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30-06-2013 | Cardiology | Article

Antihypertensive adherence sinks under depression


Free abstract

medwireNews: The onset of depression increases the risk for nonadherence to antihypertensive medication, but only among men, research published in the Journal of Hypertension suggests.

In an editorial accompanying the study, Claudio Borghi and Arrigo Cicero, from the University of Bologna in Italy, say: "The sex-related difference in the impact of depression on adherence to medications is hard to explain as the prevalence of depressive symptoms is usually higher and more disabling in the female population."

But they stress: "Regardless of the mechanisms involved, this sex difference can have important clinical implications for the prevention of cardiovascular disease, suggesting the greater preventive impact of managing depressive symptoms in hypertensive men."

The study included 236 men who developed depression while receiving treatment for hypertension. Using prescription refill data, the researchers, led by Noora Sjösten (Finnish Institute of Occupational Health, Turku), calculated that these men had an average of 32.9 "days not treated" per year (ie, had obtained insufficient medication to cover these days) during the 4 years preceding their depression diagnosis.

This rate rose by a significant 1.52-fold during the 4 years after the year in which they were diagnosed with depression. The largest increase in days not treated occurred in the year of diagnosis.

Over a comparable timeframe, 644 control men who had hypertension but did not develop depression, and were matched for variables including age and socioeconomic status, had a somewhat higher baseline rate of days not treated, at 42.5 per year, but this did not increase.

Among 616 hypertensive women, there was no change in days not treated after onset of depression, except among the subgroup who had been taking antihypertensive medication for a short time (2-5 years), at a 1.71-fold increase. There was also no change among 1715 control women with hypertension who did not develop depression.

Notably, the complexity of the antihypertensive regimen did not account for men's increased nonadherence after the onset of depression, with increased nonadherence equally likely in men taking just one drug as in those taking two or more.

However, Borghi and Cicero comment: "Unfortunately, the study does not provide any information about the overall rate of blood pressure control in patients who complain of different levels of adherence to medications, and this reduces the strength of the observation in terms of translation to clinical practice."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Eleanor McDermid, Senior medwireNews Reporter

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