OBJECTIVE: Cardiovascular diseases are associated with an increased risk of depression, but it remains unclear whether treatment with cardiovascular agents decreases or increases this risk. The effects of drugs on individual usage are also often unknown. This review aimed to examine the correlation between depression and common cardiovascular drugs, develop more potent interventions for depression in cardiovascular patients, and further research on the bio-behavioural mechanisms linking cardiovascular drugs to depression. DATA SOURCES: The data in this review were obtained from articles included in PubMed, EMBASE, and Web of Science. STUDY SELECTION: Clinical trials, observational studies, review literature, and guidelines about depression and cardiovascular drugs were selected for the article. RESULTS: We systematically investigated whether the seven most used cardiovascular drugs were associated with altered risk of incident depression in this literature review. Statins have been proven to have antidepressant effects. Some studies believe angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blocker (ARB) can exert an antidepressant influence by acting on the renin-angiotensin system, but further clinical trials are needed to confirm this. Beta-blockers have previously been associated with depression, but the current study found no significant association between beta blockers and the risk of depression. Aspirin may have antidepressant effects by suppressing the immune response, but its role as an antidepressant remains controversial. calcium channel blockers (CCBs) can regulate nerve signal transduction by adjusting calcium channels, but whether this effect is beneficial or harmful to depression remains unclear. Finally, some cases have reported that nitrates and diuretics are associated with depression, but the current clinical evidence is insufficient. CONCLUSIONS Statins have been proven to have antidepressant effect, and the antidepressant effects of ACEIs/ARB and aspirin are still controversial. CCBs are associated with depression, but it is unclear whether it is beneficial or harmful. No association has been found with β-blockers, diuretics, and nitrates.
Angiotensin Receptor Antagonists/therapeutic use* ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use* ; Antihypertensive Agents/therapeutic use* ; Calcium Channel Blockers/therapeutic use* ; Cardiovascular Agents/therapeutic use* ; Cardiovascular Diseases/drug therapy* ; Depression/drug therapy* ; Humans ; Hypertension/drug therapy* ; Renin-Angiotensin System

Dihydropyridine (DHP) calcium channel blockers (CCBs) have been widely used to treat of several cardiovascular diseases. An excessive shortening of action potential duration (APD) due to the reduction of Ca2+ channel current (I(Ca)) might increase the risk of arrhythmia. In this study we investigated the electrophysiological effects of nicardipine (NIC), isradipine (ISR), and amlodipine (AML) on the cardiac APD in rabbit Purkinje fibers, voltage-gated K+ channel currents (I(Kr), I(Ks)) and voltage-gated Na+ channel current (I(Na)). The concentration-dependent inhibition of Ca2+ channel currents (I(Ca)) was examined in rat cardiomyocytes; these CCBs have similar potency on I(Ca) channel blocking with IC50 (the half-maximum inhibiting concentration) values of 0.142, 0.229, and 0.227 nM on NIC, ISR, and AML, respectively. However, ISR shortened both APD50 and APD90 already at 1 microM whereas NIC and AML shortened APD50 but not APD90 up to 30 microM. According to ion channel studies, NIC and AML concentration-dependently inhibited I(Kr) and I(Ks) while ISR had only partial inhibitory effects (<50% at 30 microM). Inhibition of I(Na) was similarly observed in the three CCBs. Since the I(Kr) and I(Ks) mainly contribute to cardiac repolarization, their inhibition by NIC and AML could compensate for the AP shortening effects due to the block of I(Ca).
Action Potentials ; Amlodipine ; Animals ; Antihypertensive Agents ; Arrhythmias, Cardiac ; Calcium Channel Blockers* ; Calcium Channels* ; Calcium* ; Cardiovascular Diseases ; Inhibitory Concentration 50 ; Ion Channels ; Isradipine ; Myocytes, Cardiac ; Nicardipine ; Purkinje Fibers ; Rats

