WJNS  Vol.5 No.2 , May 2015
Influence of Treatments for Depression and Sleep Quality on Heart Rate and Blood Pressure in Individuals with Hypertension and Depression
ABSTRACT
Objective: To observe the influence of the treatment of depression on the regularization of blood pressure and heart rate of individuals with hypertension and depression. Methods: A total of 30 individuals who were being treated for hypertension were diagnosed for depression participated in this study. Escitalopram (10 - 20 mg) was administered to 15 individuals, while the other 15 received placebo. These individuals were followed for 8 weeks with regular monitoring of blood pressure and heart rate. Scores on the Hamilton Depression Rating Scale were evaluated within the first, second, fourth, and eighth weeks of the study onset. The same 30 individuals were further divided into groups who had or had not undergone depression remission, regardless of whether the individual was receiving the active drug or placebo. Likewise, in order to observe the influence of sleep regularization, the patients were divided into groups based on whether their sleep quality had improved. Results: There was a significant decrease in the average systolic blood pressure of the normal-sleep group (-20.07 ± 13.45 vs. -9.43 ± 14.87 mmHg, p = 0.04). Heart rate was lower in the escitalopram than in the placebo group: 66.88 ± 9.62 vs. 74.19 ± 9.55 bpm, p = 0.04. Conclusion: Treatment with escitalopram decreased heart rate, improved sleep quality, and decreased blood pressure.

Cite this paper
Peixoto, M. , Cesaretti, M. and Tavares, A. (2015) Influence of Treatments for Depression and Sleep Quality on Heart Rate and Blood Pressure in Individuals with Hypertension and Depression. World Journal of Neuroscience, 5, 137-154. doi: 10.4236/wjns.2015.52016.
References
[1]   Wells, K.B. (1996) Caring for Depression. Harvard University Press, Cambridge.

[2]   Lett, H.S., Blumenthal, J.A. and Babyak, M.A. (2004) Depression as a Risk Factor for Coronary Artery Disease: Evidence, Mechanisms, and Treatment. Psychosomatic Medicine, 66, 305-315.

[3]   Stewart, R.A., North, F.M. and West, T.M. (2003) Depression and Cardiovascular Morbidity and Mortality: Cause or Consequence? European Heart Journal, 24, 2027-2037.
http://dx.doi.org/10.1016/j.ehj.2003.08.017

[4]   Evans, D.L., Charney, D.S. and Lewis, L. (2005) Mood Disorders in the Medically Ill: Scientific Review and Recommendations. Biological Psychiatry, 58, 175-189.
http://dx.doi.org/10.1016/j.biopsych.2005.05.001

[5]   Borowicz Jr., L., Royall, R., Greek, M., Selnes, O., Lyketsos, C. and McKhann, G. (2002) Depression and Cardiac Morbidity 5 Years after Coronary Artery Bypass Surgery. Psychosomatics, 43, 464-471. http://dx.doi.org/10.1176/appi.psy.43.6.464

[6]   Egede, L.E. (2007) Major Depression in Individuals with Chronic Medical Disorders: Prevalence, Correlates and Association with Health Resource Utilization, Lost Productivity and Functional Disability. General Hospital Psychiatry, 29, 409-416. http://dx.doi.org/10.1016/j.genhosppsych.2007.06.002

[7]   Adamis, D. and Ball, C. (2000) Physical Morbidity in Elderly Psychiatric Inpatients: Prevalence and Possible Relations between the Major Mental Disorders and Physical Illness. International Journal of Geriatric Psychiatry, 15, 248-253. http://dx.doi.org/10.1002/(SICI)1099-1166(200003)15:3<248::AID-GPS102>3.0.CO;2-L

[8]   Nakagawara, M., Witzke, W. and Matussek, N. (1987) Hypertension in Depression. Psychiatry Research, 21, 85-86. http://dx.doi.org/10.1016/0165-1781(87)90065-5

[9]   Amaral, G.F., Jardim, P.C.B.V., Brasil, M.A.A., Souza, A.L.L., Freitas, H.F., Taniguchi, L.M., Melo, A.F.B. and Ribeiro C.N. (2007) Prevalência de transtorno depressivo maior em centro de referência no tratamento de hipertensao arterial. Revista de Psiquiatria do Rio Grande do Sul, 29, 161-168.

