Antidepressants and Incident Hypertension in Primary Care Patients

Abstract

Objective: Many ADMs can alter blood pressure (BP), but the research on the effect of antidepressant medication (ADMs) on incident hypertension is mixed. We investigated whether the use of ADMs was associated with the subsequent development of hypertension.Methods: A retrospective cohort study was conducted using electronic medical record data from 6224 patients with primary care visits from 2008 to 2015. Prescription orders were used to identify ADM use, and hypertension was defined by medical record diagnosis. Using package insert warnings, a 3-level ADM exposure variable was created: ADMs that increase BP (ADM BP؉), ADMs that do not increase BP, and no ADM. Unadjusted and adjusted Cox proportional hazard models were computed to estimate the association between the ADM exposure and incident hypertension.Results: Unadjusted results revealed that ADM BP؉ use compared with the no ADM group was significantly associated with incident hypertension (hazard ratio, 1.30; 95% confidence interval, 1.08 -1.57). After adjusting for covariates, ADM BP؉ use was no longer significantly associated with incident hypertension (hazard ratio, 1.20; 95% confidence interval, 0.97-1.49).Conclusions Primary care physicians manage hypertension and antidepressant medications (ADMs) almost every day. The age-adjusted prevalence of hypertension is 29.6% among the adult population in the United States. Of those with hypertension, only 48% achieve control of their blood pressure. Hypertension is directly related to both heart disease and stroke, which are counted as the first and fourth leading causes of death in the United States, respectively.1 Given the serious outcomes associated with hypertension, physicians must be mindful of iatrogenic causes of hypertension, which can include frequently prescribed medications. Recent data suggest that 10% to 11% of Americans age 6 years and older are treated with ADMs in a given year.2,3 Some concern has been expressed as to the safety of ADMs with regard to hypertension, especially when considering certain classes of ADMs. In a cohort of depressed participants with low rates of hypertension at baseline, treatment with ADMs was associated with an increased risk of developing hypertension. 4 The same study showed a stronger link between tricyclic antidepressants (TCAs) and hypertension than between selective serotonin reuptake inhibitors and hypertension. However, that study did not contrast ADMs known to increase blood pressure (BP) against those that do not, and the association of individual ADMs and incident hypertension was not studied. 5 A separate study showed an association between serotonin norepinephrine reuptake inhibitors (SNRIs), espeThis article was externally peer reviewed.

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