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Anxiety and depression symptoms in arterial hypertension: the influence of antihypertensive treatment. The HUNT study, Norway

European Journal of Epidemiology volume 27, pages 63–72 (2012)Cite this article

Abstract

Antihypertensive drugs have been suggested to modulate symptoms of depression and anxiety. It is disputed whether this is due to the hypertension per se, its treatment, or both. The aim of this study was to investigate these associations in a large population sample. 55,472 participants in the Nord-Trøndelag Health Study (HUNT 2, 1995–1997), Norway, who completed the Hospital Anxiety and Depression rating Scale, were divided into 3 groups according to their diastolic blood pressure and antihypertensive treatment status. A cut-off of ≥90 mmHg diastolic blood pressure was used to identify hypertensive status. Differences in anxiety and depression symptom levels in untreated and treated hypertensives (all treatments) versus the normotensive reference group were explained by differences in age and gender distribution in the three groups in this study. However, the receipt of two or more antihypertensive drugs was associated with depressive symptoms alone (OR = 1.40, 95% CI = 1.03–1.90), but not with symptoms of anxiety (OR = 1.14, 95% CI = 0.83–1.57) or mixed anxiety and depression (OR = 1.19, 95% CI = 0.82–1.72) in the fully adjusted model, compared to untreated hypertension. Antihypertensive monotherapy (all agents) nor any single antihypertensive drug class were associated with symptoms of depression, anxiety, or mixed anxiety and depression. There may be a positive association between multi antihypertensive drug use and symptoms of depression, whereas this was not found in persons with symptoms of anxiety or mixed anxiety and depression. This might reflect poor antihypertensive treatment adherence leading to polypharmacy, or other unfavorable health behaviors in people with symptoms of pure depression.

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References

  1. Carod-Artal FJ. Post-stroke depression (I). Epidemiology diagnostic criteria and risk factors. Revista de Neurologia. 2006;42:169–75.

    PubMed  CAS  Google Scholar 

  2. Frasure-Smith N. Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease. Arch Gen Psychiatry. 2008;65:62–71.

    PubMed  Article  CAS  Google Scholar 

  3. Lesperance F, Frasure-Smith N, Talajic M, Bourassa MG. Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after myocardial infarction. Circulation. 2002;105:1049–53.

    PubMed  Article  Google Scholar 

  4. Jonas BS, Franks P, Ingram DD. Are symptoms of anxiety and depression risk factors for hypertension? Longitudinal evidence from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Arch Fam Med. 1997;6:43–9.

    PubMed  Article  CAS  Google Scholar 

  5. Davidson K, Jonas BS, Dixon KE, Markovitz JH. Do depression symptoms predict early hypertension incidence in young adults in the CARDIA study? Arch Intern Med. 2000;160:1495–500.

    PubMed  Article  CAS  Google Scholar 

  6. Jonas BS, Lando JF. Negative affect as a prospective risk factor for hypertension. Psychosom Med. 2000;62:188–96.

    PubMed  CAS  Google Scholar 

  7. Markovitz JH, Matthews KA, Kannel WB, Cobb JL, Dagostino RB. Psychological Predictors of Hypertension in the Framingham-Study—is there tension in hypertension. Circulation. 1993;87:691.

    Google Scholar 

  8. Hildrum B, Mykletun A, Stordal E, Bjelland I, Dahl AA, Holmen J. Association of low blood pressure with anxiety and depression: the Nord-Trondelag Health Study. J Epidemiol Community Health. 2007;61:53–8.

    PubMed  Article  Google Scholar 

  9. Reiff M, Schwartz S, Northridge M. Relationship of depressive symptoms to hypertension in a household survey in Harlem. Psychosom Med. 2001;63:711–21.

    PubMed  CAS  Google Scholar 

  10. Shinn EH, Poston WSC, Kimball KT, St Jeor ST, Foreyt JP. Blood pressure and symptoms of depression and anxiety: a prospective study. Am J Hypertens. 2001;14:660–71.

