Objective: Two possible explanations for an hypothesized association betwee
n depression and hypertension were examined: (1) shared stress-related risk
factors are associated with both depression and hypertension and (2) life-
style factors associated with depression lead to hypertension. Methods: A p
redominantly black sample of 695 adults were interviewed in the Harlem Hous
ehold Survey. Two measures of hypertension were used and compared-1) self-r
eport and 2) elevated blood pressure (above 140/90 mm Hg)-on the basis of t
he mean of two blood pressure measures. Depressive symptoms were measured b
y use of a 24-item scale based on the Diagnostic Interview Schedule. Logist
ic regression models were used to test associations between hypertension an
d depressive symptoms, stressors, and life-style factors. Results: Depressi
ve symptoms were associated with self-reported hypertension but not with el
evated blood pressure. The association between self-reported hypertension a
nd depressive symptoms was explained partly by shared stress-related risk f
actors but not by life-style factors. Several stressors and life-style vari
ables were risk factors for elevated blood pressure independently of depres
sive symptoms. The findings are consistent with studies that have measured
hypertension variously by either self-report or blood pressure. Possible ex
planations were explored (labeling and help-seeking) but were not supported
by the data, Conclusions: An association was found between self-reported h
ypertension and depressive symptoms, Which was explained partly by shared s
tress-related risk factors. Elevated blood pressure was associated with str
essors and life-style factors but not with depressive symptomatology. Resea
rch on illness representations and cultural dimensions of health suggest av
enues for further investigation.