Impact Of Antihypertensive Medications Research Articles

Exploring the Comorbidity, Pathophysiology, and Integrated Treatment Strategies of Hypertension and Depression

Hypertension and depression are widely prevalent conditions with substantial comorbidity. Hypertension, characterized by persistently elevated arterial pressure, is associated with significant cardiovascular morbidity and mortality. Depression, a multifactorial mood disorder, adversely affects mental and physical health through mechanisms involving neuroinflammation, neurotransmitter imbalances, and hormonal dysregulation. The association between these disorders has been recognized since the mid-20th century.Historical medical literature from ancient Chinese and Indian systems identified symptoms indicative of hypertension, later classified as a distinct disease entity by Fredrick Akbar Mahomed in the 19th century. Notable epidemiological studies have elucidated the significant relationship between hypertension and depression, particularly among medical students and other high-risk populations.Research indicates that common pathophysiological mechanisms, including sympathetic nervous system overactivity, chronic inflammation, and endothelial dysfunction, underlie the comorbidity of hypertension and depression. Elevated levels of norepinephrine, proinflammatory cytokines, and oxidative stress contribute to the expression or worsening of both conditions. Shared genetic and environmental factors further compound this relationship, highlighting the need for integrated treatment strategies.Pharmacological interventions, including angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, have shown potential to improve mental health outcomes in patients with comorbid hypertension and depression. However, inconsistent findings regarding the impact of antihypertensive medications on depression necessitate further investigation. The comorbidity of these conditions complicates treatment adherence, leading to poorer health outcomes and increased healthcare costs.The clinical implications of this unidirectional or bidirectional comorbidity are considerable, affecting quality of life, treatment adherence, and overall health outcomes. Integrated care approaches, incorporating lifestyle modifications and combined pharmacological treatments, have shown promise in improving compliance and outcomes.Despite extensive research, limitations persist, including difficulties in establishing causality, inconsistent diagnostic criteria, and the influence of confounding variables. Future research should focus on clarifying the bidirectional relationship between these conditions, the impact of social determinants, and the efficacy of various treatment modalities. Identifying high-risk populations and refining intervention strategies are crucial for improving clinical outcomes in patients with comorbid hypertension and depression.This paper aims to review the current literature regarding the association and comorbidity of hypertension and depression.Abbreviations: ACE: Angiotensin-Converting Enzyme; ARBs: Angiotensin Receptor Blockers; DBP: Diastolic Blood Pressure; mm Hg: Millimeters of Mercury; QoL: Quality of Life; SBP: Systolic Blood Pressure

Self-Reported Late-Life Hypertension Is Associated with a Healthy Cognitive Status and Reduced Alzheimer's Disease Pathology Burden.

While mid-life hypertension represents a risk factor for the development of Alzheimer's disease (AD), the risk after the age of 65 is less certain. Establishing relationships between late life hypertension and the pathological changes of AD could be crucial in understanding the relevance of blood pressure as a risk factor for this disorder. We investigated associations between self-reported late-life hypertension, cognitive status and AD pathology at death. The impact of antihypertensive medication was also examined. Using the Cornell Medical Index questionnaire, we ascertained whether participants had ever reported hypertension. We also noted use of antihypertensive medication. The donated brains of 108 individuals were assessed for AD pathology using consensus guidelines. Statistical analysis aimed to elucidate relationships between hypertension and AD pathology. We found no associations between self-reported hypertension and cognitive impairment at death. However, those with hypertension were significantly more likely to exhibit lower levels of AD pathology as measured by Thal phase, Braak stage, CERAD score, and NIA-AA criteria-even after controlling for sex, level of education and presence of APOEɛ4 allele(s). No significant associations could be found when examining use of antihypertensive medications. Our findings suggest that late-life hypertension is associated with less severe AD pathology. We postulate that AD pathology may be promoted by reduced cerebral blood flow.

Impact of Anti-hypertensive Medication on Physical and Psychological Health Related Quality of Life (HRQOL) in Hypertensive Patients

Saroj Prasad Shah1, Gourab Prasad Borah1, Akhil Bansal1, Karun Bhatti2, Rina Das1 and Dinesh Kumar Mehta1 Author informationArticle notesCopyright and License information 1Department of Pharmacy Practice, M.M. College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, INDIA 2Department of Medicine, M.M. Institute of Medical Sciences and Research, Maharishi Markandeshwar (Deemed to be

Use of antihypertensive medication and formation of de novo intracranial aneurysms.

