EFFECT OF WITHDRAWAL OF ANTIHYPERTENSIVE DRUG ON DEPRESSIVE MOOD

To evaluate the effects on depressive mood of withdrawal of antihypert ensive medication, we conducted a randomized, multi-center study with clinical centers at the Albert Einstein College of Medicine, Bronx, NY , University of Alabama School of Medicine, Birmingham, and the Univer sity of Mississippi School of Medicine in Jackson. Patients were forme rly active participants in the Hypertension Detection and Follow-Up Pr ogram (HDFP) whose blood pressure was controlled with drugs for a peri od of 5 years. Of 496 patients, 431 had both baseline and ''1-year'' m ood scores. Patients, stratified by obesity, were randomized to one of three groups: continue the HDFP medication; discontinue medication wi th no dietary intervention, or with sodium restriction and potassium i ncrease; or, for those overweight, to a weight reduction intervention. Depression was assessed using the CES-D scale (Center for Epidemiolog ical Studies-Depressed Mood), administered at baseline and again appro ximately 1 year after randomization. Of the seven treatment groups, on ly those who continued their HDFP medication showed significant improv ement in mood from baseline. The overweight continue-medication group showed significantly greater improvement compared to the no-drugs, no- diet intervention groups, and to the overweight sodium-restriction gro up. Patients who had their blood pressure successfully controlled with weight reduction had a significant improvement in mood from 11.0 scal e points to 8.0, P=.006. Comparisons between those withdrawn from diur etic alone and those withdrawn from both diuretic plus reserpine were inconclusive. Dietary Intervention Study of Hypertension (DISH) shows no evidence that continued use of chlorthalidone has a negative impact on quality of life, while our results concerning reserpine were incon clusive. With regard to dietary interventions, only those assigned to weight reduction who succeeded in remaining off drugs had significant beneficial improvements in mood. Assessment of mood prior to initiatin g therapy and after several months of treatment may help physicians ev aluate the effects of particular drugs on mood.