PP.41.04

Objective: Depression is associated with risk of hypertension and acute coronary syndromes. High blood pressure exerts sheer stress on vessel walls and may impair carotid and retinal perfusion, contributing to early structural wall changes. We therefore aimed to assess the association between depressive symptoms, reduced perfusion pressure and remodelling of the macro- (carotid) and microvasculature (retina). Design and method: A total of 358 teachers (Blacks ∼ 48 %, aged 48.6 ± 9 years) from the Sympathetic Activity and Ambulatory Blood Pressure in Africans cohort study, were included. Cardiometabolic risk markers were assessed under fasting well-controlled conditions using standardized protocols. Depressive symptoms scores were calculated using DSM-IV criteria. Ambulatory BP, ECG and ultrasound B-mode carotid far wall thickness were obtained. Diastolic blood pressure – Intraocular pressure defined diastolic ocular perfusion pressure (DOPP). Retinal structure and retinopathy signs were quantified from externally validated digital images using standardized protocols. Responses of retinal vessels to flicker light were evaluated as marker of microvascular endothelial function. Results: Depressive symptoms predicted 24 h hypertension with an odds ratio of 2.52 (95 % CI: 2.12, 2.94; p = 0.03) in the bi-ethnic cohort, independent of cardiovascular confounders. Overall, depressive symptoms were associated with retinal vascular changes but not carotid remodelling. Retinal arteriolar narrowing was more evident in Black Africans. In that ethnic group, both depressive symptoms [Adj R2 0.26, ß = 0.31 (95% CI: 0.13, 0.49; p = 0.001) and perfusion pressure (DOPP) [Adj R2 0.26, ß = 0.16 (95% CI: 0.0, 0.32); p = 0.03] were associated with a wider venular caliber, an index of stroke risk. In Blacks, depressive symptoms were also associated with increased arteriolar responses to flicker light [Adj R2 0.22, ß = 0.17 (95% CI: 0.06, 0.38); p = 0.04]. Conclusions: Depression may trigger changes in both ocular hemodynamics and the systemic circulation. Depression, in synergy with compensatory increases in blood pressure to alleviate reduced supply, may increase stroke risk, especially in the Blacks.