Monotherapy With Major Antihypertensive Drug Classes and Risk of Hospital Admissions for Mood Disorders.
Monotherapy With Major Antihypertensive Drug Classes and Risk of Hospital Admissions for Mood Disorders.
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DOI：
10.1161/hypertensionaha.116.08188
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发表时间：
2016-11
期刊：
影响因子：
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通讯作者：
Padmanabhan S
中科院分区：
文献类型：
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作者：
Boal AH;Smith DJ;McCallum L;Muir S;Touyz RM;Dominiczak AF;Padmanabhan S
补充数字内容可在正文中找到。严重的抑郁症和双相情感障碍易导致动脉粥样硬化，动物模型、流行病学和基因组研究积累的数据表明，常用的抗高血压药物可能在心境障碍的发病机制或病程中起作用。在这项研究中，我们建议通过对525名 046名随访5年的大型医院数据库中的不同类别降压药物单一治疗的患者进行分析，来确定降压药物是否对情绪障碍有影响。有144名符合 标准的066名患者符合纳入标准：服用降压药且服药时间为90天的年龄在40岁至80岁之间。Charlson和Elixhauser评分评估的共病负担表明，共病负担与情绪障碍的诊断独立的线性相关。在299例入院患者中，因情绪障碍入院的中位时间为847天(641 685人/年的随访)。服用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的患者发生情绪障碍的风险最低，而与这组患者相比，服用β阻滞剂(危险比=2.11；[95%可信区间，1.12-3.98]；P=0.02)和钙拮抗剂(2.28[95%可信区间，1.13-4.58]；P=0.02)的患者显示出更高的风险，而不服用降压药的患者(1.63[95%可信区间，0.94-2.82]；P=0.08)和噻嗪类利尿剂(1.56[95%可信区间，0.65~3.73]；P=0.32)之间差异无统计学意义。总体而言，我们的探索性发现表明，抗高血压药物对情绪的可能不同影响值得进一步研究：钙拮抗剂和β阻滞剂可能与增加风险有关，而血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂可能与降低情绪障碍的风险相关。
Supplemental Digital Content is available in the text. Major depressive and bipolar disorders predispose to atherosclerosis, and there is accruing data from animal model, epidemiological, and genomic studies that commonly used antihypertensive drugs may have a role in the pathogenesis or course of mood disorders. In this study, we propose to determine whether antihypertensive drugs have an impact on mood disorders through the analysis of patients on monotherapy with different classes of antihypertensive drugs from a large hospital database of 525 046 patients with follow-up for 5 years. There were 144 066 eligible patients fulfilling the inclusion criteria: age 40 to 80 years old at time of antihypertensive prescription and medication exposure >90 days. The burden of comorbidity assessed by Charlson and Elixhauser scores showed an independent linear association with mood disorder diagnosis. The median time to hospital admission with mood disorder was 847 days for the 299 admissions (641 685 person-years of follow-up). Patients on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers had the lowest risk for mood disorder admissions, and compared with this group, those on β-blockers (hazard ratio=2.11; [95% confidence interval, 1.12–3.98]; P=0.02) and calcium antagonists (2.28 [95% confidence interval, 1.13–4.58]; P=0.02) showed higher risk, whereas those on no antihypertensives (1.63 [95% confidence interval, 0.94–2.82]; P=0.08) and thiazide diuretics (1.56 [95% confidence interval, 0.65–3.73]; P=0.32) showed no significant difference. Overall, our exploratory findings suggest possible differential effects of antihypertensive medications on mood that merits further study: calcium antagonists and β-blockers may be associated with increased risk, whereas angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be associated with a decreased risk of mood disorders.