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

Thomas T van Sloten; Patrick C Souverein; Coen DA Stehouwer; Johanna Hm Driessen

doi:10.1177/02698811221082470

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

Thomas T van Sloten, Patrick C Souverein, Coen DA Stehouwer, Johanna Hm Driessen

Maastricht University Medical Centre

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), commonly used antihypertensive drugs, may have a protective effect against depression in older individuals, but evidence in humans is limited.

AIMS: We evaluated the risk of depression, among older individuals with hypertension, comparing ACE or ARB initiators to thiazide(-like) diuretic initiators. Thiazide(-like) diuretics were used as control because these drugs are not associated with mood disorders.

METHODS: We used a propensity score-matched new user cohort design with routinely collected data from general practices in England from the Clinical Practice Research Datalink database. We matched 12,938 pairs of new users of ACEIs/ARBs and thiazide(-like) diuretics with hypertension (mean age 67.6 years; 54.7% women). Follow-up time started on the date of drug initiation and ended on the date of treatment discontinuation plus 30 days, or switch to a comparator, occurrence of a study event, death, date of patient's transfer out of practice, or end of the study period. The primary outcome was a composite endpoint of treated depression and nonfatal and fatal self-harm.

RESULTS/OUTCOMES: Compared to the thiazide(-like) diuretic group, ACEIs/ARBs use was not associated with a lower risk of the primary outcome (hazard ratio 0.96 (95% confidence interval: 0.79; 1.15)). Results did not differ according to lipophilicity, duration of use, and average daily dose, or class (ACEIs or ARBs).

CONCLUSIONS/INTERPRETATION: New use of ACEIs or ARBs is not associated with a lower risk of depression among individuals with hypertension.

Original language	English
Pages (from-to)	594-603
Number of pages	10
Journal	Journal of Psychopharmacology
Volume	36
Issue number	5
Early online date	7 Apr 2022
DOIs	https://doi.org/10.1177/02698811221082470
Publication status	Published - 1 May 2022

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: T.v.S. was supported by a VENI research grant (916.19.074) from the Netherlands Organization for Scientific Research and a Dutch Heart Foundation research grant (2018T025).

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: T.v.S. was supported by a VENI research grant (916.19.074) from the Netherlands Organization for Scientific Research and a Dutch Heart Foundation research grant (2018T025).

Publisher Copyright:
© The Author(s) 2022.

Keywords

Depression
antihypertensive drugs
hypertension
pharmacoepidemiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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02698811221082470Final published version, 650 KBLicence: CC BY

Cite this

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

abstract = "BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), commonly used antihypertensive drugs, may have a protective effect against depression in older individuals, but evidence in humans is limited.AIMS: We evaluated the risk of depression, among older individuals with hypertension, comparing ACE or ARB initiators to thiazide(-like) diuretic initiators. Thiazide(-like) diuretics were used as control because these drugs are not associated with mood disorders.METHODS: We used a propensity score-matched new user cohort design with routinely collected data from general practices in England from the Clinical Practice Research Datalink database. We matched 12,938 pairs of new users of ACEIs/ARBs and thiazide(-like) diuretics with hypertension (mean age 67.6 years; 54.7% women). Follow-up time started on the date of drug initiation and ended on the date of treatment discontinuation plus 30 days, or switch to a comparator, occurrence of a study event, death, date of patient's transfer out of practice, or end of the study period. The primary outcome was a composite endpoint of treated depression and nonfatal and fatal self-harm.RESULTS/OUTCOMES: Compared to the thiazide(-like) diuretic group, ACEIs/ARBs use was not associated with a lower risk of the primary outcome (hazard ratio 0.96 (95% confidence interval: 0.79; 1.15)). Results did not differ according to lipophilicity, duration of use, and average daily dose, or class (ACEIs or ARBs).CONCLUSIONS/INTERPRETATION: New use of ACEIs or ARBs is not associated with a lower risk of depression among individuals with hypertension.",

keywords = "Depression, antihypertensive drugs, hypertension, pharmacoepidemiology",

author = "{van Sloten}, {Thomas T} and Souverein, {Patrick C} and Stehouwer, {Coen DA} and Driessen, {Johanna Hm}",

note = "Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: T.v.S. was supported by a VENI research grant (916.19.074) from the Netherlands Organization for Scientific Research and a Dutch Heart Foundation research grant (2018T025). Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: T.v.S. was supported by a VENI research grant (916.19.074) from the Netherlands Organization for Scientific Research and a Dutch Heart Foundation research grant (2018T025). Publisher Copyright: {\textcopyright} The Author(s) 2022.",