    PubMed  Article  CAS  Google Scholar 

  11. Wiehe M. Absence of association between depression and hypertension: results of a prospectively designed population-based study. J Hum Hypertens. 2006;20:434–9.

    PubMed  Article  CAS  Google Scholar 

  12. Hildrum B, Romild U, Holmen J. Anxiety and depression lowers blood pressure: 22-year follow-up of the population based HUNT study, Norway. BMC Public Health. 2011;11:601.

    PubMed  Article  Google Scholar 

  13. Patten SB. Propranolol and depression—evidence from the antihypertensive trials. Can J Psychiatry-Revue Canadienne de Psychiatrie. 1990;35:257–9.

    CAS  Google Scholar 

  14. Rathmann W, Haastert B, Roseman JM, Giani G. Cardiovascular drug prescriptions and risk of depression in diabetic patients. J Clin Epidemiol. 1999;52:1103–9.

    PubMed  Article  CAS  Google Scholar 

  15. Hallas J. Evidence of depression provoked by cardiovascular medication: a prescription sequence symmetry analysis. Epidemiology. 1996;7:478–84.

    PubMed  Article  CAS  Google Scholar 

  16. Patten SB, Williams JVA, Love EJ. Case-control studies of cardiovascular medications as risk factors for clinically diagnosed depressive disorders in a hospitalized population. Can J Psychiatry-Revue Canadienne de Psychiatrie. 1996;41:469–76.

    CAS  Google Scholar 

  17. Ko DT, Hebert PR, Coffey CS, Sedrakyan A, Curtis JP, Krumholz HM. Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction. JAMA. 2002;288:351–7.

    PubMed  Article  CAS  Google Scholar 

  18. Huffman JC. Neuropsychiatric consequences of cardiovascular medications. Dialogues Clin Neurosci. 2007;9:29–45.

    PubMed  Google Scholar 

  19. Dunn NR. Cohort study on calcium channel blockers, other cardiovascular agents, and the prevalence of depression. Br J Clin Pharmacol. 1999;48:230–3.

    PubMed  Article  CAS  Google Scholar 

  20. Kornischka J, Cordes J, Agelink MW. 40 years beta-adrenoceptor blockers in psychiatry. Fortschritte der Neurologie Psychiatrie. 2007;75:199–210.

    PubMed  Article  CAS  Google Scholar 

  21. Hollister LE. Calcium channel blockers in psychiatric disorders: a review of the literature. Can J Psychiatry. 1999;44:658–64.

    PubMed  CAS  Google Scholar 

  22. Holmen J, Midthjell K, Kruger Ø, Langhammer A, Holmen TL, Bratberg GH, Vatten L, Lund-Larsen PG. The Nord-Trøndelag Health Study 1995–97 (HUNT 2): objectives, content, methods and participation. Norsk Epidemiologi. 2003;13:19–32.

    Google Scholar 

  23. Bjelland I, Dahl AA, Haug TT. The validity of the Hospital Anxiety and Depression Scale—an updated literature review. J Psychosom Res. 2002;52:69–77.

    PubMed  Article  Google Scholar 

  24. Bosworth HB. The association of psychosocial factors and depression with hypertension among older adults. Int J Geriatr Psychiatry. 2003;18:1142–8.

    PubMed  Article  Google Scholar 

  25. Wells KB, Golding JM, Burnam MA. Affective, substance use, and anxiety disorders in persons with arthritis, diabetes, heart-disease, high blood-pressure, or chronic lung conditions. Gen Hosp Psychiatry. 1989;11:320–7.

    PubMed  Article  CAS  Google Scholar 

  26. Gaynes BN, Burns BJ, Tweed DL, Erickson P. Depression and health-related quality of life. J Nerv Ment Dis. 2002;190:799–806.

