was positively correlated with the severity of depression. In
present study, hypertensive patients with depression had higher
level of Hcy than patients with non-depression and HAMD
score of patients with depression was positively correlated with
the level of Hcy, which indicated that when the level of plasma
Hcy of hypertensive patients increased, the occurrence risk of

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J Int Transl Med, 2015, 3(4): 263-266
depressive disorder increased correspondingly. On the contrary,
physiological changes and anorexia caused by depressive state
in patients with depression could affect the homergy of Hcy in
the body, thus forming a vicious circle which jointly influences
the prognosis of patients.
Under physiological conditions, thyroid hormone can influence the
gene expression by promoting the transcription of RNA and the
translation of the protein, and regulate the synthesis and metabolism
velocity of a variety of neurotransmitters in central nervous system,
thus making patients highly emotional. If the level of thyroid
hormone decreases, depressive symptoms appear. Moreover, due
to long-term psychological disorders, neuroendocrine metabolism
in depressive patients changes, which, in turn, aggravates the
abnormality of thyroid hormone level, thus forming a vicious
cycle[15]. A previous study has shown that there is double procession
between depressive state and hypothyroidism, positron emission
tomography (PET) displays that the level of thyroid hormone has
positive correlation with cerebral cortical blood flow which is
negatively correlated with the severity of depression, consequently
indicating that thyroid hormone level might be negatively
correlated with the severity of depression. In present study, the
levels of hypertensive patients complicated with depression were
obviously lower than patients with non-depression, HAMD score of
hypertensive patients with depression was negatively correlated with
the level of serum FT3, indicating that patients complicated with
depression were more easier to suffer from low triiodothyronine,
and the level of FT3 could be regarded as one indicator for judging
the severity of depression of patients and be of significance in the
judgment of prognosis and guidance of treatment.
In conclusion, the prevalence of hypertensive patients with
depression is high, for whom blood pressure should be controlled,
and meanwhile, the levels of plasma Hcy and serum FT3 should be
closely monitored for learning the severity of depression of patients
and adopting individualized treatment for lowering cardiovascular
disease risk and improving the prognosis of patients.
Declaration
The authors of this manuscript declare that they have no conflict
of interest.
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