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, 13, 2781-2796
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A Meta-Analysis of Effects of Selective Serotonin Reuptake Inhibitors on Blood Pressure in Depression Treatment: Outcomes From Placebo and Serotonin and Noradrenaline Reuptake Inhibitor Controlled Trials

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Review

A Meta-Analysis of Effects of Selective Serotonin Reuptake Inhibitors on Blood Pressure in Depression Treatment: Outcomes From Placebo and Serotonin and Noradrenaline Reuptake Inhibitor Controlled Trials

Zhuoyuan Zhong et al. Neuropsychiatr Dis Treat.

Abstract

Background: Selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) have been commonly prescribed for depression treatment. However, their effects on blood pressure are unclear.

Materials and methods: Effects on blood pressure of depressive patients in two groups (SSRIs versus placebo and SSRIs versus SNRIs) were evaluated. A search was conducted for double-blind, randomized controlled trials (RCTs) in PubMed, EMBASE, ISI Web of Science, PsycNET, CCRCT, and DARE (up to March 2017). The outcomes were systolic blood pressure (SBP) changes and diastolic blood pressure (DBP) changes from baseline to endpoint or to a certain period of treatment duration. Weighted mean differences (WMDs) and 95% CIs were calculated and pooled using random effects models. The χ2 test and I2 statistics were used to assess heterogeneity. Funnel plots, Begg's test, and Egger's test were used to estimate publication bias.

Results: A total of 23 RCTs involving 13,285 participants were included. Patients on SSRIs showed no significant differences in blood pressure changes compared with placebo. In the group of SSRIs versus SNRIs, overall SBP changes and DBP changes revealed statistical significances (WMD 1.5 mmHg, 95% CI -2.15, -0.84, Z=4.46, P<0.00001 and WMD 1.34 mmHg, 95% CI -1.92, -0.75, Z=6.18, P<0.00001). Subgroup analyses on treatment duration and age further evidenced these findings.

Conclusion: It was established that SSRIs did not affect blood pressure, while SNRIs led to a modest increase in SBP and DBP with statistical significance compared with SSRIs.