    PubMed  Article  Google Scholar 

  27. Paterniti S, Alperovitch A, Ducimetiere P, Dealberto MJ, Lepine JP, Bisserbe JC. Anxiety but not depression is associated with elevated blood pressure in a community group of French elderly. Psychosom Med. 1999;61:77–83.

    PubMed  CAS  Google Scholar 

  28. Jorgensen RS. Elevated blood pressure and personality: a meta-analytic review. Psychol Bull. 1996;120:293–320.

    PubMed  Article  CAS  Google Scholar 

  29. Panicker V, Evans J, Asvold BO, Dayan CM, Bjerkeset O. A paradoxial difference in relationship between anxiety, depression and thyroid function in subjects on and not on T4: findings from the HUNT study. Clin Endocrinol. 2009;71:574–80.

    Article  Google Scholar 

  30. Niu K. Home blood pressure is associated with depressive symptoms in an elderly population aged 70 years and over: a population-based, cross-sectional analysis. Hypertens Res. 2008;31:409–16.

    PubMed  Article  Google Scholar 

  31. Vasudev A, O’Brien JT, Tan MP, Parry SW, Thomas AJ. A study of orthostatic hypotension, heart rate variability and baroreflex sensitivity in late-life depression. J Affect Disord. 2011;131:374–8.

    PubMed  Article  Google Scholar 

  32. Oppenheim G. Propranolol-induced depression: mechanism and management. Aust N Z J Psychiatry. 1983;17:400–2.

    PubMed  CAS  Google Scholar 

  33. Pollack MH. Comorbid anxiety and depression. J Clin Psychiatry. 2005;66:22–9.

    PubMed  Article  CAS  Google Scholar 

  34. Fitzgerald JD. Propranolol-induced depression. Br Med J. 1967;2:372–3.

    PubMed  Article  CAS  Google Scholar 

  35. Bright RA. Beta-blockers and depression. Evidence against an association. JAMA. 1992;267:1783–7.

    PubMed  Article  CAS  Google Scholar 

  36. Stoudemire A. Propranolol and depression: a reevaluation based on a pilot clinical trial. Psychiatric Med. 1984;2:211–8.

    CAS  Google Scholar 

  37. Carney RM. Prevalence of major depressive disorder in patients receiving beta-blocker therapy versus other medications. Am J Med. 1987;83:223–6.

    PubMed  Article  CAS  Google Scholar 

  38. Ried LD, McFarland BH, Johnson RE, Brody KK. Beta-blockers and depression: the more the murkier? Ann Pharmacother. 1998;32:699–708.

    PubMed  Article  CAS  Google Scholar 

  39. Gerstman BB, Jolson HM, Bauer M, Cho P, Livingston JM, Platt R. The incidence of depression in new users of beta-blockers and selected antihypertensives. J Clin Epidemiol. 1996;49:809–15.

    PubMed  Article  CAS  Google Scholar 

  40. Schneier FR. Clinical practice. Social anxiety disorder. N Engl J Med. 2006;355:1029–36.

    PubMed  Article  CAS  Google Scholar 

  41. Zamorski MA. What to do when SSRIs fail: eight strategies for optimizing treatment of panic disorder. Am Fam Physician. 2002;66:1477–84.

    PubMed  Google Scholar 

  42. Dannon PN. Pindolol augmentation in treatment-resistant obsessive compulsive disorder: a double-blind placebo controlled trial. Eur Neuropsychopharmacol. 2000;10:165–9.

    PubMed  Article  CAS  Google Scholar 

  43. Ried LD. Depressive symptoms in coronary artery disease patients after hypertension treatment. Ann Pharmacother. 2006;40:597–604.

