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Depression and Hypertension

Matt Hiltibran March 19, 2024 Depression, depressive symptoms, Hypertension

Author: Abimbola Farinde, PhD., PharmD

As humans continue to live longer due to advances in technology and medicine, it is important that there are effective therapeutic interventions in place to manage acute and chronic health conditions, both medical and behavioral in nature. It is reported that over 13% of the United States population is comprised of adults who are 65 years of age and older and this number continues to increase with each passing year (Young et al., 2021).

Older adult hypertensive individuals can be more likely to experience depressive symptoms and it is vital that depression is not viewed as a normal part of the aging process. In an older adult, the presence of depression has the potential to affect the course of the hypertensive illness so it is important that immediate steps are taken to provide interventions that can treat both conditions (Scalco et al., 2005). It has been reported that depression and hypertension can occur concurrently so the treatment approach that is applied should seek to complement one another to treat both conditions when feasible.

There are evidence based treatment options that can be applied to manage various conditions that older adults can experience that include depression and hypertension. Depression and hypertension are known to engage in an interaction though a complex interplay of social, behavioral and biological factors. (Boima et al., 2020). The presence of depression can be associated with cardiovascular disease and poor long-term outcomes. It is important that the negative emotions that accompany depression are initially managed so that older adults can improve adherence to therapies that are important in the management of hypertension. The presence of long standing depression that is not appropriately managed can exacerbate the symptoms of hypertension which can include severe headaches, shortness of breath, nosebleeds, or severe anxiety (Saxena et al., 2018).

Given that older adults can experience polypharmacy related to the management of multiple health conditions, the use of non-pharmacological intervention in the form of cognitive behavioral therapy (CBT) or psychotherapy can be employed as an initial treatment for their depression. The treatment of the depression would be managed initially because this would not require the initiation of another pharmacological agent but an effective pharmacological intervention. CBT is considered to be an effective non medication treatment for depression in adults of all ages but it is recognized as the most systematically researched psychosocial treatment for mild to moderate depression in later life (Serfaty et al., 2009). The use of CBT in older adults allows for the identification and modification of thoughts and behaviors that can contribute to the depression can help with shifting the pattern that can hold an individual back from healing.

The ultimate goal of CBT is to help a person align their thoughts and actions with their mental health goals. Since there are a number of drug interactions that can occur with certain medications that older adults take in combination, the use of CBT for depression and antihypertensive medications for hypertension management would not pose a similar problem. The use of antihypertensive medication such as diuretics, rennin-angiotensin system blockers, and calcium channel blockers are evidence based treatments that have shown benefit of hypertension management and cardiovascular outcomes in older adults (Oliveros et al., 2020).
The use of interventions that do not involved medication for the management of depression symptoms and pharmacotherapy for hypertension management can produce less adverse reactions if implemented in older adults as an evidence based treatment options. However, the limitation of the use of CBT and other interventions that do not involved medications is that they might not successfully manage the symptom during the first trial of the intervention and in this case an additional therapeutic agent would need to be added to the regimen. Another limitation is that the initial treatment of the depression with CBT rather than treating the hypertension might cause conflict among a multidisciplinary team where members can disagree on which condition takes priority when it comes to treatment.

In addition, the role of the behavioral health provider in providing support to patients in a primary care setting is to ensure that both the medical and behavioral aspects of the patient’s care can be taken care of. The medical and behavioral needs of patients can be addressed in an immediate and effective manner due to a higher level of communication and accessibility among the providers. The behavioral health provider should seek to work closely with their medical partners though an integrated approach to target all of the problems that a person presents with when they come for a visit to the primary care setting. While the focus of the behavioral health provider might on the mental element this does not mean they are to ignore the medical issues that the patient presents to as well. The behavioral health provider is to strive to work in conjunction with the medical partners to appropriately address the whole person when it comes to the implantation of therapeutic interventions (Beehle Wray, 2012).

Beehler, G. P., & Wray, L. O. (2012). Behavioral health providers’ perspectives of delivering behavioral health services in primary care: a qualitative analysis. BMC Health Services research, 12, 337.

Boima, V., Tetteh, J., Yorke, E., Archampong, T., Mensah, G., Biritwum, R., &Yawson, A. E. (2020). Older adults with hypertension have increased risk of depression compared to their younger counterparts: Evidence from the World Health Organization study of global ageing and adult health wave 2 in Ghana. Journal of Affective Disorders, 277, 329–336.

Oliveros, E., Patel, H., Kyung, S., Fugar, S., Goldberg, A., Madan, N., & Williams, K. A. (2020). Hypertension in older adults: Assessment, management, and challenges. Clinical Cardiology, 43(2), 99–107.

Scalco, A. Z., Scalco, M. Z., Azul, J. B., &LotufoNeto, F. (2005). Hypertension and depression. Clinics (Sao Paulo, Brazil), 60(3), 241–250.

Serfaty, M. et al. (2009). Clinical effectiveness of individual cognitive behavioral therapy for depressed older people in primary care. Journal of American Medical Association Psychiatry, 66 (12), 1332-1340.

Saxena, T., Ali, A. O., &Saxena, M. (2018). Pathophysiology of essential hypertension: an update. Expert review of cardiovascular therapy, 16(12), 879–887.
Young, E., Pan, S., Yap, A. et al. (2021). Polypharmacy prevalence in older adults seen in United States physician offices fom 2009-2016. PLOS One.

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