***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Objective To compare the predictive powers of self-measurement of blood pressure at home ( home blood pressure measurement ) and casual ( screening ) blood pressure measurement for mortality . Design A prospect i ve cohort study . Subjects and methods We obtained  home and screening blood pressure measurements for 1789 subjects aged ≥ 40 years who were followed up for a mean of 6.6 years . The prognostic significance of blood pressure for mortality was determined by the Cox proportional hazards regression model adjusted for age , sex , smoking status , past history of cardiovascular disease , and the use of antihypertensive medication . Results When the home blood pressure values and the screening blood pressure values were simultaneously incorporated into the Cox model as continuous variables , only the average of multiple ( taken more than three times ) home systolic blood pressure values was significantly and strongly related to the cardiovascular mortality risk . The average of the two initial home blood pressure values was also better related to the mortality risk than were the screening blood pressure values . Conclusions Home blood pressure measurement had a stronger predictive power for mortality than did screening blood pressure measurement for a general population . This appears to be the first study in which the prognostic significance s of home and screening blood pressure measurements have been compared CONTEXT Significant symptoms of depression are common in the older community-dwelling population . Although depressive symptoms and disability may commonly occur in the same person , whether depressive symptoms contribute to subsequent functional decline has not been eluci date d. OBJECTIVE To determine whether depressive symptoms in older persons increase the risk of subsequent decline in physical function as measured by objective performance-based tests . DESIGN A 4-year prospect i ve cohort study . SETTING The communities of Iowa and Washington counties , Iowa . PARTICIPANTS A total of 1286 persons aged 71 years and older who completed a short battery of physical performance tests in 1988 and again 4 years later . MAIN OUTCOME MEASURES Baseline depressive symptoms were assessed by the  Center for Epidemiological Studies Depression Scale .  Physical performance tests included an  assessment of st and ing balance , a timed 2.4-m ( 8-ft ) walk , and a timed test of 5 repetitions of rising from a chair and sitting down .  RESULTS After adjustment for baseline performance score , health status , and sociodemographic factors , increasing levels of depressive symptoms were predictive of greater decline in physical performance over 4 years ( odds ratio for decline in those with depressed mood vs those without , 1.55 ; 95 % confidence interval [ CI ] , 1.02 - 2.34 ) . Even among those at the high end of the functional spectrum , who reported no disability , the severity of depressive symptoms predicted subsequent decline in physical performance ( odds ratio for decline , 1.03 ; 95 % CI , 1.00 - 1.08 ) . CONCLUSIONS This study provides evidence that older persons who report depressive symptoms are at higher risk of subsequent physical decline . These results suggest that prevention or reduction of depressed mood could play a role in reducing functional decline in older persons The consequences of orthostatic hypotension , a serious and common problem among the elderly , are falls , transient ischemic attacks , strokes , and myocardial infa rct ions .  Depressed elderly taking tricyclic antidepressants ( TCAs )  are at increased risk , and the pretreatment presence of orthostatic hypotension is considered a relative contraindication to TCA treatment . Recently , it was reported that the presence of pretreatment orthostatic hypotension in geriatric out patients with unipolar depression predicted good clinical response to imipramine or doxepin . We investigated the predictive value of pretreatment systolic orthostatic pressure changes ( PSOP ) in unipolar depressed elderly out patients ( mean age , 64 ) who were to receive a 16-week course of nortriptyline or interpersonal psychotherapy .  Overall , PSOP was significantly correlated with improvement on both the Beck Depression Inventory and the Hamilton Depression Rating Scale . Although both groups responded equally to treatment , PSOP was more strongly correlated with improvement on the Beck Depression Inventory ( r = 0.74 , p less than 0.01 ) in the nortriptyline-treated group than in the group treated with interpersonal therapy ( r = 0.31 , not significant ) . The nortriptyline-treated subjects with a PSOP of greater than or equal to 10 mm Hg had a greater improvement than those with a PSOP of less than 10 mm HG ( t = -2.36 , p less than 0.05 ) . No episodes of symptomatic orthostatic hypotension occurred in the nortriptyline-treated subjects . The results suggest that orthostatic hypotension , a relative contraindication to TCA use , may potentially identify patients more likely to respond to TCAs Factors associated with orthostatic blood pressure change in elderly out patients were determined by surveying 398 medical clinical out patients aged 65 years and older .  