BACKGROUND AND OBJECTIVES: 2018 ESC/ESH Hypertension guideline recommends 2-drug combination as initial anti-hypertensive therapy. However, real-world evidence for effectiveness of recommended regimens remains limited. We aimed to compare the effectiveness of first-line anti-hypertensive treatment combining 2 out of the following classes: angiotensin-converting enzyme (ACE) inhibitors/angiotensin-receptor blocker (A), calcium channel blocker (C), and thiazide-type diuretics (D).METHODS: Treatment-naïve hypertensive adults without cardiovascular disease (CVD) who initiated dual anti-hypertensive medications were identified in 5 databases from US and Korea. The patients were matched for each comparison set by large-scale propensity score matching. Primary endpoint was all-cause mortality. Myocardial infarction, heart failure, stroke, and major adverse cardiac and cerebrovascular events as a composite outcome comprised the secondary measure.RESULTS: A total of 987,983 patients met the eligibility criteria. After matching, 222,686, 32,344, and 38,513 patients were allocated to A+C vs. A+D, C+D vs. A+C, and C+D vs. A+D comparison, respectively. There was no significant difference in the mortality during total of 1,806,077 person-years: A+C vs. A+D (hazard ratio [HR], 1.08; 95% confidence interval [CI], 0.97−1.20; p=0.127), C+D vs. A+C (HR, 0.93; 95% CI, 0.87−1.01; p=0.067), and C+D vs. A+D (HR, 1.18; 95% CI, 0.95−1.47; p=0.104). A+C was associated with a slightly higher risk of heart failure (HR, 1.09; 95% CI, 1.01−1.18; p=0.040) and stroke (HR, 1.08; 95% CI, 1.01−1.17; p=0.040) than A+D.CONCLUSIONS: There was no significant difference in mortality among A+C, A+D, and C+D combination treatment in patients without previous CVD. This finding was consistent across multi-national heterogeneous cohorts in real-world practice.
Adult ; Angiotensin Receptor Antagonists ; Antihypertensive Agents ; Calcium Channel Blockers ; Calcium Channels ; Cardiovascular Diseases ; Cohort Studies ; Diuretics ; Heart Failure ; Humans ; Hypertension ; Korea ; Mortality ; Myocardial Infarction ; Propensity Score ; Stroke

The risk attributable to cardiovascular disease (CVD) that is induced by hypertension in the Korean population is 35% for stroke and 21% for ischemic heart disease. The prevalence of hypertension in persons older than 30 years is as high as 34.4% in men and 26.5% in women, and the prevalence of prehypertension is 39.4% in men and 30.6% in women. Therefore, the proportion of normotension is merely 28.4% in men and 47.3% in women. However, the current control rates (a systolic blood pressure (BP) <140 mmHg and a diastolic BP <90 mmHg), although improved, are still only (r)10%, which is far below those of western society. This situation urgently mandates a new guideline for making appropriate clinical decisions regarding the needs of individual patients and that this guideline can be applied with due regard to local circumstances and policies. Individuals with hypertension or prehypertension require health-promoting lifestyle modifications to prevent CVD. Drug treatment is recommended for most patients with uncomplicated hypertension that is persistently higher than 140/90 mmHg. The BP goal is less than 140/90 mmHg for most uncomplicated patients with hypertension, and less than 130/80 mmHg for the patients with diabetes or chronic kidney disease. In the absence of compelling indications, any kind of thiazidetype diuretics, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers or calcium channel blockers are recommended for initial use as antihypertensive drugs. If 2 or more drugs are needed to achieve the BP goal the committee recommends a treatment algorithm based on the AB/CD rule. Even though the committee had concerns on the guideline's accuracy due to the paucity of data on Korean people, the Korean Hypertension Treatment Guideline should be implemented to educate and guide both patients and physicians.
Angiotensin-Converting Enzyme Inhibitors ; Antihypertensive Agents ; Blood Pressure ; Calcium Channel Blockers ; Cardiovascular Diseases ; Diuretics ; Female ; Humans ; Hypertension* ; Life Style ; Male ; Myocardial Ischemia ; Prehypertension ; Prevalence ; Renal Insufficiency, Chronic ; Stroke

There are numerous drug interactions related to many psychotropic and cardiovascular medications. Firstly, the principles in predicting drug interactions are discussed. Cytochrome P (CYP) 450 plays a significant role in the metabolism of these drugs that are substrates, inhibitors, or inducers of CYP450 enzymes. The two most significant enzymes are CYP2D6 and CYP3A4. The ability of psychotropic drugs to act as inhibitors for the enzymes may lead to altered efficacy or toxicity of co-administered cardiovascular agents as a substrate for the enzymes. The following is also a review of the known interactions between many commonly prescribed cardiovascular agents and psychotropic drugs. Most beta blockers are metabolized by CYP2D6, which may lead to drug toxicity when they use in combination with potent CYP2D6 inhibitors including bupropion, chlorpromazine, haloperidol, selective serotonin reuptake inhibitors, and quinidine. Concomitant administration of lithium with angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and diuretics may increase serum lithium concentrations and toxicity. Calcium channel blockers and cholesterol lowering agents are subject to interactions with potent inhibitors of CYP3A4, such as amiodarone, diltiazem, fluvoxamine, nefazodone, and verapamil. Prescribing antiarrhythmic drugs in conjunction with medications are known to prolong QT interval and/or inhibitors on a relevant CYP450 enzyme is generally not recommended, or needs watchful monitoring. Digoxin and warfarin also have warrant careful monitoring if co-administered with psychotropic drugs.
Amiodarone ; Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Anti-Arrhythmia Agents ; Bupropion ; Calcium Channel Blockers ; Cardiovascular Agents ; Chlorpromazine ; Cholesterol ; Cytochrome P-450 CYP2D6 ; Cytochrome P-450 Enzyme System ; Cytochromes ; Digoxin ; Diltiazem ; Diuretics ; Drug Interactions ; Drug Toxicity ; Fluvoxamine ; Haloperidol ; Lithium ; Psychotropic Drugs ; Quinidine ; Serotonin Uptake Inhibitors ; Triazoles ; Verapamil ; Warfarin

