Effect of Antihypertensives on Risk for Depression in a Real-World Setting

two pills in someones hand
two pills in someones hand
In China, researchers found data that showed that the highest incidence of depression was found in the beta blocker and angiotensin-converting enzyme inhibitor classes of drugs.

Compared with the use of angiotensin II receptor blockers (ARBs), a class effect associated with the use of other antihypertensive agents on an individual’s risk for depression has been suggested, with the highest incidence density reported in the beta blocker (BB) and angiotensin-converting enzyme or ACE inhibitors classes. A retrospective cohort study on the topic was conducted using information extracted from an insurance database in Beijing, China. Results of the analysis were published in the Journal of Affective Disorders.

Recognizing that evidence has been increasing on the effects of different antihypertensive agents on depression, the investigators sought to explore the current facts via the use of the Beijing Medical Claims Data for Employees database, realizing that how the various classes of antihypertensive agents have an impact on depression remains unclear. In this study, the antihypertensive agents evaluated included calcium channel blockers (CCBs), ACEIs, ARBs, beta blockers, and diuretics (DIUs). Individuals who were initially treated with only 1 class of antihypertensive agent were included in the analysis.

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A total of 181,709 patients with newly diagnosed hypertension were enrolled in the study. The median study follow-up period was 4.33 years. Overall, 19,030 patients had depression at the end of the study. After adjusting for a number of covariates, such as age, sex, occupation, employment status, statin prescription, antidiabetic prescription, presence of cardiovascular disease comorbidity, hospital type, and hospital level, the incidence densities of depression in patients treated with a BB, ACEI, DIU, CCB, and ARB were: 3.16 (95% CI, 2.98-3.33), 3.10 (95% CI, 2.91-3.29), 2.70 (95% CI, 2.45-2.94), 2.67 (95% CI, 2.53-2.81), and 2.30 (95% CI, 2.16-2.43) per 100-person years, respectively.

When compared with the ARB group, the hazard ratios of depression in the BB, ACEI, DIU, and CCB groups were: 1.37 (95% CI, 1.32-1.43), 1.35 (95% CI, 1.28-1.42), 1.17 (95% CI, 1.08-1.27), and 1.16 (95% CI, 1.12-1.21), respectively. Based on stratified analysis, the highest depression incidence density remained in the BB and ACEI arms.

Major study limitations include the fact that detailed clinical information was not available, which may introduce bias into the results. Moreover, since patients who received monotherapy as their initial treatment were included in the analysis, caution is needed when extrapolating the results.

The investigators concluded that based on the claims database used for urban employees, they could adjust their findings only for occupation and employment status. Future studies on the subject  in which other psychosocial factors are taken into consideration are warranted.

Cao YY, Xiang X, Song J, et al. Distinct effects of antihypertensives on depression in the real-world setting: a retrospective cohort study. J Affect Disord. 2019;259:386-391.