Blood pressure medications have several known—and unpleasant—side effects, including dizziness, headache and upset stomach. But a new study from the journal Hypertension suggests that four of the most common high blood pressure medications also affect mood disorders.
According to the study’s findings, calcium antagonists and beta blockers are associated with a two-fold increased risk for mood disorders, while angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers decrease mood disorder risk.
The connection between cardiovascular disease and mood disorders is not a new concept. According to lead author Dr. Angela Boal, a lecturer at the University of Glasgow’s Institute of Cardiovascular and Medical Sciences, several interacting biological systems contribute to shared pathophysiological mechanisms between the two, including over activity of the hypothalamic-pituitary-adrenal axis, neuro-inflammation, oxidative stress and endothelial dysfunction.
While the two systems are known to be linked, not much research has been done into the pharmacological impact treating hypertension has on a patient’s mental health.
“Mental health is under-recognized in hypertension clinical practice, and the possible impact of antihypertensive drugs on mental health is an area that physicians should be aware of and consider if the treatment of high blood pressure is having a negative impact on their patient’s mental health,” said Sandosh Padmanabhan, MD, PhD, study author and Professor at the Institute of Cardiovascular and Medical Sciences, University of Glasgow in Glasgow, Scotland.
Researchers collected data on 525,000 patients ages 40 to 80 years old from two large secondary care Scottish hospitals. They selected 144,000 patients being treated for hypertension with either angiotensin antagonists, beta blocker, calcium channel blockers or thiazide diuretics. They were compared to a group of 112,000 patients not taking any of those drugs. Researchers followed the patients for five years documenting hospitalization for mood disorders, such as depression or bipolar disorder.
Their findings showed 299 hospital admissions due primarily to major depression. Symptoms arose an average of 2.3 years after the patients began drug therapy.
Patients on beta blockers and calcium antagonists were at a two-fold increased risk of hospital admission for mood disorder compared to patients on angiotensin antagonists and angiotensin-receptor blockers.
Treatment with angiotensin antagonists resulted in the lowest risk for hospitalization with mood disorders compared to both patients on other blood pressure medications and patients on no antihypertensive therapy.
These findings suggest that angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers that are used to treat hypertension may be useful as new or “repurposed” treatments for mood disorders, according to Padmanabhan.
Repurposed or off-label usage of drugs is not directly supported by the U.S. Food and Drug Administration, but there is leeway in its ruling. From its perspective, once the FDA approves a drug, physicians are entrusted to prescribe it in a way that is medically appropriate for the patient. An unapproved use, especially if there is a drug not currently approved to treat a patient’s specific disease or medical condition is allowed.