Hypertension is a risk factor for subarachnoid hemorrhage and is also considered a risk factor for saccular intracranial aneurysm (sIA) formation. However, there is little direct evidence that antihypertensive medication will reduce sIA formation. The impact of antihypertensive medication on de novo sIA formation was studied in an angiographically followed cohort of 1419 patients. Patients were identified from our population-based Kuopio Intracranial Aneurysm Database, and data on the purchases of antihypertensive medication were obtained from a national registry. Univariate and multivariate analyses were used to investigate the risk factors. Of the 966 sIA patients who were prescribed with antihypertensive medication, 841 patients used the medication regularly; 20 of them had de novo sIA. One hundred and twenty-five patients used the medication irregularly and 12 of them developed de novo sIAs. Four hundred and fifty-three patients did not use antihypertensive medication even though 27 of them had a diagnosis of hypertension, and 10 of them developed de novo sIAs. In the multivariate analysis antihypertensive medication did not significantly reduce de novo sIA formation (hazard ratio [HR] 1.60, 95% confidence interval [CI] 0.84-3.06). Age at primary diagnosis (HR: 0.95, 95%: CI 0.93-0.98) and smoking history (HR: 5.53, 95% CI: 2.77-11.05) were significant risk factors for de novo sIA formation. Also, irregular usage of antihypertensive medication was a significant risk factor (HR: 3.84, 95% CI: 1.59-9.29) for de novo sIA formation. Antihypertensive agents were not associated with a reduction of de novo sIA formation, but irregular use of antihypertensive agents was associated with an increased risk of de novo sIA formation.

Impact of renin-angiotensin system inhibitors and beta-blockers on dental implant stability

BackgroundCurrent experimental research suggests antihypertensive medication reduces the failure risk of dental implants due to enhanced bone remodeling. However, evidence from clinical studies evaluating the impact of antihypertensive medication on implant stability is lacking.MethodsWe retrospectively analyzed 377 implants in 196 patients (46 implants inserted in antihypertensive drug users (AH) and 331 implants in non-users (NAH)) for implant stability measured by radiofrequency analysis, and we determined the implant stability quotient (ISQ). AH subgroups were stratified by the use of beta-blockers, renin-angiotensin system (RAS) inhibitors, and both of the aforementioned. The impact of antihypertensive medication on ISQ values at implant insertion (primary stability) and implant exposure (secondary stability) was analyzed by a linear regression model with a regression coefficient and its 95% confidence interval (95% CI), adjusted for potential confounders.ResultsTime between implant insertion and implant exposure was 117.1 ± 56.6 days. ISQ values at insertion were 71.8 ± 8.7 for NAH and 74.1 ± 5.6 for AH, respectively. ISQ at exposure was 73.7 ± 8.1 for NAH and 75.7 ± 5.9 for AH. Regression analysis revealed that none of the AH subgroups were significantly related to ISQ at implant insertion. However, renin-angiotensin system inhibitors (RAS) were significantly associated with higher ISQ values at exposure (reg. coeff. 3.59, 95% CI 0.46–6.71 (p=0.025)).ConclusionsOutcome of the present study indicates enhanced bone remodeling and osseointegration following dental implant insertion in patients taking RAS inhibitors than in non-users. Future randomized prospective studies must confirm these indicative results.

The Impact of Antihypertensive Medications on Bone Mineral Density and Fracture Risk.

