Effect of withdrawal of antihypertensive drug on depressive mood.
To evaluate the effects on depressive mood of withdrawal of antihypertensive medication, we conducted a randomized, multi-center study with clinical centers at the Albert Einstein College of Medicine, Bronx, NY, University of Alabama School of Medicine, Birmingham, and the University of Mississippi School of Medicine in Jackson. Patients were formerly active participants in the Hypertension Detection and Follow-Up Program (HDFP) whose blood pressure was controlled with drugs for a period of 5 years. Of 496 patients, 431 had both baseline and "1-year" mood scores. Patients, stratified by obesity, were randomized to one of three groups: continue the HDFP medication; discontinue medication with no dietary intervention, or with sodium restriction and potassium increase; or, for those overweight, to a weight reduction intervention. Depression was assessed using the CES-D scale (Center for Epidemiological Studies--Depressed Mood), administered at baseline and again approximately 1 year after randomization. Of the seven treatment groups, only those who continued their HDFP medication showed significant improvement in mood from baseline. The overweight continue-medication group showed significantly greater improvement compared to the no-drugs, no-diet intervention groups, and to the overweight sodium-restriction group. Patients who had their blood pressure successfully controlled with weight reduction had a significant improvement in mood from 11.0 scale points to 8.0, P = .006. Comparisons between those withdrawn from diuretic alone and those withdrawn from both diuretic plus reserpine were inconclusive. Dietary Intervention Study of Hypertension (DISH) shows no evidence that continued use of chlorthalidone has a negative impact on quality of life, while our results concerning reserpine were inconclusive.(ABSTRACT TRUNCATED AT 250 WORDS)
Thaler
L
L
Albert Einstein College of Medicine, Bronx, New York 10461.
Wassertheil-Smoller
S
S
Blaufox
M D
MD
Oberman
A
A
Langford
H G
HG
D000339:Affect / Q000187:drug effects*; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003863:Depression / Q000139:chemically induced* / Q000523:psychology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000178:diet therapy / Q000188:drug therapy / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012110:Reserpine / Q000009:adverse effects; D013375:Substance Withdrawal Syndrome / Q000523:psychology*; D011795:Surveys and Questionnaires
D000959:Antihypertensive Agents; D012110:Reserpine