Adverse childhood experiences and hypertension: Examining the roles of depressive symptoms and cardiometabolic dysregulations based on CHARLS data

Xuemei Huang¹Huiqiong Song¹Shuyang Liu¹Limeihui Gong¹Rui Miao^2*

• ¹Department of Humanities and Social Sciences, Zhuhai Campus, Zunyi Medical University, Zunyi, China
• ²Basic Teaching Department, Zhuhai Campus, Zunyi Medical University, Zunyi, China

Objective: This study aims to explore the relationship between Adverse Childhood Experiences (ACEs), depressive symptoms, and cardiometabolic dysregulations in the context of hypertension risk, while examining both psychological and physiological factors contributing to the development of hypertension. Methods: Prospective data were sourced from the China Health and Retirement Longitudinal Study (CHARLS). The data used in this study were collected from the baseline survey in 2011, with followup data obtained in 2013 and 2015, covering a 4-year period. Depressive symptoms and cardiometabolic dysregulations were derived from the 2011 baseline survey. Data on ACEs were obtained from the 2014 survey. Incident hypertension cases were defined as new cases of hypertension during the follow-up period (2013 and 2015) among participants who were not hypertensive in 2011.The study found that 50.23% of the population had experienced at least one ACE. ACEs were associated with an increased risk of hypertension, with each additional ACE increasing the risk of developing hypertension by 28.8% (OR 1.288 [95% CI 1.004, 1.652], P = 0.046). No significant association was observed with diastolic blood pressure. The model indicated that ACEs did not directly lead to hypertension but rather mediated the relationship through depressive symptoms and cardiometabolic dysregulations. The indirect effect of depressive symptoms was 0.291 [95% CI 0.101, 0.427], P = 0.002, while the indirect effect of cardiometabolic dysregulations was 0.017 [95% CI 0.004, 0.121], P = 0.002.The SEM indicated that ACEs did not have a direct effect on hypertension. Instead, the relationship was mediated by depressive symptoms and cardiometabolic dysregulations. The indirect effect along the ACEs → cardiometabolic dysregulations → SBP pathway was 0.066 (95% CI 0.002, 0.105, P = 0.002), and for the ACEs → cardiometabolic dysregulations → DBP pathway, the coefficient was 0.013 (95% CI 0.003, 0.124, P = 0.002).The study found no evidence supporting depressive symptoms as a significant mediator.ACEs are positively associated with the occurrence of hypertension, and ACEs may contribute to the development of hypertension through their impact on depressive symptoms and cardiometabolic dysregulations.ACEs show a positive association with hypertension occurrence.