[10]   Bensenor, I.M., Pereira, A.C., Tannuri, A.C., Valeri, C.M., Akashi, D., Fucciolo, D.Q., Issa, F.K., Lobato, M.L., Titan, S.M.O., Galvao, T.G. and Lotufo, P.A. (1998) Hipertens?o arterial sistêmica e morbidade psiquiátrica em ambulatório de hospital terciário. Arquivos de Neuropsiquiatria, 56, 406-411.

[11]   Jonas, B.S., Franks, P. and Ingram, D.D. (1997) Are Symptoms of Anxiety and Depression Risk Factors for Hypertension? Longitudinal Evidence from the National Health and Nutrition Examination Survey Epidemiologic I Follow-Up Study. Archives of Family Medicine, 6, 43-49.
http://dx.doi.org/10.1001/archfami.6.1.43

[12]   Rabkin, J., Charles, E. and Kass, F. (1983) Hypertension and DSM-III Depression in Psychiatric Outpatients. American Journal of Psychiatry, 140, 1072-1074.
http://dx.doi.org/10.1176/ajp.140.8.1072

[13]   Everson, A.S., Kaplan, G.A., Goldberg, D.E. and Salomen, J.T. (2000) Hypertension Incidence Is Predicted by High Levels of Hopelessness in Finnish Men. Hypertension, 34, 561-567.
http://dx.doi.org/10.1161/01.HYP.35.2.561

[14]   Poulter, N.R., Khaw, K.T., Hopwood, B.E.C., Mugambi, M., Peart, W.S., Rose, G. and Sever, P.S. (1990) The Kenyan Luo Migration Study: Observations on the Initiation of the Rise in Blood Pressure. British Medical Journal, 300, 967-972. http://dx.doi.org/10.1136/bmj.300.6730.967

[15]   Brenner, B. and Rector, F. (2011) Brenner and Rector’s The Kidney. 9th Edition, Saunders, Philadelphia.

[16]   Goodwin, F.K. and Jamison, R.K. (2010) Doenca maníaco depressive, transtorno bipolar e depressao recorrente. 2nd Edition, ARTMED, Porto Alegre.

[17]   Giacaglia, L.R., Silva, M.E.R. and Santos, R.F. (2010) Tratado de Síndrome Metabólica. Roca, Sao Paulo.

[18]   Deicken, R.F. (1986) Captopril Treatment of Depression. Biological Psychiatry, 21, 1425-1428.
http://dx.doi.org/10.1016/0006-3223(86)90334-3

[19]   Zubenko, G.S. and Nixon, R.A. (1984) Mood Elevating Effect of Captopril in Depressed Patients. American Journal of Psychiatry, 141, 110-111. http://dx.doi.org/10.1176/ajp.141.1.110

[20]   Gard, P.R. (2004) Angioteinsin as a Target for the Treatment of Alzheimer’s Disease, Anxiety and Depression. Expert Opinion on Therapeutic Targets, 8, 7-14.
http://dx.doi.org/10.1517/14728222.8.1.7

[21]   Giardina, W.J. and Ebert, D.M. (1989) Positive Effects of Captopril in the Behavioral Despair Swim Test. Biological Psychiatry, 25, 697-702. http://dx.doi.org/10.1016/0006-3223(89)90240-0

[22]   Martin, P., Massol, J. and Puech, A.J. (1990) Captopril as an Antidepressant? Effects on the Learned Helplessness Paradigm in Rats. Biological Psychiatry, 27, 968-974. http://dx.doi.org/10.1016/0006-3223(90)90034-Y

