From the Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen Affective Disorder Research Center, Psychiatric Center Copenhagen, Rigshospitalet (L.V.K.), University of Copenhagen, Denmark.
Department of Biostatistics (H.C.R., C.T.E., T.A.G.), University of Copenhagen, Denmark.
Hypertension. 2020 Oct;76(4):1263-1279. doi: 10.1161/HYPERTENSIONAHA.120.15605. Epub 2020 Aug 24.
Hypertension, cardiovascular diseases, and cerebrovascular diseases are associated with an increased risk of depression, but it remains unclear whether treatment with antihypertensive agents decreases or increases this risk. The effects of individual drugs are also unknown. We used Danish population-based registers to systematically investigate whether the 41 most used individual antihypertensive drugs were associated with an altered risk of incident depression. Analyses of diuretics were included for comparisons. Participants were included in the study in January 2005 and followed until December 2015. Two different outcome measures were included: (1) a diagnosis of depressive disorder at a psychiatric hospital as an inpatient or outpatient and (2) a combined measure of a diagnosis of depression or use of antidepressants. Continued use of classes of angiotensin agents, calcium antagonists, and β-blockers was associated with significantly decreased rates of depression, whereas diuretic use was not. Individual drugs associated with decreased depression included 2 of 16 angiotensin agents: enalapril and ramipril; 3 of 10 calcium antagonists: amlodipine, verapamil, and verapamil combinations; and 4 of 15 β-blockers: propranolol, atenolol, bisoprolol, and carvedilol. No drug was associated with an increased risk of depression. In conclusion, real-life population-based data suggest a positive effect of continued use of 9 individual antihypertensive agents. This evidence should be used in guiding prescriptions for patients at risk of developing depression including those with prior depression or anxiety and patients with a family history of depression.
高血压、心血管疾病和脑血管疾病与抑郁症风险增加相关，但降压药物治疗是否降低或增加这种风险尚不清楚。个别药物的作用也不清楚。我们使用丹麦基于人群的登记处系统地调查了 41 种最常用的降压药物是否与新发抑郁症风险改变有关。利尿剂的分析也包括在内进行比较。参与者于 2005 年 1 月被纳入研究，并随访至 2015 年 12 月。纳入了两种不同的结局指标：（1）在精神病院住院或门诊诊断为抑郁症障碍；（2）抑郁症的诊断或使用抗抑郁药的综合测量。继续使用血管紧张素类药物、钙拮抗剂和β受体阻滞剂的类别与抑郁发生率显著降低相关，而利尿剂的使用则没有。与抑郁症发生率降低相关的个别药物包括：血管紧张素类药物中的 2 种（依那普利和雷米普利）；钙拮抗剂中的 3 种（氨氯地平、维拉帕米和维拉帕米联合制剂）；β受体阻滞剂中的 4 种（普萘洛尔、阿替洛尔、比索洛尔和卡维地洛）。没有药物与抑郁症风险增加相关。总之，基于真实人群的临床数据表明，继续使用 9 种降压药物与积极的效果相关。该证据应在指导处方时用于有发生抑郁症风险的患者，包括有既往抑郁症或焦虑症病史的患者以及有抑郁症家族史的患者。