Humans ; Cardiovascular Diseases/drug therapy* ; Fibrinolytic Agents/therapeutic use* ; Hemorrhage ; Anticoagulants ; Platelet Aggregation Inhibitors

Humans ; Cardiovascular Diseases/drug therapy* ; Fibrinolytic Agents/therapeutic use* ; Hemorrhage ; Anticoagulants ; Platelet Aggregation Inhibitors

No abstract available.
Cardiovascular Agents*

Hypertension is an independent risk factor of atherosclerotic cardiovascular disease. Diabetes multiplies the risk when combined. Therefore, it is crucial for the doctors to control the blood pressure (BP) properly in hypertensive patients with diabetes. And then, how much do we lower the BP? Several guidelines recommend target BP levels to minimize the risk under the basis of so many experimental and observational studies. But, we must consider several factors to properly apply the guidelines in the clinical fields. First, diabetes is not a uniform but a diverse disease. From asymptomatic microvascular disease to macrovascular cardiovascular disease, diabetic clinical findings are so different. So we must define where the patients stand in long diabetic road, and what the patients want to us. Second, because more people are becoming health-conscious, more people take the aspirin, lipid-lowering agents and other medications. It's means that interpretation of the results of recent studies is more difficult than previous, old studies. Third, measuring the BP in the hospital is really reflect the ambulatory BP? Now, it's too early to conclude that the one is more better than the other. From the next study, we can consider the use of ambulatory, home BP monitoring combined with hospital BP measuring. Finally, although BP lowering-effects are similar, all anti-hypertensives do not have same effect in diabetic patients. For example, angiotensin converting enzyme-inhibitor is more superior than calcium channel blocker in patients with heart failure. So, we must consider what type of drug used in the study.
Angiotensins ; Antihypertensive Agents ; Aspirin ; Blood Pressure ; Calcium Channels ; Cardiovascular Diseases ; Heart Failure ; Humans ; Hypertension ; Risk Factors

BACKGROUND/AIMS: Essential hypertension is the most common cardiovascular disease and is involved in the development of the various cardiac arrhythmias, including atrial fibrillation. Recently, several studies have shown that statins have anti-arrhythmic effects, including the prevention of atrial fibrillation. This study investigated the effects of statins on cardiac electrophysiologic remodeling in patients with essential hypertension using the signal-averaged electrocardiogram (ECG) and standard 12-lead ECG. METHODS: This prospective multicenter study enrolled 115 patients with hypertension. Various antihypertensive drugs were administered alone or in combination according to their blood pressure. Statins were administrated in 56 patients. Laboratory tests, a standard 12-lead ECG, and signal-averaged ECG were performed at 1, 3, 6, and 12 months. Statistical analysis was performed using paired and independent t-tests and repeated measures analysis of variance (ANOVA). RESULTS: There was no significant difference in the clinical characteristics of the patients with and without statins. After antihypertensive therapy for 1 year, the P wave dispersion, high-frequency low-amplitude (HFLA) signals in the QRS complex of less than 40 micronV, and T peak-to-end dispersion were increased significantly (p<0.001, p<0.05, and p<0.01, respectively) in the patients who were not taking statins, while these changes were not seen in the statin group. CONCLUSIONS: These results demonstrate that electrophysiologic remodeling was progressive in patients with essential hypertension, despite antihypertensive therapy. However, combination therapy with a statin may inhibit the deterioration of inhomogeneity in atrial refractoriness and conduction disturbance.
Antihypertensive Agents ; Arrhythmias, Cardiac ; Atrial Fibrillation ; Blood Pressure ; Cardiovascular Diseases ; Electrocardiography ; Electrophysiology ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypertension ; Prospective Studies