A Study of Antihypertensive Drugs and Depressive Symptoms (SADD-Sx) in patients treated with a calcium antagonist versus an atenolol hypertension Treatment Strategy in the International Verapamil SR-Trandolapril Study (INVEST).
BACKGROUND
The International Verapamil/Trandolapril Study (INVEST) demonstrated comparable efficacy between verapamil SR and atenolol antihypertensive treatment strategies for clinical outcomes and blood pressure (BP) control in hypertensive patients with coronary artery disease (N = 22,576). Effects of these antihypertension strategies on mood-related issues are not well understood.


OBJECTIVE
The objectives of this study were 1) to compare depressive symptoms by strategy and 2) to identify predictors of depressive symptoms in INVEST patients after 1 year of follow up.


METHODS
Depressive symptoms were assessed in a subset (N = 2317) of consecutively randomized U.S. patients enrolled between April 1, 1999, and October 31, 1999. Patients were mailed surveys after randomization and after 1 year of treatment.


METHODS
Patients were assigned to either a verapamil SR or atenolol strategy to achieve Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure BP goals. Trandolapril and/or hydrochlorothiazide were recommended as add-on agents.


METHODS
Depressive symptoms were measured by the Center for Epidemiologic Studies-Depression (CES-D) scale.


RESULTS
CES-D scores improved 1.45 points (p < .001) after 1 year in patients assigned to the verapamil SR strategy, whereas a nonsignificant improvement was observed in patients assigned to the atenolol strategy (0.27 points, p = .44). Predictors of higher depressive symptoms were higher baseline CES-D score (p < .001), history of depression diagnosis (p = .03), history of stroke (p < .001), and assignment to the atenolol strategy (p < .001).


CONCLUSIONS
A verapamil SR strategy is a viable alternative to beta-blocker therapy for hypertensive patients with coronary artery disease, especially those at risk of depression.
Ried
L Douglas
LD
Rehabilitation Outcomes Research Center, Malcom Randall Veterans Affairs Medical Center, Department of Veterans Affairs, Gainesville, Florida, USA. ried@cop.ufl.edu
Tueth
Michael J
MJ
Handberg
Eileen
E
Kupfer
Stuart
S
Pepine
Carl J
CJ
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects; D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects*; D001262:Atenolol / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy*; D003866:Depressive Disorder / Q000139:chemically induced* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007211:Indoles / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome; D014700:Verapamil / Q000009:adverse effects*
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D007211:Indoles; D006852:Hydrochlorothiazide; C052035:trandolapril; D001262:Atenolol; D014700:Verapamil