[23]   Emanuele, E., Geroldi, D., Minoretti, P., Coen, E. and Politi, P. (2005) Increased Plasma Aldosterone in Patients with Clinical Depression. Archives of Medical Research, 36, 544-548.
http://dx.doi.org/10.1016/j.arcmed.2005.03.046

[24]   Murck, H., Held, K., Ziegenbein, M., Künzel, H., Koch, K. and Steiger, A. (2003) The Renin-Angiotensin-Aldosterone System in Patients with Depression Compared to Controls—A Sleep Endocrine Study. BMC Psychiatry, 3, 15-23. http://dx.doi.org/10.1186/1471-244X-3-15

[25]   Bhattacharyya, N. and Kepnes, L.J. (2012) Ambulatory Office Visits and Medical Comorbidities Associated with Obstructive Sleep Apnea. Otolaryngology—Head and Neck Surgery, 147, 1154-1157. http://dx.doi.org/10.1177/0194599812459850

[26]   Blumenthal, J.A., Williams, R.S., Wallace, A.G., Williams Jr., R.B. and Needles, T.L. (1982) Physiological and Psychological Variables Predict Compliance to Prescribed Exercise Therapy in Patients Recovering from Myocardial Infarction. Psychosomatic Medicine, 44, 519-527.
http://dx.doi.org/10.1097/00006842-198212000-00003

[27]   Kaplan, G.A., Lazarus, N.B., Cohen, R.D. and Leu, D.J. (1991) Psychosocial Factors in the Natural History of Physical Activity. American Journal of Preventive Medicine, 7, 12-17.

[28]   Sociedade Brasileira de Cardiologia / Sociedade Brasileira de Hipertensao / Sociedade Brasileira de Nefrologia (2010) VI Diretrizes Brasileiras de Hipertensao. Arquivos Brasileiros de Cardiologia, 95, 1-51.

[29]   Mari, J.J. and Williams, P. (1986) A Validity Study of a Psychiatric Screening Questionnaire (SRQ—20) in Primare Care in the City of Sao Paulo. British Journal of Psychiatry, 148, 23-26.
http://dx.doi.org/10.1192/bjp.148.1.23

[30]   National Institute on Alcohol Abuse and Alcoholism (NIAAA)—Alcohol Alert, No. 16, 1992.
http://pubs.niaaa.nih.gov/publications/aa16.htm

[31]   Palombo, O.J., Hoywaert, E., Bistran, B.R. and Blakburn, G.L. (1981) Nutritional Assessment of the Obese Pacientes. In: Leverson, S.M., Ed., Nutritional Assessment—Present Status, Future Directions and Prospects, Ross Lab, Columbus, 3-10.

[32]   Spitzer, R.L., Williams, J.B.W., Gibbon, M. and First, M.B. (1989) Instruction Manual for the Structured Clinical Interview for DSMIIIR (SCID, 5/1/89 Revision). Biometrics Research Department, New York State Psychiatric Institute.

[33]   Moreno, R.A. and Moreno, D.H. (1988) Escalas de depress?o de Montgomery & Asberg (MADRS) e de Hamilton (HAM-D). Revista de Psiquiatria Clínica, 25, 262-272.

[34]   Kendall, J.M. (2003) Designing a Research Project: Randomized Controlled Trials and Their Principles. Emergency Medicine Journal, 20, 164-168. http://dx.doi.org/10.1136/emj.20.2.164

[35]   World Health Organization (WHO). Raised Blood Pressure.
http://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/

[36]   Marcus, M., Yasamy, M.T., Ommeren, M., Chisholm, D. and Saxena, S. (2012) DEPRESSION: A Global Public Health Concern.
http://www.who.int/mental_health/management/depression/who_paper_depression_wfmh_2012.pdf

[37]   Wells, K.B. (1996) Caring for Depression. Harvard University Press, Cambridge.

