A retrospective cohort study will be performed by analyzing data obtained from the Catalan Southern Metropolitan data warehouse system, which collects data from both hospitalized and primary care patients from the Bellvitge University Hospital's area of influence. The investigators will begin by gathering information only on patients treated with antihypertensive drugs, which then will be stratified in two groups: 1) Angiotensin Agents group; 2) Other Antihypertensive Agents (Non-Angiotensin Agents) group. Afterwards, a separated analysis will be performed to assess the effects of ARBs and ACEIs separately on the prescription of antidepressant drugs.
Hypertension is a multifactorial disease and an important risk factor for cardiovascular and cerebrovascular diseases. Also, major depression is commonly found on these patients. Together, they represent a substantial burden for patients and their families, with an increased morbimortality and reduced life-quality. It also has a major social impact by increasing healthcare assistance demand and by affecting patients' daily-life productivity, therefore generating direct and indirect health-associated costs. The Renin-Angiotensin System is one of the known pathways that modulate systemic and central nervous system inflammation. Basic research studies have shown ARBs-related allosteric changes on receptors implicated on the pathophysiology of schizophrenia and depression, and also a pharmacological reversal of depression-like behavior in rats after the administration of losartan. Human research studies have also presented evidence that points towards an antidepressant effect of some antihypertensive drugs. A retrospective cohort study will be performed by analyzing data obtained from the Catalan Southern Metropolitan data warehouse system, which collects data from both hospitalized and primary care patients from the Bellvitge University Hospital's area of influence. The investigators will begin by gathering information only on patients treated with antihypertensive drugs, which then will be stratified in two groups: 1) Angiotensin Agents group; 2) Other Antihypertensive Agents (Non-Angiotensin Agents) group. Afterwards, a separated analysis will be performed to assess the effects of ARBs and ACEIs separately on the prescription of antidepressant drugs. Our primary objective is to estimate the prevalence, incidence, and clearance (incidence of antidepressant drugs withdrawal) of antidepressant drugs prescription in hypertensive patients under treatment with angiotensin agents (ARBs and/or ACEIs). Our secondary objectives are as follows: I. For ARBs: 1. To estimate the prevalence of antidepressant drugs prescription in hypertensive patients under treatment with ARBs. 2. To estimate the clearance of antidepressant drugs prescription in patients concomitantly treated with ARBs and antidepressant drugs. 3. To estimate the incidence of antidepressant drugs initiation in patients with hypertension treated with ARBs. II. For ACEIs: 1. To estimate the prevalence of antidepressant drugs prescription in hypertensive patients under treatment with ACEIs. 2. To estimate the clearance (incidence of antidepressant drugs withdrawal) of antidepressant drugs prescription in patients concomitantly treated with ACEIs and antidepressant drugs. 3. To estimate the incidence of antidepressant drugs initiation in patients with hypertension treated with ACEIs. III. For other antihypertensive drugs (i.e., non-angiotensin agents: CCBs, β-blockers, and diuretics): 1. To estimate the prevalence of antidepressant drugs prescription in hypertensive patients under treatment with other antihypertensive drugs (non-angiotensin agents). 2. To estimate the clearance (incidence of antidepressant drugs withdrawal) of antidepressant drugs prescription in patients concomitantly treated with other antihypertensive drugs and antidepressant drugs. 3. To estimate the incidence of antidepressant drugs initiation in patients with hypertension treated with other antihypertensive drugs. IV. To perform an exploratory comparative analysis among the different antihypertensive drugs sub-cohorts. The protocol (Final Version: February 18th, 2021) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation- Committee, code HUB-FC-2020-01, date April 20th, 2021). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings.
Study Type
OBSERVATIONAL
Current users of an antidepressant drug.
Non-current users of an antidepressant drug.
Hospital Universitari de Bellvitge
L'Hospitalet de Llobregat, Catalonia, Spain
Patients treated with antihypertensive drugs
Number of patients under treatment with antihypertensive drugs
Time frame: 3 years
Patients treated with an antidepressant drug
Number of patients under treatment with antidepressant drug
Time frame: 3 years
Patients diagnosed with Hypertension
Number of patients diagnosed with Hypertension
Time frame: 3 years
Patients diagnosed with Depression
Number of patients diagnosed with Depression
Time frame: 3 years
Patients treated with ARBs
Number of patients treated with ARBs
Time frame: 3 years
Patients treated with ACEIs
Number of patients treated with ACEIs
Time frame: 3 years
Patients treated with other antihypertensive drugs
Number of patients treated with other antihypertensive drugs (i.e., non-ARBs and non-ACEIs).
Time frame: 3 years
Patients treated with Amitriptyline
Number of patients treated with Amitriptyline, since this is an antidepressant drug commonly used to treat neuropathic pain in our usual practice.
Time frame: 3 years
Patients treated with Duloxetine
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Number of patients treated with Duloxetine, since this is an antidepressant drug commonly used to treat neuropathic pain in our usual practice.
Time frame: 3 years