February 24, 2009Hypertension322 citationsOpen Access
Depression Is Associated With Decreased Blood Pressure, but Antidepressant Use Increases the Risk for Hypertension
Key Result
Depressive disorder is associated with lower systolic blood pressure, whereas the use of tricyclic antidepressants significantly increases the risk of stage 2 hypertension (OR 3.19).
Study Design
Type
Cross-Sectional (n=2,618)
Multicenter
Yes
Structured PICO
Are clinical anxiety, depressive disorders, and antidepressant use associated with changes in blood pressure and hypertension risk?
P
Population
2,981 participants from the Netherlands Study of Depression and Anxiety, including healthy controls (N=590) and subjects with current or remitted depression or anxiety (N=2028, of which 644 used antidepressants and 1384 did not).
I
Intervention
Presence of clinical anxiety or depressive disorders, and use of antidepressants (including tricyclic, noradrenergic, and serotonergic antidepressants).
C
Comparator
Healthy controls (N=590) and non-users of antidepressants.
O
Outcome
Diastolic and systolic blood pressures, and risk of hypertension.surrogate
While depression itself is associated with lower systolic blood pressure, the use of certain antidepressants significantly increases the risk of elevated blood pressure and hypertension.
Main Result
Effect estimate: OR 3.19 (95% CI 1.35 to 7.59)
Absolute Event Rate: 13.4% vs 4.4%
p-value: p=0.008
Limitations
- Cross-sectional design prevents causal inferences.
- Unable to investigate whether associations were mediated by sympathetic control over the heart due to missing pure sympathetic activity measure.
Abstract
The present study compared blood pressure levels between subjects with clinical anxiety and depressive disorders with healthy controls. Cross-sectional data were obtained in a large cohort study, the Netherlands Study of Depression and Anxiety (N=2981). Participants were classified as controls (N=590) or currently or remittedly depressed or anxious subjects (N=2028), of which 1384 were not and 644 were using antidepressants. Regression analyses calculated the contributions of anxiety and depressive disorders and antidepressant use to diastolic and systolic blood pressures, after controlling for multiple covariates. Heart rate and heart rate variability measures were subsequently added to test whether effects of anxiety/depression or medication were mediated by vagal control over the heart. Higher mean diastolic blood pressure was found among the current anxious subjects (beta=0.932; P=0.03), although anxiety was not significantly related to hypertension risk. Remitted and current depressed subjects had a lower mean systolic blood pressure (beta=-1.74, P=0.04 and beta=-2.35, P=0.004, respectively) and were significantly less likely to have isolated systolic hypertension than controls. Users of tricyclic antidepressants had higher mean systolic and diastolic blood pressures and were more likely to have hypertension stage 1 (odds ratio: 1.90; 95% CI: 0.94 to 3.84; P=0.07) and stage 2 (odds ratio: 3.19; 95% CI: 1.35 to 7.59; P=0.008). Users of noradrenergic and serotonergic working antidepressants were more likely to have hypertension stage 1. This study shows that depressive disorder is associated with low systolic blood pressure and less hypertension, whereas the use of certain antidepressants is associated with both high diastolic and systolic blood pressures and hypertension.
Cite This Study
Licht et al. (2009) conducted a cross-sectional in Depression and anxiety disorders (n=2,618). Tricyclic antidepressants (TCAs) vs. No TCA use was evaluated on Hypertension stage 2 (OR 3.19, 95% CI 1.35 to 7.59, p=0.008). Depressive disorder is associated with lower systolic blood pressure, whereas the use of tricyclic antidepressants significantly increases the risk of stage 2 hypertension (OR 3.19).