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HYPERTENSION

Depressive Symptoms in Coronary Artery Disease Patients After Hypertension Treatment

Professor, Department of Pharmacy Health Care Administration, College of Pharmacy, University of Florida and Rehabilitation Outcomes Research Center, Malcom Randall Veterans Affairs Medical Center, Gainesville, FL

Michael J Tueth, MD

Associate Professor, Department of Psychiatry, Malcom Randall Veterans Affairs Medical Center and Department of Psychiatry, College of Medicine, University of Florida

Michael D Taylor, PharmD PhD

at time of writing, PhD Candidate, Department of Pharmacy Health Care Administration, College of Pharmacy, University of Florida; now, Associate Epidemiologist, Genentech, South San Francisco, CA

Brian C Sauer, PhD

at time of writing, PhD Candidate, Department of Pharmacy Health Care Administration, College of Pharmacy, University of Florida; now, Medical Informatics Fellow, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT

Larry M Lopez, PharmD

Professor, Department of Pharmacy Practice, College of Pharmacy, University of Florida

Carl J Pepine, MD

Professor and Division Head, Division of Cardiovascular Medicine, College of Medicine, University of Florida

Reprints: Dr. Ried, Department of Pharmacy Health Care Administration, College of Pharmacy, PO Box 100496, University of Florida, Gainesville, FL 32610-0496, fax 352/273-6270, ried{at}cop.ufl.edu

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.

Key Words: antihypertensive, ß-blocker, calcium-channel antagonist, depressive symptoms, hypertension, quality of life

Published Online, March 28, 2006. www.theannals.com, DOI 10.1345/aph.1G438