Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers and risk of depression among older people with hypertension

Association between antihypertensive drug use and the risk of depression: a systematic review and network meta-analysis

Hypertension is the biggest and most prevalent risk factor for cardiovascular diseases. Depression is the most common psychiatric illness worldwide. Many studies have linked the development of new depression to the use of antihypertensive drugs. This meta-analysis was done to ascertain the relationship. Using standard reporting techniques a literature search was undertaken in Pubmed from inception till 10 May 2024. The risk bias assessment was done using the ROBINS-I tool. Data for the odds ratio were combined using Revman 5.4 using a random or fixed effects model. Our analysis found a significant association between beta blockers and calcium channel blockers use and the risk of developing new depression. Results for other classes of antihypertensives were not significant. The findings highlight the importance of taking into account the potential psychiatric side effects of antihypertensive drugs in people with hypertension. Physicians should stay vigilant and screen their patients for these conditions regularly.

Role of brain renin-angiotensin system in depression: A new perspective

Depression is a mood disorder characterized by abnormal thoughts. The pathophysiology of depression is related to the deficiency of serotonin (5HT), which is derived from tryptophan (Trp). Mitochondrial dysfunction, oxidative stress, and neuroinflammation are involved in the pathogenesis of depression. Notably, the renin-angiotensin system (RAS) is involved in the pathogenesis of depression, and different findings revealed that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may be effective in depression. However, the underlying mechanism for the role of dysregulated brain RAS-induced depression remains speculative. Therefore, this review aimed to revise the conceivable role of ACEIs and ARBs and how these agents ameliorate the pathophysiology of depression. Dysregulation of brain RAS triggers the development and progression of depression through the reduction of brain 5HT and expression of brain-derived neurotrophic factor (BDNF) and the induction of mitochondrial dysfunction, oxidative stress, and neuroinflammation. Therefore, inhibition of central classical RAS by ARBS and ACEIs and activation of non-classical RAS prevent the development of depression by regulating 5HT, BDNF, mitochondrial dysfunction, oxidative stress, and neuroinflammation.

The 18-year risk of cancer, angioedema, insomnia, depression, and erectile dysfunction in association with antihypertensive drugs: post-trial analyses from ALLHAT-Medicare linked data

Purpose

This study aimed to determine the 18-year risk of cancer, angioedema, insomnia, depression, and erectile dysfunction in association with antihypertensive drug use.

Methods

This is a post-trial passive follow-up study of Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants between 1994 and 1998 that was conducted by linking their follow-up data with Medicare claims data until 2017 of subjects who were free of outcomes at baseline on 1 January 1999. The main outcomes were the occurrence of cancer (among n = 17,332), angioedema (among n = 17,340), insomnia (among n = 17,340), depression (among n = 17,330), and erectile dysfunction (among n = 7,444 men) over 18 years of follow-up.

Results

The 18-year cumulative incidence rate of cancer other than non-melanoma skin cancer from Medicare inpatient claims was 23.9% for chlorthalidone, 23.4% for amlodipine, and 25.3% for lisinopril. There were no statistically significant differences in the 18-year risk of cancer, depression, and erectile dysfunction among the three drugs based on the adjusted hazard ratios. The adjusted 18-year risk of angioedema was elevated in those receiving lisinopril than in those receiving amlodipine (hazard ratio: 1.63, 95% CI: 1.14-2.33) or in those receiving chlorthalidone (1.33, 1.00-1.79), whereas the adjusted 18-year risk of insomnia was statistically significantly decreased in those receiving lisinopril than in those receiving amlodipine (0.90, 0.81-1.00).

Conclusions

The 18-year risk of angioedema was significantly higher in patients receiving lisinopril than in those receiving amlodipine or chlorthalidone; the risk of insomnia was significantly lower in patients receiving lisinopril than in those receiving amlodipine; and the risk of cancer, depression, and erectile dysfunction (in men) was not statistically significantly different among the three drug groups.

Latent profile analysis of depression in non-hospitalized elderly patients with hypertension and its influencing factors

BACKGROUND

Hypertension is a common chronic disease in the elderly, which seriously affects people's physical and mental health, leading to anxiety, depression and other symptoms. To analyze the types of depression that may occur in elderly patients with non-hospitalized hypertension and explore its influencing factors can reduce the level of depression and improve the quality of life.

METHODS

Based on the data of the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), latent profile analysis (LPA) was used to establish the potential profile model of elderly hypertensive patients with depression, and multiple logistic regression analysis was employed to explore the influencing factors of patients with depression.

RESULTS

3514 elderly patients with hypertension could be divided into three potential characteristics of depression: low-level (13.9 %), medium-level (51.9 %) and high-level (34.2 %). Multiple logistic regression showed that anxiety, IADL, age, exercise, economic level, hearing difficulty, self-reported health and visual function predicted the depression of the medium-level in the comparison between the low-level and the medium-level; taking low levels as a reference, anxiety, IADL, co-residence of interviewee, age, exercise, self-reported health marital status and visual function can predict the depression of high-level; anxiety, exercise, self-reported health and marital status predicted the depression of the high-level in the comparison between the medium-level and the high-level.

LIMITATIONS

(1) This study is a cross-sectional study; (2) due to data limitations, other influencing factors may be ignored.

CONCLUSION

Depression in elderly patients with hypertension was divided into three potential profiles, which had obvious classification characteristics.