Arterial hypertension and depressive disorders: combination treatment with antihypertensive and psychotropic therapy

Objective. To evaluate the effectiveness of combination treatment with antihypertensive drugs and antidepressant in patients with uncontrolled hypertension (UHTN) and depressive disorders (DD).

Design and methods. The study involved 160 patients with UHTN and DD and prescribed a combination therapy including an angiotensin-converting enzyme (ACE) inhibitor (perindopril 10 mg/day) and a thiazide-like diuretic (indapamide SR, 1,5 mg/day). Patients were randomized into 2 groups: 1st group recieved antihypertensive treatment with an antidepressant (selective serotonin reuptake inhibitors, escitalopram 10 mg/day); 2nd group received calcium channel blocker (CCBs, amlodipine 5–10 mg/day). At baseline and after 24 weeks all patients underwent clinical examination, ambulatory blood pressure monitoring (ABPM) (“Petr Telegin”, BPLab Vasotens, Russia) with 25‑minute intervals between the measurements during the day and 50‑minute intervals at night. We assessed the average 24‑hour, daytime and nighttime systolic blood pressure (SBP), diastolic blood pressure (DBP), variability of blood pressure (BP), hypertension time index, the size and speed of morning rise in BP, daily index, pulse pressure. In addition, we evaluated arterial stiffness: the propagation time of the reflected wave (RWTT, ms), the estimated PWV in the aorta (PWVao, m/s) adjusted to systolic BP 100 mm Hg and heart rate 60 beats/min (RWTT ms, PWVao m/s), augmentation index. We also assessed central aortic pressure: systolic aortic pressure, aortic diastolic pressure, mean pressure in the aorta, aortic augmentation index. All the patients filled in the Hospital Anxiety and Depression Scale (HADS), Tsung depression scale, Spielberger’s scale of the anxiety, Wayne questionnaire and the SF‑36 questionnaire for the assessment of quality of life.

Results. Combined antihypertensive therapy with escitalopram provided the target BP achievement in half of patients after 4 weeks, while in the control group an increase in the amlodipine dose to 10 mg per day was required to achieve target BP in 75.6 % of patients. After 24 weeks, group 1 showed better ABPM parameters compared to the control group. In addition, daily BP profile was normalized in a larger number of patients than in control group. Antidepressants led to a comparable to the calcium antagonist therapy regression of the indicators of arterial stiffness and the central aortic pressure. After 24 weeks, a positive change in DD was registered in the group treated with escitalopram, while in the group 2 depression indicators remained at a high level. The use of antidepressant resulted in a significant decrease in anxiety disorders and autonomic disturbances, whereas in patients treated with “traditional” antihypertensive therapy, an increase of anxiety level and baseline autonomic dysfunction remained unchanged. Also, the group of antidepressant showed greater improvement of the quality of life assessed by the SF‑36 questionnaire.

Conclusions. The use of escitalopram in combination therapy provided a rapid achievement of target BP and more significant improvement in the main ABPM indicators, normalization of daily BP profile, a significant improvement in the emotional status and autonomic function, reduction of the depression and anxiety symptoms, improvement in quality of life compared to the treatment without antidepressant.

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