Depressed Patients Not Getting Intensified BP Therapy

March 13, 2014

NEW YORK CITY — Hypertensive patients with clinical depression are less likely to have their medication intensified or be referred to a hypertension specialist, according to the results of a small study[1].

This "clinical inertia" might be one reason that clinically depressed patients with cardiovascular disease have a poorer prognosis than those without depression, say researchers.

"Research has shown that patients with mental illness receive less intensive medical care, such as coronary revascularization," write Dr Nathalie Moise (Columbia University Medical Center, New York City) and colleagues March 10, 2014 in JAMA: Internal Medicine. "Our study extends this literature by demonstrating differences in clinician behavior with respect to cardiovascular risk factor management in this population."

The study included 158 patients treated by 28 primary-care physicians at two inner-city clinics affiliated with an academic medical center. The mean age of the hypertensive patients was 65 years, 74% were women, and 79% were Hispanic. The average systolic blood pressure at last clinic visit was 158.7 mm Hg, and patients were taking, on average, 2.5 medications for hypertension. Just under half (45%) had a diagnosis of depression.

Clinical inertia—defined as a failure to intensify antihypertensive treatment, no referral to a hypertension specialist, or a lack of workup for identifiable hypertension despite uncontrolled blood pressure—was significantly more common in depressed than nondepressed patients (70% vs 51%, respectively). In an adjusted model, those with depression were 40% more likely to experience clinical inertia than those without mental illness. This association remained even after adjustment for adherence counseling.

The researchers say future studies should attempt to understand why physicians treat patients with depression differently from other patients, but in the meantime they encourage primary-care doctors to be "cautious about undertreating cardiovascular risk factors among patients identified as having depression."

Recently, an expert panel of the American Heart Association (AHA) recommended that depression be considered as official risk factor for heart disease.


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