Antihypertensives Affect Risk of Hospitalization for Depression

Some common antihypertensive medications affect mood disorders, either positively or negatively, according to a new study.

Calcium antagonists and beta blockers may be associated with an increased risk of hospital admission for mood disorders, while angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARB) appear to decrease the risk for mood disorder admissions.

“Mental health is underrecognized in hypertension clinical practice, and the possible impact of antihypertensive drugs on mental health is an area that physicians should be aware of and consider if the treatment of high blood pressure is having a negative impact on their patient’s mental health,” said senior author Sandosh Padmanabhan, MD, PhD, Professor at the Institute of Cardiovascular and Medical Sciences, University of Glasgow in Glasgow, United Kingdom.

Evidence is accumulating from animal models, epidemiologic, and genomic studies that commonly prescribed antihypertensive drugs may have a role in the pathogenesis or course of mood disorders. Padmanabhan and colleagues analyzed data on 525,046 patients from two large secondary care Scottish hospitals. They selected 144,066 patients being treated for hypertension with angiotensin antagonists, beta blockers, calcium channel blockers, or thiazide diuretics, and compared them to 111,936 patients who were not taking any of those drugs.

The researchers followed the patients for five years, documenting hospitalization for mood disorders, such as depression or bipolar disorder, after more than 90 days on the antihypertensive medications.

There were 299 hospital admissions, predominantly due to major depression, among the patients studied, at an average 2.3 years after patients began antihypertensive treatment.

The results show that the burden of comorbidity showed an independent linear association with mood disorder diagnosis. Findings included:

• Patients on beta-blockers and calcium channel blockers had twice the increased risk of hospital admission for mood disorder as compared to patients on angiotensin antagonists, including angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers.
• Patients on angiotensin antagonists had the lowest risk for hospitalization with mood disorders as compared to patients on other antihypertensive medications and patients on no antihypertensive therapy.
• Patients taking thiazide diuretics showed the same risk for mood disorders compared to patients taking no antihypertensive medications.
• The presence of co-existing medical conditions increased the risk of mood disorders.

The results suggest that angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers may be useful as new or “repurposed” treatments for mood disorders, according to Padmanabhan. The researchers suggested that the reduced risk of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers “could lead to consideration of these drugs in certain subgroups of patients at risk of mood disorders.”

Padmanabhan added that “it is important that these results are validated in independent studies. This is a single center study, which looked at the risk of the more severe forms of mood disorders requiring hospitalization. It would be important to study the effect of these drugs on minor to modest changes in mood, as these will have an impact on the quality of life among hypertensive patients.”

The researchers published the results on October 10, 2016 in Hypertension.