Integration of Depression and Hypertension Treatment: A Pilot, Randomized Controlled Trial

Abstract

PURPOSE We wanted to examine whether integrating depression treatment into care for hypertension improved adherence to antidepressant and antihypertensive medications, depression outcomes, and blood pressure control among older primary care patients. METHODSOlder adults prescribed pharmacotherapy for depression and hypertension from physicians at a large primary care practice in West Philadelphia were randomly assigned to an integrated care intervention or usual care. Outcomes were assessed at baseline, 2, 4, and 6 weeks using the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depression, an electronic monitor to measure blood pressure, and the Medication Event Monitoring System to assess adherence. RESULTSIn all, 64 participants aged 50 to 80 years participated. Participants in the integrated care intervention had fewer depressive symptoms (CES-D mean scores, intervention 9.9 vs usual care 19.3; P <.01), lower systolic blood pressure (intervention 127.3 mm Hg vs usual care 141.3 mm Hg; P <.01), and lower diastolic blood pressure (intervention 75.8 mm Hg vs usual care 85.0 mm Hg; P <.01) compared with participants in the usual care group at 6 weeks. Compared with the usual care group, the proportion of participants in the intervention group who had 80% or greater adherence to an antidepressant medication (intervention 71.9% vs usual care 31.3%; P <.01) and to an antihypertensive medication (intervention 78.1% vs usual care 31.3%; P <.001) was greater at 6 weeks.CONCLUSION A pilot, randomized controlled trial integrating depression and hypertension treatment was successful in improving patient outcomes. Integrated interventions may be more feasible and effective in real-world practices, where there are competing demands for limited resources. Ann Fam Med 2008;6:295-301. DOI: 10.1370/afm.843. INTRODUCTIONP rimary care occupies a strategic position in the evaluation and treatment of depression among older adults, 1 and enhancing depression management in primary care appears to be a promising use of health care resources.2 To have an impact on public health, advances in the treatment of depression must be realized in primary care. Although recent studies have shown that a variety of primary care interventions can improve depression outcomes among older adults, 3,4 these interventions are not being widely implemented in practice. Some evidence indicates that addressing medical comorbidity, especially cardiovascular disease (CVD), may be essential in managing depression. [5][6][7] In addition, managing depression in the context of medical comorbidity may be more acceptable to patients than managing depression alone. DEPR ES SION A ND HY PER T ENSION T R E AT MEN Tmanagement of depression with management of medical comorbidity.In this trial, we focused on integrating depression management into care for hypertension. Hypertension affects between 20% to 50% of adults in most countries 9 and is a major risk factor for cardiovascular morbidity and mortality, 10 representing two-thirds of all s...

Integrated Management of Type 2 Diabetes Mellitus and Depression Treatment to Improve Medication Adherence: A Randomized Controlled Trial

“…The integrated care manager worked individually with patients to address the factors involved in adherence presented in our conceptual model, adapted from Cooper and colleagues, 26 and previously published. 27,28 In our conceptual model, the patient-level factors resulting in nonadherence included depression, chronic medical conditions, function, cognition, social support, cost of medications, side effects, and past experiences with medications. Patient-level factors were addressed through a variety of activities that included in-person sessions, telephone contacts, and collaborating with the physician.…”

Influence of Combination Antihypertension Therapy on the Parameters of Vessel Wall Rigidity in Non-Controlled Arterial Hypertension Patients With Depression

“…Данные литературы об антигипертензивных эффектах СИОЗС немногочисленны и достаточно противоречивы [13,14]. Предполагается, что исполь-зование Эс может обеспечивать блокаду пресинапти-ческих серотониновых рецепторов, увеличивать выделение и накопление серотонина в синаптиче-ской щели, и, как результат, стабилизирует функцио-нирование серотонинергической системы [11].…”

Simplifying Care for Complex Patients

“…For example, Lin et al and others have previously shown that depression care management has the potential to improve multiple symptom domains. [8][9][10] Further, patient populations with multiple morbidities and depression may be more responsive to general self-management interventions than are populations with no depression and fewer medical conditions. 11,12 Thus, there seems to be little doubt that care management attending to depression and other conditions has the potential to improve several health outcomes for both conditions.…”