P-245: Depressive symptoms among hypertensive patients treated with verapamil-SR-led versus atenolol-led treatment strategies

Beta-blockers and calcium channel blockers both have been associated with treatment-related mood disorders; however, few rigorous studies have compared them directly. Given equal clinical effectiveness, the impact of alternative hypertension treatment strategies on patients' mood is an important issue. This study's objectives were to compare the level of depressive symptoms among patients assigned to the two primary hypertension treatment strategies used by INVEST and identify whether treatment was a significant predictor of subsequent depressive symptoms. INVEST was a prospective, randomized trial in 22,576 patients with hypertension and CAD who were assigned to a Verapamil-SR (Ve)-led or atenolol (At)-led strategy. Dose titration and additional drugs (trandolapril and/or hydrochlorothiazide) were available to achieve JNC VI BP control. A subset of consecutively randomized INVEST patients enrolled between April 1, and October 31, 1999, and living in the US (N=2317) were mailed surveys that contained the Center for Epidemiologic Studies - Depression (CES-D) scale within 24 hours of randomization and 1-year later. Nearly 52% of patients returned both the randomization and follow-up survey (52.2%, n = 618 for the Ve-led group; 50.8%, n = 575 for the At-led group, p=0.49). Patients in the Ve-led group improved an average of 1.45 points (p < 0.001) on the CES-D scale from randomization to follow-up, whereas improvement was negligible in patients assigned to the At-led group (0.25 points, p = 0.48). Depressive symptoms of patients in the At-led strategy were more likely to worsen by ≥ 5-points (27% versus 18%, p = 0.03). Significant multivariate predictors of higher depressive symptoms at one-year were baseline CES-D score (p < 0.001), prior history of depression diagnosis (p = 0.03), history of stroke at baseline (p < 0.001), and assignment to the At-led strategy (p < 0.001). Among patients with pre-existing CAD, guideline-based, hypertension treatment choice may influence patients' mood. While depressive symptoms improved among patients assigned to both treatment strategies, the verapmail SR strategy had a more favorable mood-related impact than the atenolol strategy. Am J Hypertens (2004) 17, 122A–122A; doi: 10.1016/j.amjhyper.2004.03.320