According to a new study published in the Journal of the American Board of Family Medicine, commonly used antidepressant medications (ADMs) were not associated with incident hypertension after controlling for other factors associated with ADM use and hypertension. Research on potential dose and duration effects is warranted.

Primary care physicians manage hypertension and antidepressant medications (ADMs) almost every day. The age-adjusted prevalence of hypertension is 29.6% among the adult population in the United States. Of those with hypertension, only 48% achieve control of their blood pressure. Hypertension is directly related to both heart disease and stroke, which are counted as the first and fourth leading causes of death in the United States, respectively.

Given the serious outcomes associated with hypertension, physicians must be mindful of iatrogenic causes of hypertension, which can include frequently prescribed medications. Many ADMs can alter blood pressure (BP), but the research on the effect of antidepressant medication (ADMs) on incident hypertension is mixed. Researchers investigated whether the use of ADMs was associated with the subsequent development of hypertension.

A retrospective cohort study was conducted using electronic medical record data from 6224 patients with primary care visits from 2008 to 2015. Prescription orders were used to identify ADM use, and hypertension was defined by medical record diagnosis. Using package insert warnings, a 3-level ADM exposure variable was created: ADMs that increase BP (ADM BP+), ADMs that do not increase BP, and no ADM.

Unadjusted and adjusted Cox proportional hazard models were computed to estimate the association between the ADM exposure and incident hypertension. Unadjusted results revealed that ADM BP+ use compared with the no ADM group was significantly associated with incident hypertension (hazard ratio, 1.30; 95% confidence interval, 1.08–1.57). After adjusting for covariates, ADM BP+ use was no longer significantly associated with incident hypertension.

The results suggest that patient characteristics associated with receiving an ADM may account for the observation that ADMs with BP-altering effects could lead to hypertension. The findings are hypothesis generating, and future research should focus on the potential of long-term use of ADMs with strong BP effects to lead to hypertension in primary care. Given the differences between prior prospective controlled studies and the real-world analysis, further investigation into the relationship between these extremely common parts of primary care practice is warranted.