    PubMed  Article  Google Scholar 

  44. Keller SSFWW. Neuropsychiatric effects of cardiovascular drug therapy. Cardiol Rev. 2003;11:73–93.

    PubMed  Article  Google Scholar 

  45. Germain L. Treatment of recurrent unipolar major depression with captopril. Biol Psychiatry. 1988;23:637–41.

    PubMed  Article  CAS  Google Scholar 

  46. Hertzman M. Lisinopril may augment antidepressant response. J Clin Psychopharmacol. 2005;25:618–20.

    PubMed  Article  Google Scholar 

  47. Maas R. Antihypertensive therapy: special focus on drug interactions. Expert Opin Drug Saf. 2003;2:549–79.

    PubMed  Article  CAS  Google Scholar 

  48. Carter BL. Antihypertensive drug interactions. Drugs Today. 2005;41:55–63.

    PubMed  Article  CAS  Google Scholar 

  49. Carter BL, Lund BC, Chrischilles EA, Hayase N. Longitudinal analysis of antihypertensive drug interactions. Am J Hypertens. 2003;16:13A.

    Article  Google Scholar 

  50. Roness A, Mykletun A, Dahl AA. Help-seeking behaviour in patients with anxiety disorder and depression. Acta Psychiatr Scand. 2005;111:51–8.

    PubMed  Article  CAS  Google Scholar 

  51. Simon G, Ormel J, VonKorff M, Barlow W. Health care costs associated with depressive and anxiety disorders in primary care. Am J Psychiatry. 1995;152:352–7.

    PubMed  CAS  Google Scholar 

  52. Roy-Byrne PP, Stang P, Wittchen HU, Ustun B, Walters EE, Kessler RC. Lifetime panic-depression comorbidity in the National Comorbidity Survey. Association with symptoms, impairment, course and help-seeking. Br J Psychiatry. 2000;176:229–35.

    PubMed  Article  CAS  Google Scholar 

  53. Mykletun A, Bjerkeset O, Dewey M, Prince M, Overland S, Stewart R. Anxiety, depression, and cause-specific mortality: the HUNT study. Psychosom Med. 2007;69:323–31.

    PubMed  Article  Google Scholar 

  54. Herrmann C, Brand-Driehorst S, Buss U, Ruger U. Effects of anxiety and depression on 5-year mortality in 5, 057 patients referred for exercise testing. J Psychosom Res. 2000;48:455–62.

    PubMed  Article  CAS  Google Scholar 

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Acknowledgments

Nord-Trøndelag Health Study (The HUNT Study) is a collaboration between HUNT Research Centre, Faculty of Medicine at the Norwegian University of Science and Technology (NTNU, Verdal), Norwegian Institute of Public Health, and Nord-Trøndelag County Council. None of the authors have received any financial benefits or other support in this study and there are no conflicts of interest. Robert Stewart is funded by the NIHR Specialist Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London.

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Authors and Affiliations

  1. Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

    Aslak Johansen

  2. Department of Public Health and General Practise, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

    Jostein Holmen

  3. King’s College London (Institute of Psychiatry), London, UK

    Robert Stewart

  4. Department of Research and Development (RaD), Levanger Hospital, Nord-Trøndelag Health Trust, Kirkegt. 2, 7600, Levanger, Norway

    Ottar Bjerkeset

  5. Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

    Ottar Bjerkeset

Authors
  1. Aslak Johansen
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  2. Jostein Holmen
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  3. Robert Stewart
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  4. Ottar Bjerkeset
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Correspondence to Ottar Bjerkeset.

Appendix

Appendix

See Table 4.

Table 4 Drugs registered in the HUNT 2 antihypertensive medication follow-up study according to mode of action
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Johansen, A., Holmen, J., Stewart, R. et al. Anxiety and depression symptoms in arterial hypertension: the influence of antihypertensive treatment. The HUNT study, Norway. Eur J Epidemiol 27, 63–72 (2012). https://doi.org/10.1007/s10654-011-9641-y

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  • DOI: https://doi.org/10.1007/s10654-011-9641-y

Keywords

  • Anxiety
  • Depression
  • General population
  • Hypertension
  • Treatment
  • Antihypertensive medication