Blood pressure  was measured with r and om-zero sphygmomanometers after patients were 5 minutes in a supine and 5 minutes in a st and ing position .  Orthostatic blood pressure changes were at normally distributed levels with systolic and diastolic pressures dropping an average of 4 mm Hg ( st and ard deviation [SD]=15 mm Hg ) and 2 mm Hg ( SD=11 mm Hg ) , respectively . Orthostatic blood pressure changes were unassociated with age , race , sex , body mass , time since eating , symptoms , or other factors . According to multiple linear regression analysis , supine systolic pressure , chronic obstructive pulmonary disease ( COPD ) , and diabetes mellitus were associated with a decrease in systolic pressure on st and ing . Hypertension , antiarthritic drugs , and abnormal heartbeat were associated with an increase in systolic pressure on st and ing . For orthostatic diastolic pressure changes , supine diastolic pressure and COPD were associated with a decrease in diastolic pressure on st and ing . Congestive heart failure was associated with an increase in st and ing diastolic pressure . Using logistic regression analysis , only supine systolic pressure was associated with a greater than 20-mm Hg drop in systolic pressure ( n=53 , prevalence=13 % ) . Supine diastolic pressure and COPD were the only variables associated with a greater than 20-mm Hg drop in diastolic pressure ( n=16 , prevalence=4 % ) . These factors may help physicians in identifying older persons at risk for having orthostatic hypotension OBJECTIVES To examine the relationship between persistently high depressive symptoms and long-term changes in functional disability in elderly persons . DESIGN A community-based , prospect i ve , observational study . SETTING Participant data from the Cardiovascular Health Study . PARTICIPANTS From the overall sample of 5,888 subjects , three types of participants were identified for this study : ( 1 ) persistently depressed individuals , who experienced an onset of depressive symptoms that persisted over 4 years ( n=119 ) ; ( 2 ) temporarily depressed individuals , who experienced an onset of depressive symptoms that resolved over time ( n=259 ) ; and ( 3 ) nondepressed individuals , with persistently low depressive symptoms throughout the follow-up period who were matched on baseline activity of daily living ( ADL ) scores , sex , and age to the previous two groups combined ( n=378 ) . MEASUREMENTS Four consecutive years of data were assessed : vali date d measures of depression ( 10-item CES-D ) , functional disability ( 10-item ADL/instrumental ADL measure ) , physical performance , medical illness , and cognition . RESULTS The persistently depressed group showed a greater linear increase in functional disability ratings than the temporarily depressed and nondepressed groups . This association between persistent depression and functional disability was robust even when controlling for baseline demographic and clinical /performance measures , including cognition . The persistently depressed group had an adjusted odds ratio ( OR ) of 5.27 ( 95 % confidence interval ( CI ) 3.03 - 9.16 ) for increased functional disability compared with the nondepressed group over 3 years of follow-up , whereas the temporarily depressed group had an adjusted OR of 2.39 ( 95 % CI=1.55 - 3.69 ) compared with the nondepressed group . CONCLUSION Persistently elevated depressive symptoms in elderly persons are associated with a steep trajectory of worsening functional disability , generating the hypothesis that treatments for late-life depression need to be assessed on their efficacy in maintaining long-term functional status as well as remission of depressive symptoms . These results also demonstrate the need for studies to differentiate between persistent and temporary depressive symptoms when examining their relationship to disability A total of 1070 men and women aged 65 years and over living in the community in Liverpool were interviewed using the Geriatric Mental State . Diagnoses of depression at case and subcase level were made using the GMS‐AGECAT package from an initial interview and at follow‐up three years later . Data relating to blood pressure at year 0 was available on 748 subjects . Men not taking anti‐hypertensives or antidepressants with diastolic blood pressure greater than 85 mmHg were