A Study of Antihypertensive Drugs and Depressive Symptoms (SADD-Sx) in Patients Treated With a Calcium Antagonist Versus an Atenolol Hypertension Treatment Strategy in the International Verapamil SR-Trandolapril Study (INVEST)

Background: The International Verapamil/Trandolapril Study (INVEST) demonstrated comparable efficacy between verapamil SR and atenolol antihypertensive treatment strategies for clinical outcomes and blood pressure (BP) control in hypertensive patients with coronary artery disease (N = 22,576). Effects of these antihypertension strategies on mood-related issues are not well understood. Objectives: The objectives of this study were 1) to compare depressive symptoms by strategy and 2) to identify predictors of depressive symptoms in INVEST patients after 1 year of follow up. Design, Setting, and Patients: Depressive symptoms were assessed in a subset (N = 2317) of consecutively randomized U.S. patients enrolled between April 1, 1999, and October 31, 1999. Patients were mailed surveys after randomization and after 1 year of treatment. Intervention: Patients were assigned to either a verapamil SR or atenolol strategy to achieve Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure BP goals. Trandolapril and/or hydrochlorothiazide were recommended as add-on agents. Main Outcome Measure: Depressive symptoms were measured by the Center for Epidemiologic Studies–Depression (CES-D) scale. Results: CES-D scores improved 1.45 points (p < .001) after 1 year in patients assigned to the verapamil SR strategy, whereas a nonsignificant improvement was observed in patients assigned to the atenolol strategy (0.27 points, p = .44). Predictors of higher depressive symptoms were higher baseline CES-D score (p < .001), history of depression diagnosis (p = .03), history of stroke (p < .001), and assignment to the atenolol strategy (p < .001). Conclusions: A verapamil SR strategy is a viable alternative to beta-blocker therapy for hypertensive patients with coronary artery disease, especially those at risk of depression. CAD = coronary artery disease; MI = myocardial infarction; SADD-Sx = Study of Antihypertensive Drugs and Depressive Symptoms; INVEST = International Verapamil SR-Trandolapril Study; CES-D = Center for Epidemiologic Studies–Depression scale; JNC VI = Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.