This review summarizes the impact of thiazide diuretics on fracture risk in older hypertensive individuals. We performed a post hoc evaluation of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, a randomized, prospective, double blind hypertension study comparing a thiazide-like diuretic, a calcium channel blocker (CCB), and an angiotensin converting enzyme inhibitor (ACEi). We examined the risk of hip and pelvic fractures during the in-trial period (n=22,180 participants; mean 4.9-year follow-up) and during the post-trial period using national data bases (n=16,622 participants) (mean total follow-up 7.8years). During the trial, participants randomized to the thiazide diuretic versus the CCB or the ACEi had a lower risk of fracture on adjusted analyses (HR 0.79 [95% CI, 0.63, 0.98], p=0.04). Risk of fracture was significantly lower in participants randomized to the diuretic as compared to those randomized to the ACEi (HR 0.75 [95% CI, 0.58, 0.98]; p=0.04), but not significantly different compared to the CCB (HR 0.87 [95% CI, 0.71, 1.09]; p=0.17). Over the entire trial and post-trial period of follow-up, the cumulative incidence of fractures was non-significantly lower in participants assigned to the diuretic vs assignment to the ACEi or the CCB (HR 0.87 [0.74-1.03], p=0.10) and versus each medication separately. These findings establish a benefit for thiazide diuretic treatment for the prevention of fractures versus other commonly used antihypertensive medications using prospective, randomized data. The effects of the thiazide diuretic on bone appear to be long lasting.

OS 12-01 ARB AND CCB LONGEST COMBINATION TREATMENT ON AMBULATORY AND HOME BP IN HYPERTENSION WITH ATRIAL FIBRILLATION - MULTICENTER STUDY ON TIME OF DOSING (ACROBAT)

Objective: It has been long believed that there is a close association between hypertension and atrial fibrillation (AF). However, there have been few studies on the impact of antihypertensive medication in hypertensives with AF. To investigate whether the timing of the antihypertensive drug administration influences blood pressure (BP) level and biomarkers to hypertensives with AF. Design and Method: The present study was a multicentered, prospective, randomized, open-labelled clinical trial to investigate the difference in the effect of telmisartan/amlodipine combination tablets on BP levels and BP variability using ambulatory BP monitoring (ABPM) and home BP between the morning administration and the bedtime administration in hypertensives with paroxysmal AF. ClinicalTrials.gov number NCT01748253. Results: In hypertensives with AF, 24-hour BP, night-time BP, preawake BP and morning BP by ABPM were significantly reduced, and their antihypertensive effects were similar regardless of timing of administration. The standard deviation of night-time BP was also significantly reduced. In addition, day-by-day home SBP variability and maximum home SBP were significantly reduced, and their effects were similar regardless of the timing of administration. On the other hand, levels of N-terminal pro-brain natriuretic peptide, urinary albumin/creatinine ratio and high-sensitivity troponin T were significantly decreased in the bedtime administration group only (Table). Conclusions: Telmisartan/amlodipine combination tablets maintained the effects by significantly reducing 24-hours BP as well as short-term BP variability regardless of the timing of administration in high-risk hypertensives with AF. Based on the results of the biomarker examination, the combination tablets are expected to be possible to maximize the reduction in the risk of developing AF recurrence and organ damage at bedtime administration.

H5. Second trimester vascular function parameters in women with chronic hypertension and their association with adverse maternal and perinatal outcomes

Introduction: Increased aortic systolic BP (SBPao), pulse wave velocity (PWVao) and augmentation index of the aorta (AIXao) are associated with increased cardiovascular morbidity. These measures may also be increased prior to the development of adverse maternal and perinatal outcomes. The aim of this study was to evaluate the association between haemodynamic parameters and adverse outcomes in women with chronic hypertension (CHT).Methods: Women recruited to the PANDA study (Pregnancy And chronic hypertension: NifeDipine versus lAbetalol as antihypertensive treatment) had Arteriograph (Tensio Med) readings taken while sitting. Brachial BP, central SBPao, AIXao and PWVao were measured between 12 and 23 + 6 weeks gestation. Pregnancy outcomes were recorded. Medians within each group were calculated and compared using the Mann–Whitney test.Results: Of the 70 participants; 24% developed superimposed preeclampsia (SPE), and there was a 19% incidence of SGA-3 (GROW customised birthweight below the third percentile).Conclusions: This study highlights interesting changes in vascular function in the second trimester in women with CHT, prior to the onset of superimposed pre-eclampsia or SGA-3. Assessing the impact of antihypertensive medication on these parameters may improve understanding of the mechanism of such treatments.

The association between antihypertensive medications and breast cancer characteristics.

e12000Background: Data regarding the impact of antihypertensive medications on breast cancer are inconsistent. We evaluated the association between antihypertensive medications on tumor characteris...

