While hypertension is associated with an increased risk of depression, continued treatment of the disease with hypertensive agents may reduce this risk, according to a study in Hypertension.
In this study, researchers from Denmark obtained anonymized data from Danish population-based registers, including data on all prescribed medications purchased at pharmacies from January 1, 1995, and onward. The study population included 5.4 million people in Denmark.
The investigators focused their research on 41 most commonly used antihypertensive drugs and their association with incident depression compared with diuretics. Types of drugs included angiotensin agents, calcium channel blockers, and beta blockers.
Two different outcome measures were evaluated, including: a depressive disorder diagnosed as an inpatient or outpatient at a psychiatric disorder, and a combined measure of a depression diagnosis or use of antidepressant medications.
During an exposure period from 2005 to 2015, a total of 3,747,190 people in Denmark were exposed to an antihypertensive agent. Significant decreased rates of depression were associated with exposure to angiotensin agents (hazard ratio [HR], 0.97; 95% CI, 0.96–0.99; P <.001), calcium antagonists (HR, 0.97; 95% CI, 0.95–0.98; P <.001), and β-blockers (HR, 0.90; 0.89–0.91; P <.001) in the fully adjusted model. No significant reduction in depression rates was observed in patients who received diuretics (HR, 0.99; 95% CI, 0.98–1.00; P =.079).
In addition, the combined rate of a depression diagnosis or use of an antidepressant was lower in patients prescribed angiotensin agents (HR, 0.97; 95% CI, 0.96-0.98; P <.001), calcium antagonists (HR, 0.96; 95% CI, 0.95-0.97; P <.001), and β-blockers (HR, 0.93-0.94; P <.001), but not in patients prescribed diuretics (HR, 1.00; 95% CI, 1.00-1.01; P =.25).
Individual drugs associated with decreased rates of depression included enalapril, ramipril, amlodipine, verapamil and verapamil combinations, propranolol, atenolol, bisoprolol, and carvedilol. None of the studied drugs were associated with an increased risk of depression.
Limitations of this study included that the diagnosis of depression was not research based but based on clinical diagnosis, the lack of data on drug adherence as well as the potential of residual confounding from unmeasured variables, the investigators noted.
The researchers concluded that their study suggests that clinicians treating patients with hypertension should prescribe 1 of the identified individual antihypertensive “drugs depending on the somatic indication, especially in patients at increased risk of developing depression, including patients with prior depression or anxiety and patients with a family history of depression.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Kessing LV, Rytgaard HC, Ekstrøm CT, et al. Antihypertensive drugs and risk of depression: a nationwide population-based study. Hypertension. 2020;76(4):1263-1279. doi:10.1161/HYPERTENSIONAHA.120.15605