From the Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO.
J Am Board Fam Med. 2018 Jan-Feb;31(1):22-28. doi: 10.3122/jabfm.2018.01.170234.
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.
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.
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).
Commonly used ADMs were not associated with incident hypertension after controlling for other factors associated with ADM use and hypertension. Research on potential dose and duration effects is warranted.
许多抗抑郁药物（ADM）可改变血压（BP），但关于 ADM 对高血压发病影响的研究结果不一。我们研究了 ADM 使用是否与高血压的发生有关。
采用 2008 年至 2015 年的 6224 例初级保健就诊者的电子病历数据进行回顾性队列研究。根据处方医嘱确定 ADM 使用情况，根据病历诊断确定高血压。根据说明书警告，创建了一个 3 级 ADM 暴露变量：增加 BP 的 ADM（ADM BP+）、不增加 BP 的 ADM 和无 ADM。使用未调整和调整后的 Cox 比例风险模型估计 ADM 暴露与高血压发病的相关性。
未经调整的结果显示，与无 ADM 组相比，ADM BP+ 组发生高血压的风险显著升高（风险比，1.30；95%置信区间，1.08-1.57）。调整了其他与 ADM 使用和高血压相关的混杂因素后，ADM BP+ 组与高血压发病的相关性不再显著（风险比，1.20；95%置信区间，0.97-1.49）。
在控制与 ADM 使用和高血压相关的其他因素后，常用的 ADM 与高血压发病无关。有必要研究潜在的剂量和持续时间效应。
