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Depressive symptoms in coronary artery disease patients after hypertension treatment
L Douglas Ried1, Michael J Tueth, Michael D Taylor
1Department of Pharmacy Health Care Administration, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA. ried@cop.ufl.edu
Insights
For patients with coronary artery disease (CAD) and hypertension, a verapamil SR-based strategy improved depressive symptoms compared to atenolol, particularly in those without a history of depression.
Area of Science:
- Cardiology
- Psychiatry
- Pharmacology
Background:
- Depression is common in patients with coronary artery disease (CAD) and hypertension.
- Some hypertension medications may increase depression risk.
Purpose of the Study:
- Compare depressive symptoms in patients with CAD and hypertension on two treatment strategies.
- Stratify analysis by history of physician-diagnosed depression.
Main Methods:
- 1152 patients (≥50 years) with hypertension and stable CAD were randomized.
- Depressive symptoms assessed using Center for Epidemiologic Studies-Depression (CES-D) at baseline and 1 year.
- Compared verapamil sustained-release (SR) and atenolol-based treatments.
Main Results:
- Depressive symptoms improved in patients with prior depression on both treatments.
- Verapamil SR improved symptoms in patients without prior depression; atenolol did not.
- Patients on atenolol without prior depression history were more likely to worsen.
Conclusions:
- Verapamil SR-based strategy may be preferred for patients with CAD and hypertension.
- Consider verapamil SR, especially for patients without a history of depression.
- Treatment choice can impact depressive symptoms in this population.
Background:
Depression is highly prevalent and frequently recurs in patients with coronary artery disease (CAD) and hypertension. Certain medications used to treat hypertension are alleged to be associated with higher risk of depression.
Objective:
To compare depressive symptoms before and during treatment with 2 equivalent hypertension treatment strategies in patients with CAD stratified according to a self-reported history of physician-diagnosed depression.
Methods:
Patients enrolled in a randomized hypertension treatment study were mailed baseline and one year follow-up surveys and stratified according to a self-reported history of depression. Patients (N = 1152) were 50 years old or older with hypertension and clinically stable CAD. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression (CES-D). High risk of depression was defined as a history of physician-diagnosed depression reported by patients on the baseline survey. Depressive symptoms were compared for verapamil sustained-release (SR)- and atenolol-based hypertension treatment.
Results:
Among patients with a previous history of depression, depressive symptoms improved over the one year follow-up period for patients assigned to both treatment regimens. Depressive symptoms improved for patients with no depression history in the verapamil SR group (p < 0.001) and were unchanged in the atenolol group (p = 0.52). Patients assigned to the atenolol-based strategy without prior history of depression were more likely to worsen 5 or more points on the CES-D.
Conclusions:
When antihypertensive treatment options are clinically equivalent, prescribers may first consider using a verapamil SR-based strategy, especially in patients with CAD who have no history of depression.
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