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AU - van Sloten, Thomas T

AU - Souverein, Patrick C

AU - Stehouwer, Coen DA

AU - Driessen, Johanna Hm

N1 - Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: T.v.S. was supported by a VENI research grant (916.19.074) from the Netherlands Organization for Scientific Research and a Dutch Heart Foundation research grant (2018T025). Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: T.v.S. was supported by a VENI research grant (916.19.074) from the Netherlands Organization for Scientific Research and a Dutch Heart Foundation research grant (2018T025). Publisher Copyright: © The Author(s) 2022.

PY - 2022/5/1

Y1 - 2022/5/1

N2 - BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), commonly used antihypertensive drugs, may have a protective effect against depression in older individuals, but evidence in humans is limited.AIMS: We evaluated the risk of depression, among older individuals with hypertension, comparing ACE or ARB initiators to thiazide(-like) diuretic initiators. Thiazide(-like) diuretics were used as control because these drugs are not associated with mood disorders.METHODS: We used a propensity score-matched new user cohort design with routinely collected data from general practices in England from the Clinical Practice Research Datalink database. We matched 12,938 pairs of new users of ACEIs/ARBs and thiazide(-like) diuretics with hypertension (mean age 67.6 years; 54.7% women). Follow-up time started on the date of drug initiation and ended on the date of treatment discontinuation plus 30 days, or switch to a comparator, occurrence of a study event, death, date of patient's transfer out of practice, or end of the study period. The primary outcome was a composite endpoint of treated depression and nonfatal and fatal self-harm.RESULTS/OUTCOMES: Compared to the thiazide(-like) diuretic group, ACEIs/ARBs use was not associated with a lower risk of the primary outcome (hazard ratio 0.96 (95% confidence interval: 0.79; 1.15)). Results did not differ according to lipophilicity, duration of use, and average daily dose, or class (ACEIs or ARBs).CONCLUSIONS/INTERPRETATION: New use of ACEIs or ARBs is not associated with a lower risk of depression among individuals with hypertension.

AB - BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), commonly used antihypertensive drugs, may have a protective effect against depression in older individuals, but evidence in humans is limited.AIMS: We evaluated the risk of depression, among older individuals with hypertension, comparing ACE or ARB initiators to thiazide(-like) diuretic initiators. Thiazide(-like) diuretics were used as control because these drugs are not associated with mood disorders.METHODS: We used a propensity score-matched new user cohort design with routinely collected data from general practices in England from the Clinical Practice Research Datalink database. We matched 12,938 pairs of new users of ACEIs/ARBs and thiazide(-like) diuretics with hypertension (mean age 67.6 years; 54.7% women). Follow-up time started on the date of drug initiation and ended on the date of treatment discontinuation plus 30 days, or switch to a comparator, occurrence of a study event, death, date of patient's transfer out of practice, or end of the study period. The primary outcome was a composite endpoint of treated depression and nonfatal and fatal self-harm.RESULTS/OUTCOMES: Compared to the thiazide(-like) diuretic group, ACEIs/ARBs use was not associated with a lower risk of the primary outcome (hazard ratio 0.96 (95% confidence interval: 0.79; 1.15)). Results did not differ according to lipophilicity, duration of use, and average daily dose, or class (ACEIs or ARBs).CONCLUSIONS/INTERPRETATION: New use of ACEIs or ARBs is not associated with a lower risk of depression among individuals with hypertension.

KW - Depression

KW - antihypertensive drugs

KW - hypertension

KW - pharmacoepidemiology

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JO - Journal of Psychopharmacology

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ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

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