The Effect of Antihypertensive Therapy on Depressive Symptoms in Patients With Chronic Kidney Disease: A Cohort Study

Background

Depressive disorders are the most common mental health conditions among patients on maintenance hemodialysis and may directly affect the outcomes.

Aim

To evaluate the effect of antihypertensive therapy on depression severity in patients with stage 5D chronic kidney disease.

Methods

A three-year cohort study was conducted in 377 patients on maintenance hemodialysis. The mean age was 55.3 ± 10.8 years, and the dialysis duration was 1–28 years (Me = 3; IQR: 2–6). Based on additional inclusion criteria (controlled hypertension, regular use of mono- or two-drug antihypertensive therapy for 3 months), subgroups were formed according to drug class: calcium channel blockers (n = 25), renin-angiotensin-aldosterone system inhibitors (n = 21), beta-blockers (n = 20), calcium channel blockers with beta-blockers (n = 99), beta-blockers with renin-angiotensin-aldosterone system inhibitors (n = 34), calcium channel blockers with an imidazoline receptor agonist (n = 46), and calcium channel blockers with renin-angiotensin-aldosterone system inhibitors (n = 70). Patients completed the Beck Depression Inventory on their own. Depression levels were assessed according to outcomes. Statistical analysis included paired t-tests, stepwise multivariable regression analysis, and Pearson chi-square test with Bonferroni correction. Differences were considered significant at p 0.05.

Results

Survivors showed a decrease in depressive symptoms over 3 years (p = 0.001), whereas patients who died showed progressive worsening (p = 0.019). In patients on calcium channel blockers, depression scores decreased (p = 0.001). With beta-blockers, the increase in depression scores was driven by the cognitive-affective subscale. Regression analysis found no difference in the effect of antihypertensive monotherapy on depression severity. In the calcium channel blocker + beta-blocker group, depression improved (p = 0.001) due to a decrease in the somatic subscale (p = 0.001). With beta-blockers + renin-angiotensin-aldosterone system inhibitors, no significant changes were found. Regression analysis showed that use of a calcium channel blocker with an imidazoline receptor agonist or a renin-angiotensin-aldosterone system inhibitor was associated with more severe depressive symptoms (p = 0.001).

Conclusion

Calcium channel blocker monotherapy was associated with a reduction in depressive symptoms, while beta-blocker therapy was associated with an increase, mainly in the cognitive-affective subscale.