Anxiety and depression symptoms in arterial hypertension: the influence of antihypertensive treatment. The HUNT study, Norway

Abstract

Antihypertensive drugs have been suggested to modulate symptoms of depression and anxiety. It is disputed whether this is due to the hypertension per se, its treatment, or both. The aim of this study was to investigate these associations in a large population sample. 55,472 participants in the Nord-Trøndelag Health Study (HUNT 2, 1995-1997), Norway, who completed the Hospital Anxiety and Depression rating Scale, were divided into 3 groups according to their diastolic blood pressure and antihypertensive treatment status. A cut-off of ≥90 mmHg diastolic blood pressure was used to identify hypertensive status. Differences in anxiety and depression symptom levels in untreated and treated hypertensives (all treatments) versus the normotensive reference group were explained by differences in age and gender distribution in the three groups in this study. However, the receipt of two or more antihypertensive drugs was associated with depressive symptoms alone (OR = 1.40, 95% CI = 1.03-1.90), but not with symptoms of anxiety (OR = 1.14, 95% CI = 0.83-1.57) or mixed anxiety and depression (OR = 1.19, 95% CI = 0.82-1.72) in the fully adjusted model, compared to untreated hypertension. Antihypertensive monotherapy (all agents) nor any single antihypertensive drug class were associated with symptoms of depression, anxiety, or mixed anxiety and depression. There may be a positive association between multi antihypertensive drug use and symptoms of depression, whereas this was not found in persons with symptoms of anxiety or mixed anxiety and depression. This might reflect poor antihypertensive treatment adherence leading to polypharmacy, or other unfavorable health behaviors in people with symptoms of pure depression.

Cardiac function associated with previous, current and repeated depression and anxiety symptoms in a healthy population: the HUNT study

“…One explanation might be differences in behaviour and biological response, where individuals with anxiety symptoms often seek and cohere with medical and lifestyle advice, while individuals with depression tend to have an unhealthy lifestyle associated with both lower help-seeking and proinflammatory cytokine release,34 35 which can adversely affect pathways in the development towards CVD 931…”

Personalized Approach to Treatment and Rehabilitation of Cardiovascular Patients (On the Materials of Arterial Hypertension and Heart Failure)

“…Наличие тревожных расстройств имеет высокое про-гностическое значение для пациентов. Доказано, что сопутствующий хронический эмоциональный стресс и повышенный уровень тревоги является независи-мым фактором риска возникновения и ухудшения прогноза при АГ и ХСН, способствует прогрессиро-ванию заболевания [20,21]. Патогенез влияния пси-хоэмоционального стресса на развитие и течение АГ и ХСН подробно описан.…”

Antihypertensive treatment and depressive symptoms in Chinese middle‐aged and older hypertensive adults: A population‐based longitudinal study

“…A number of studies confirmed that lack of communication skills of hypertension management, 11 irrational use of medicines, 12 or poor antihypertensive treatment adherence 13 could result in the subsequent depressive symptoms. But, poor management of hypertension may actually have reverse effects instead of controlling blood pressure.…”

“…A number of studies confirmed that lack of communication skills of hypertension management, 11 irrational use of medicines, 12 or poor antihypertensive treatment adherence 13 could result in the subsequent depressive symptoms. 12,13 Until now, epidemiological evidence for an association between any antihypertensive therapy and depressive disorders is inconclusive, and it is unclear whether this relationship is because of lowering blood pressure per se, its treatment, or both. 14,15 None of meta-analyses provided clear evidence on whether antihypertensive treatment reduced or increased the subsequent depressive symptoms.…”