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Common Blood Pressure Meds Don’t Raise Risk of Depression, Study Finds

CardioSmart News

None of the 41 most common blood pressure medicines were found to heighten the risk of developing depression, according to new research published in the journal Hypertension. The findings call into question earlier research that suggested some of these medicines may contribute to depression or make mood disorders worse. And, in fact, nine blood pressure medications appear to significantly lower the chance of depression.

The study, “ Antihypertensive Drugs and Risk of Depression: A Nationwide Population-Based Study,” rigorously examines whether individual blood pressure-lowering medicines play a role in increasing someone’s risk of depression, according to the researchers.

The Danish team analyzed data from more than 3.7 million adults in Denmark who had taken one or more of the 41 most commonly prescribed blood pressure medications between 2005 to 2015. Of these, 37 are approved for use in the U.S. by the U.S. Food and Drug Administration. Patients who had depression or were previously prescribed an antidepressant were excluded from the study to focus on new cases of the condition.

There are four main categories or classes of medications used to lower blood pressure: angiotensin agents (angiotensin converting enzyme, or ACE, inhibitors and angiotensin II receptor blockers, or ARBs), calcium antagonists, beta-blockers, and diuretics. While no blood pressure-lowering medicines heightened the risk of depression, nine drugs across three of these classes of medicines were found to have protective properties for depression, including two angiotensin drugs, three calcium agonists and four beta-blockers. Diuretics didn’t seem to impact the likelihood of depression one way or the other.

Because depression has been linked to low-grade levels of inflammation, authors explained these medications may work to curb the risk of depression through their anti-inflammatory effects. Inflammation is the body’s response to something that is harming it—an infection or injury, for example, to try to heal itself.

They said the findings can be used to help guide prescriptions for patients with high blood pressure who are at risk for developing depression, already have depression or anxiety, or have a family history. “However, if a patient is doing well with their current blood pressure prescription, there is no reason to switch,” said study co-author, Dr. Lars Vedel Kessing in a statement. Among patients who do end up developing symptoms of depression while on a blood pressure medication, authors said it may be reasonable for clinicians to consider one of the blood pressure-lowering medications found to lower depression risk.

Depression is common among people with high blood pressure, heart disease and stroke, and it can take a toll on heart health. When someone is depressed, they are less likely to make healthy lifestyle choices. Depression has also been linked to low-grade inflammation and higher levels of stress hormones, which can damage the heart and blood vessels.

Although this is a very large population study that was able to look at the rate of new depression separately for each drug, it is not a randomized controlled clinical trial, nor did it consider combination of blood pressure medications on new depression. Researchers also relied on health record data and a clinical diagnosis of depression, so many more people may have had depression. More research is needed to expand and verify these results.

“Individual drugs associated with decreased depression included 2 of 16 angiotensin agents: enalapril and ramipril; 3 of 10 calcium antagonists: amlodipine, verapamil, and verapamil combinations; and 4 of 15 β-blockers: propranolol, atenolol, bisoprolol, and carvedilol.”

Visit CardioSmart.org/HighBP to learn more.

Reference: “ Antihypertensive Drugs and Risk of Depression: A Nationwide Population-Based Study,” Hypertension, Aug. 24, 2020. 

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