Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China.
BeiGene (Beijing) Co., Ltd., Beijing 100027, China.
J Affect Disord. 2019 Dec 1;259:386-391. doi: 10.1016/j.jad.2019.08.075. Epub 2019 Aug 24.
Evidence is increasing that pathways of antihypertensives may have a role in the pathogenesis of depression. However, how the class of antihypertensives affects depression risk remains unclear.
The effects of different classes of antihypertensives on depression were explored using an insurance database in Beijing, China. Antihypertensives in our study included calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), beta-blockers (BBs), and diuretics (DIUs). Those initially treated with only one class of antihypertensives were included. Stratified analysis was conducted for demographic characteristics, comorbidities, and statin prescriptions.
In total, 181,709 newly detected hypertension patients were included. The median follow-up period was 4.33 years and 19,030 participants were with depression by the end. After adjusting for covariates, the incidence density (95% confidence interval, CI) of depression in the BB, ACEI, DIU, CCB, and ARB groups was 3.16 (2.98-3.33), 3.10 (2.91-3.29), 2.70 (2.45-2.94), 2.67 (2.53-2.81), and 2.30 (2.16-2.43) per 100 person-years, respectively. Compared with ARB group, the hazard ratio (95% CI) of depression for BB, ACEI, DIU, and CCB group was 1.37 (1.32-1.43), 1.35 (1.28-1.42), 1.17 (1.08-1.27), and 1.16 (1.12-1.21), respectively. Stratified analysis suggested the highest depression ID remained within the BB or ACEI group.
Detailed clinical information was unavailable, which may introduce bias. Patients on monotherapy as initial treatment were included and caution is needed for extrapolation.
Compared with ARBs, there may be a class effect of other antihypertensives on the risk of depression.
越来越多的证据表明，降压药物的作用途径可能与抑郁症的发病机制有关。然而，降压药物的类别如何影响抑郁风险尚不清楚。
我们利用中国北京的一个保险数据库来研究不同类别的降压药对抑郁症的影响。本研究中的降压药包括钙通道阻滞剂（CCB）、血管紧张素转换酶抑制剂（ACEI）、血管紧张素 II 受体阻滞剂（ARB）、β受体阻滞剂（BB）和利尿剂（DIU）。仅接受一种降压药治疗的患者被纳入研究。对人口统计学特征、合并症和他汀类药物处方进行分层分析。
共纳入 181709 例新诊断的高血压患者。中位随访时间为 4.33 年，研究结束时共有 19030 例患者患有抑郁症。在调整了混杂因素后，BB、ACEI、DIU、CCB 和 ARB 组的抑郁发生率密度（95%置信区间，CI）分别为 3.16（2.98-3.33）、3.10（2.91-3.29）、2.70（2.45-2.94）、2.67（2.53-2.81）和 2.30（2.16-2.43）/100 人年。与 ARB 组相比，BB、ACEI、DIU 和 CCB 组发生抑郁的风险比（95%CI）分别为 1.37（1.32-1.43）、1.35（1.28-1.42）、1.17（1.08-1.27）和 1.16（1.12-1.21）。分层分析表明，BB 或 ACEI 组的抑郁发生率最高。
缺乏详细的临床信息，可能会引入偏倚。仅纳入初始接受单药治疗的患者，外推时需谨慎。
与 ARBs 相比，其他降压药可能对抑郁风险有类效应。
