Poor blood pressure and urinary albumin excretion responses to home blood pressure-based antihypertensive therapy in depressive hypertensive patients

Abstract

There has been no report comparing the changes in home blood pressure (HBP) and target organ damage between depressive and nondepressive hypertensives receiving antihypertensive therapy based on HBP monitoring. This study was a multicenter prospective study conducted by 7 doctors at 2 institutions. The authors prospectively studied 42 hypertensive patients with home systolic blood pressure >135 mm Hg. Participants were divided into a depression group (Beck Depression Inventory score >10; n=21) and a nondepression group (Beck Depression Inventory score <9, matched for HBP level; n=21). The authors performed antihypertensive therapy to reduce home systolic blood pressure to below 135 mm Hg and, 6 months later, evaluated the urinary albumin/creatinine ratio (UACR). Although patients in the depression group tended to require the addition of a greater number of medications than those in the nondepression group (2.3+/-1.0 vs 1.7+/-1.0 drugs, P<.05), HBP was reduced similarly in both groups at 6 months (depression group: 150+/-17/78+/-11 mm Hg to 139+/-11/73+/-8 mm Hg, P<.001; nondepression group: 150+/-11/76+/-9 mm Hg to 135+/-9/70+/-8 mm Hg, P<.01). The reduction of UACR was smaller in the depression group than in the nondepression group (2.4 vs 10.1 mg/gCr, P<.05). Depressive hypertensive patients required a larger number of antihypertensive drugs to control HBP, and showed a smaller reduction in UACR than nondepressive hypertensives.

Figure

Home systolic blood pressure (BP) and increase of medication over 6 months.