Impact of Anti-hypertensive Medication On Psychological Status and Quality of Life in Essential Hypertension

Background Previous findings regarding a possible association among anti-hypertensive medication and dimensions of depressive symptoms, psychopathology and quality of life are mixed. Objectives This study examined whether anti-hypertensive medication impacts on depressive symptoms, psychopathology and quality of life in a sample of hypertensive patients. Aims Using a prospective design we aimed to explore the psychological status of hypertensive patients both at baseline and one year later. Methods A sample of 198 patients (89 men – 108 women, mean age 52, 9 years, SD = 11, 81 ranged 25-78) with a newly diagnosis of essential hypertension was recruited from a general hospital. The questionnaires included at baseline (T1): a) question for the recording of social-demographic characteristics and clinical features, b) The Short Form 36 (SF-36) General Health Survey questionnaire, c) the Beck Depression Inventory –II (BDI-II), and d) The Symptom Checklist-90-Revised (SCL-90-R). Sixty-two participants completed the SF-36, BDI-II and SCL-90-R again one year later (T2). Results Paired t tests showed that there were not significant differences on the psychological measures from baseline to one-year follow-up (Table 1). Conclusions Our findings do not support that anti-hypertensive medication has any impact on depression, general psychopathology and quality of life scores than those who use only a dietary program. Download : Download full-size image

Impact of the Treatment of Isolated Systolic Hypertension on Behavioral Variables

Little information has been published on the impact of antihypertensive medications on quality of life in older persons. Particular concern has existed that lowering systolic blood pressure in older persons might have adverse consequences on cognition, mood, or leisure activities. A multicenter double-blind randomized controlled trial was conducted over an average of 5 years' followup involving 16 academic clinical trial clinics. Participants consisted of 4736 persons (1.06%) selected from 447,921 screenees aged 60 years and older. Systolic blood pressure at baseline ranged from 160 to 219 mm Hg, while diastolic blood pressure was less than 90 mm Hg. Participants were randomized to active antihypertensive drug therapy or matching placebo. Active treatment consisted of 12.5 to 25 mg of chlorthalidone for step 1, while step 2 consisted of 25 to 50 mg of atenolol. If atenolol was contraindicated, 0.05 to 0.10 mg of reserpine could be used for the second-step drug. The impact of drug treatment on measures of cognitive, emotional, and physical function and leisure activities was assessed. Our analyses demonstrate that active treatment of isolated systolic hypertension in the Systolic Hypertension in the Elderly Program cohort had no measured negative effects and, for some measures, a slight positive effect on cognitive, physical, and leisure function. The positive findings in favor of the treatment group were small. There was no effect on measures related to emotional state. Measures of cognitive and emotional function were stable in both groups for the duration of the study. Both treatment groups showed a modest trend toward deterioration of some measures of physical and leisure function over the study period. The overall study cohort exhibited decline over time in activities of daily living, particularly the more strenuous ones, and some decline in certain leisure activities. However, mood, cognitive function, basic self-care, and moderate leisure activity were remarkably stable for both the active and the placebo groups throughout the entire study. Results of this study support the inference that medical treatment of isolated systolic hypertension does not cause deterioration in measures of cognition, emotional state, physical function, or leisure activities.

Reflections on the Impact of Antihypertensive Medications on Mood, Sedation, and Neuropsychologic Functioning

All antihypertensive treatments, including placebo, are associated with cognitive side effects. These side effects are rarely clear-cut and involve mood, quality of sleep, daytime sedation, and various neuropsychologic functions. This review article reflects on the vast literature on this topic and comments on substantive findings, as well as methodologic difficulties in sorting through findings from quality-of-life studies. Hypertension itself is associated with many of the above changes, and some cognitive functions actually improve with treatment. Nonetheless, many medications are accused of causing side effects, despite the fact that side effects with placebo are common, particularly for nonspecific complaints, such as fatigue. Side effects are not limited to sympatholytic antihypertensive agents and are commonly reported even by patients who are treated with diuretics. It is not at all clear that side effects are more commonly reported in patients who are treated with lipophilic beta-blockers. The patient may be a relatively poor observer of these subtle changes. The spouse is an important source of additional information with regard to side effects. The virtual absence of any standardization in quality-of-life measures makes comparisons across studies extremely difficult.

Reflections on the impact of antihypertensive medications on mood, sedation, and neuropsychologic functioning

Reflections on the impact of antihypertensive medications on mood, sedation, and neuropsychologic functioning