Investigating the Impact of the Number of Medication Use on Depression Among Hypertensive Patients: Results from the National Health and Nutrition Examination Survey Database

Q: What are the key findings of this study?

Use of 11 or more medications was associated with a ten-fold higher likelihood of depressive symptoms compared to 1 to 2 medications in hypertensive patients (OR 10.06, p < 0.001).

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension (n=2543). Intervention: Polypharmacy (use of 11 or more prescription medications) vs. Use of 1 to 2 prescription medications. Primary outcome: Depressive symptoms (Patient Health Questionnaire [PHQ-9] score >= 10) (OR 10.06, p=<0.001).

Q: What does this research mean for the field?

Use of 11 or more medications is associated with a ten-fold higher likelihood of depressive symptoms among hypertensive patients compared to taking 1 to 2 medications. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the relationship between polypharmacy, measured by total medication count, and depressive symptoms among hypertensive adults.

Fahad T. Alsulami; Atiah H. Almalki; Majed A. Algarni; Mohammad S. Alzahrani; Yousef Saeed Alqarni

doi:10.3390/medicina60101708

October 18, 2024MedicinaOpen Access

Investigating the Impact of the Number of Medication Use on Depression Among Hypertensive Patients: Results from the National Health and Nutrition Examination Survey Database

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Key result

Use of ≥11 medications linked to ~10.1-fold higher odds of depressive symptoms in hypertension.

OR 10.06
P<0.001
n=2,543

Figures

Why the study?

Hypertension is frequently treated with multiple medications leading to polypharmacy, which may heighten the risk of psychological issues like depression.

Is a higher number of prescribed medications (polypharmacy) associated with an increased risk of depressive symptoms in adults with hypertension?

Key Points

To evaluate the relationship between polypharmacy, measured by total medication count, and depressive symptoms among hypertensive adults.
Cross-sectional analysis using National Health and Nutrition Examination Survey (NHANES) data collected between 2017 and March 2020 among N=2543 hypertensive participants.
Depressive symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9 score ≥ 10).
Weighted multivariate binary logistic regression evaluated the effect of medication count on depression, adjusting for age, gender, education, and marital status.
Depression criteria were met by 12.3% of participants (weighted n = 6,949,529).
Compared to patients taking 1 to 2 medications, those taking 11 or more medications were ten times more likely to experience depressive symptoms (OR = 10.06, p < 0.001).
Increased odds of depression were observed with 5 to 6 medications (OR = 4.51, p < 0.001), 7 to 8 medications (OR = 4.47, p < 0.001), and 9 to 10 medications (OR = 4.97, p < 0.001); female patients were also more likely to experience depression than males (OR = 1.47, p = 0.032).

Study Design

Type

Cross-Sectional (n=2,543)

Multicenter

Yes

Structured PICO

Is a higher number of prescribed medications (polypharmacy) associated with an increased risk of depressive symptoms in adults with hypertension?

P

Population

2,543 US adults with hypertension (mean age 60.95 years, 52.4% female) from the cross-sectional NHANES 2017-2020 database taking prescription antihypertensive medication.

E

Exposure

Polypharmacy / higher number of total prescribed medications used at the time of survey (categorized into 3-4, 5-6, 7-8, 9-10, and ≥11 medications)

C

Comparator

Use of 1 to 2 prescribed medications

O

Outcome

Presence of depressive symptoms, defined as a Patient Health Questionnaire (PHQ-9) score of ≥10 over the previous two weekspatient reported

Main Result

Odds Ratio: 10.06

p-value: p=<0.001

Limitations

Did not differentiate between specific types or classes of medications used.
Depression was assessed using the self-reported PHQ-9 scale, which may be subject to reporting bias and misclassification.
Did not account for underlying medical conditions other than hypertension that may influence both polypharmacy and depression risk.
Did not exclude medications used to treat or potentially cause depression or anxiety.
Cross-sectional design of NHANES prevents determination of causality between polypharmacy and depression.
Number of medications used was self-reported and subject to reporting bias.
Did not differentiate between specific classes of medications used
Self-reported PHQ-9 scale and medication counts are subject to reporting bias and misclassification
Did not account for underlying medical comorbidities other than hypertension
Did not exclude medications used to treat or potentially cause depression or anxiety
Cross-sectional design precludes establishing causality between polypharmacy and depression

Implication

In US adults with hypertension, higher medication burden (polypharmacy) is strongly and independently associated with depressive symptoms, underscoring the need for routine mental health screening and medication reconciliation.

Abstract

Background and Objective: Hypertension is a prevalent chronic condition often treated with multiple medications, leading to polypharmacy, which can heighten the risk of adverse drug reactions and contribute to psychological issues like depression. This study aimed to investigate the relationship between polypharmacy and depressive symptoms in hypertensive patients using data from the National Health and Nutrition Examination Survey (NHANES) from 2017 to 2020. Materials and Methods: This study utilized data from the National Health and Nutrition Examination Survey (NHANES) collected between 2017 and March 2020. Results: Among 2543 hypertensive participants, 12.3% met the criteria for depression. The findings revealed that patients using 11 or more medications were ten times more likely to experience depressive symptoms compared to those taking 1 to 2 medications (OR = 10.06, p < 0.001). Additionally, younger age (18 to 45 years), female gender, and lower educational attainment were significantly associated with higher rates of depressive symptoms. Specifically, females were 1.47 times more likely to experience depression compared to males (p = 0.032). Conclusions: This research highlights the substantial impact of medication burden on mental health among hypertensive patients, emphasizing the need for tailored clinical interventions for this vulnerable population.

Discussion

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Cite This Study

Alsulami et al. (2024) conducted a cross-sectional in Hypertension (n=2,543). Polypharmacy (use of 11 or more prescription medications) vs. Use of 1 to 2 prescription medications was evaluated on Depressive symptoms (Patient Health Questionnaire [PHQ-9] score >= 10) (OR 10.06, p=<0.001). Use of 11 or more medications was associated with a ten-fold higher likelihood of depressive symptoms compared to 1 to 2 medications in hypertensive patients (OR 10.06, p < 0.001).

synapsesocial.com/papers/6a73549f8e3434b3274e54f2 https://doi.org/10.3390/medicina60101708

Topics

Hypertension management

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Investigating the Impact of the Number of Medication Use on Depression Among Hypertensive Patients: Results from the National Health and Nutrition Examination Survey Database

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Investigating the Impact of the Number of Medication Use on Depression Among Hypertensive Patients: Results from the National Health and Nutrition Examination Survey Database

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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