[38]   Sibbald, B. and Roland, M. (1998) Understanding Controlled Trials: Why Are Randomized Controlled Trials Important? British Medical Journal, 316, 201. http://dx.doi.org/10.1136/bmj.316.7126.201

[39]   Swarts, C.M. and Inglis, A.E. (1990) Blood Pressure Reduction with ECT Response. Journal of Clinical Psychiatry, 51, 414-416.

[40]   Malik, M. (1996) Heart Rate Variability—Standards of Measurement, Physiological Interpretation, and Clinical Use. Circulation, 93, 1043-1065. http://dx.doi.org/10.1161/01.CIR.93.5.1043

[41]   Einarson, T.R. (2004) Evidence Based Review of Escitalopram in Treating Major Depressive Disorder in Primary Care. International Clinical Psychopharmacology, 19, 305-310.
http://dx.doi.org/10.1097/01.yic.0000139342.22133.77

[42]   Buysse, D.J., Angst, J., Gamma, A., Ajdacic, V., Eich, D. and Rossler, W. (2008) Prevalence, Course and Comorbidity of Insomnia and Depression in Young Adults. Sleep, 31, 473-480.

[43]   Carney, E.C., Segal, Z.V., Edinger, J.D. and Krystal, A.D. (2007) A Comparison of Rates of Residual Insomnia Symptoms Following Pharmacotherapy or Cognitive-Behavioral Therapy for Major Depressive Disorder. Journal of Clinical Psychiatry, 68, 254-260. http://dx.doi.org/10.4088/JCP.v68n0211

[44]   Gangwisch, J.E., Malaspina, D., Posner, K., Babiss, L.A., Heymsfield, S.B., Turner, J.B., Zammit, G.K. and Pickering, T.G. (2010) Insomnia and Sleep Duration the Mediators of the Relationship between Depression and Hypertension Incidence. American Journal of Hypertension, 23, 62-69.
http://dx.doi.org/10.1038/ajh.2009.202

[45]   Pedrosa, R.P., Drager, L.F., Paula, L.K., Amaro, A.C., Bortolotto, L.A. and Lorenzi-Filho, G. (2013) Effects of OSA Treatment on BP in Patients with Resistant Hypertension: A Randomized Trial. CHEST Journal, 144, 1487. http://dx.doi.org/10.1378/chest.13-0085

[46]   Takase, B., Akim, T., Uehata, A., Ohsuza, M. and Kurita, A. (2004) Effect of Chronic Stress and Sleep Deprivation on Both Flow-Mediation Dilation in the Brachial Artery and the Intracellular Magnesium Level in Humans. Clinical Cardiology, 27, 223-227. http://dx.doi.org/10.1002/clc.4960270411

[47]   Portaluppi, F., Cortelli, P., Avoni, P., Vergnani, L., Contin, M., Maltoni, P., Pavani, A., Sforza, E., degli Uberti, E.C. and Gambetti, P. (1994) Diurnal Blood Pressure Variation and Hormonal Correlates in Fatal Familial Insomnia. Hypertension, 23, 569-576. http://dx.doi.org/10.1161/01.HYP.23.5.569

[48]   Fernandez-Mendoza, J., Vgontzas, A.N., Liao, D., Shaffer, M.L., Vela-Bueno, A., Basta, M. and Bixler, E.O. (2010) Insomnia with Objective Short Sleep Duration and Incident Hypertension: The Penn State Cohort. Hypertension, 60, 929-935. http://dx.doi.org/10.1161/HYPERTENSIONAHA.112.193268

[49]   Almeida, O.P., Alfonso, H., Yeap, B.B., Hankey, G. and Flicker, L. (2011) Complaints of Difficulty to Fall Asleep Increase the Risk of Depression in Later Life: The Health in Men Study. Journal of Affective Disorders, 134, 208-216. http://dx.doi.org/10.1016/j.jad.2011.05.045

[50]   Weber, M.A. (1990) Documentation of the Effective Length of Action of Antihypertensive Treatment. The American Journal of Cardiology, 66, 43C-48C. http://dx.doi.org/10.1016/0002-9149(90)90763-Q

 
 
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