significantly less likely to be subcases than men with low or normal diastolic pressure . People in this group were also significantly less likely to be cases 3 years later . There were no other significant findings . These results do not support an association between low blood pressure and coincidental or future subcase‐ or case‐level depressive illness OBJECTIVE The aim of this study was to examine the longitudinal impact of blood pressure variations and vascular risk factors on depressive symptoms in the elderly . DESIGN Longitudinal and cross-sectional cohort study . SETTING Urban population of elderly men , city of Malmö , Sweden . PARTICIPANTS A total of 809 r and omly included men took part in a prospect i ve cohort study , " Men born in 1914 " , and 171 survivors reached the age of 81 years . MEASUREMENTS Depressive symptoms were estimated at the age of 81 using the Zung Self-Rating Depression Scale ( ZSDS ) . Vascular risk factors were identified at both 68 and 81 years of age . RESULTS At the age of 68 , diagnosis of hypertension and on-going antihypertensive therapy were more frequent in subjects with high than low ZSDS scores . In contrast , at age 81 , the highest ZSDS scores correlated with low systolic blood pressure ( SBP ) . Declining SBP between the ages of 68 and 81 was more frequent in high-scoring than in low-scoring groups . Subjects with high ZSDS scores took more drugs and had more clinical diagnoses at age 81 . Those taking hypnotics and sedatives had higher ZSDS scores , lower SBP at 81 , and showed more frequent decrease in SBP during the observation period . CONCLUSION Depressive symptoms in octogenarian men could be predicted by hypertension earlier in life , and were strongly associated with decreasing SBP during the last decade Previous studies on the relationship between blood pressure ( BP ) and depression have produced inconsistent results ( Paterniti et al. , 2000 ; Lenoir et al. , 2008 ; Stewart and Hirani , 2010 ; Siennicki-Lantz et al. , 2012 ) . There have been no studies examining changes in BP prior to depression over a relatively long period . Participants in this study were primary care patients aged 60 years or older who screened negative for depression using the Center for Epidemiologic Studies Depression Scale ( CES-D < 16 ) and had no prior depression diagnosis . Participants were screened from 1991 to 1993 during regularly scheduled primary care appointments at an urban public health system ( Callahan et al. , 1994 ) . Participants were then followed through December 31 , 2010 . The study end point was defined as the time to a physician diagnosis of clinical depression based on International Classification of Disease codes . For patients not diagnosed with depression , date of the last encounter with the health system was their study endpoints . Clinical information was extracted from the Regenstrief Medical Record System including all height , weight , systolic BP , diastolic BP from outpatient visits , and 15 diagnoses ( hypertension , diabetes , atherosclerotic vascular disease , coronary artery disease , peripheral artery disease , congestive heart failure , cerebrovascular disease , cancer , anemia , chronic obstructive pulmonary disease , arthritis , liver disease , renal disease , thyroid disease , hyperlipidemia , and dementia ) . Age , gender , race , years of education , and history of smoking were collected at enrollment . Repeated systolic and diastolic BP from enrollment to study endpoints were used as dependent variables in mixed effect models with r and om intercepts and r and om slopes while adjusting for time dependent covariates of patients ’ medical conditions . The BP measures were aligned to each patient ’s study endpoint , indexing a BP measure by the number of years this measure was taken before the patient ’s endpoint . A total of 2581 participants were included with a median of 21 BP measures per patient . The mean times from enrollment to endpoints for the depression and no-depression groups were 7.2 years ( SD = 4.6 ) and 7.9 years ( SD = 5.8 ) , respectively . Participants in the incident depression group had lower systolic BP at enrollment than those without depression ( p = 0.0057 ) and were younger , more likely to be a woman , had a higher mean body mass index , and a higher rate of arthritis at enrollment ( p < 0.0001 ) . No other differences in rates of medical conditions were evident and the total numbers of comorbid conditions did not differ between the two groups at enrollment ( p = 0.1699 ) 
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DISCUSSION This systematic review found that cross-sectional studies demonstrated a consistent relationship between hypotension and LLD , but longitudinal data to date is less consistent , with discordant findings .