Keywords: antidepressant; blood pressure change; depression; depression treatment; diastolic blood pressure; meta-analysis; selective serotonin reuptake inhibitors; serotonin and noradrenaline reuptake inhibitors; systolic blood pressure.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow chart of study selection. Abbreviation: RCT, randomized controlled trial.
Figure 2
Figure 2
Assessment of risk of bias for each individual trial. ?, unclear risk of bias; +, low risk of bias.
Figure 3
Figure 3
A forest plot of RCTs comparing SSRI group with placebo group for change in systolic blood pressure. Abbreviations: RCTs, randomized controlled trials; SSRI, selective serotonin reuptake inhibitor.
Figure 4
Figure 4
A forest plot of RCTs comparing SSRI group with placebo group for change in diastolic blood pressure. Abbreviations: RCTs, randomized controlled trials; SSRI, selective serotonin reuptake inhibitor.
Figure 4
Figure 4
A forest plot of RCTs comparing SSRI group with placebo group for change in diastolic blood pressure. Abbreviations: RCTs, randomized controlled trials; SSRI, selective serotonin reuptake inhibitor.
Figure 5
Figure 5
A forest plot of RCTs comparing SSRI group with SNRI group for change in systolic blood pressure change of short-/long-term duration. Abbreviations: RCTs, randomized controlled trials; SSRI, selective serotonin reuptake inhibitor; SNRI, serotonin and noradrenaline reuptake inhibitor.
Figure 6
Figure 6
A forest plot of RCTs comparing SSRI group with SNRI group for change in diastolic blood pressure change of short-/long-term duration. Abbreviations: RCTs, randomized controlled trials; SSRI, selective serotonin reuptake inhibitor; SNRI, serotonin and noradrenaline reuptake inhibitor.
Figure 7
Figure 7
A forest plot of RCTs comparing SSRI group with SNRI group for change in systolic blood pressure change of different ages. Abbreviations: RCTs, randomized controlled trials; SSRI, selective serotonin reuptake inhibitor; SNRI, serotonin and noradrenaline reuptake inhibitor.
Figure 8
Figure 8
A forest plot of RCTs comparing SSRI group with SNRI group for change in diastolic blood pressure change of different ages. Abbreviations: RCTs, randomized controlled trials; SSRI, selective serotonin reuptake inhibitor; SNRI, serotonin and noradrenaline reuptake inhibitor.
Figure 9
Figure 9
Begg’s test and Egger’s test identified no publication bias. In the group of SSRI versus placebo: Begg’s test: Z=0.33, P=0.742 (A); Egger’s test: t=0.36, P=0.724 (B). In the group of SSRI versus SNRI: Begg’s test: Z=1.19, P=0.236 (C); Egger’s test: t=0.85, P=0.405 (D). Abbreviations: WMD, weighted mean difference; SSRI, selective serotonin reuptake inhibitor; SNRI, serotonin and noradrenaline reuptake inhibitor.
Figure 9
Figure 9
Begg’s test and Egger’s test identified no publication bias. In the group of SSRI versus placebo: Begg’s test: Z=0.33, P=0.742 (A); Egger’s test: t=0.36, P=0.724 (B). In the group of SSRI versus SNRI: Begg’s test: Z=1.19, P=0.236 (C); Egger’s test: t=0.85, P=0.405 (D). Abbreviations: WMD, weighted mean difference; SSRI, selective serotonin reuptake inhibitor; SNRI, serotonin and noradrenaline reuptake inhibitor.
Figure 10
Figure 10
The sensitivity analysis showed the influence of omitting each study in turn in the meta-analysis of SSRI versus placebo. The pooled WMDs (95% CI) ranged from −0.19 (−0.89, 0.50) to 0.10 (−0.55, 0.76) in systolic blood pressure change (A), and from −0.01 (−0.53, 0.52) to 0.19 (−0.34, 0.72) in diastolic blood pressure change (B), with all showing no statistical significance. Notes: (A) The sensitivity analysis showed the influence of omitting each study in turn in the meta-analysis of selective serotonin reuptake inhibitor versus placebo in systolic blood pressure change. (B) The sensitivity analysis showed the influence of omitting each study in turn in the meta-analysis of selective serotonin reuptake inhibitor versus placebo in diastolic blood pressure change. Abbreviations: SSRI, selective serotonin reuptake inhibitor; WMDs, weighted mean differences.
Figure 10
Figure 10
The sensitivity analysis showed the influence of omitting each study in turn in the meta-analysis of SSRI versus placebo. The pooled WMDs (95% CI) ranged from −0.19 (−0.89, 0.50) to 0.10 (−0.55, 0.76) in systolic blood pressure change (A), and from −0.01 (−0.53, 0.52) to 0.19 (−0.34, 0.72) in diastolic blood pressure change (B), with all showing no statistical significance. Notes: (A) The sensitivity analysis showed the influence of omitting each study in turn in the meta-analysis of selective serotonin reuptake inhibitor versus placebo in systolic blood pressure change. (B) The sensitivity analysis showed the influence of omitting each study in turn in the meta-analysis of selective serotonin reuptake inhibitor versus placebo in diastolic blood pressure change. Abbreviations: SSRI, selective serotonin reuptake inhibitor; WMDs, weighted mean differences.
Figure 11
Figure 11
The sensitivity analysis showed the influence of omitting each study in turn in the meta-analysis of SSRI versus SNRI. The pooled WMDs (95% CI) ranged from −1.58 (−2.22, −0.93) to −1.36 (−1.94, −0.77) in systolic blood pressure change (A), and from −1.43 (−2.01, −0.85) to −1.22 (−1.77, −0.67) in diastolic blood pressure change (B), with all showing statistical significances. Notes: (A) The sensitivity analysis showed the influence of omitting each study in turn in the meta-analysis of selective serotonin reuptake inhibitor versus serotonin and noradrenaline reuptake inhibitor on systolic blood pressure change. (B) The sensitivity analysis showed the influence of omitting each study in turn in the meta-analysis of selective serotonin reuptake inhibitor versus serotonin and noradrenaline reuptake inhibitor on diastolic blood pressure change. Abbreviations: SNRI, serotonin and noradrenaline reuptake inhibitor; WMDs, weighted mean differences.
Figure 11
Figure 11
The sensitivity analysis showed the influence of omitting each study in turn in the meta-analysis of SSRI versus SNRI. The pooled WMDs (95% CI) ranged from −1.58 (−2.22, −0.93) to −1.36 (−1.94, −0.77) in systolic blood pressure change (A), and from −1.43 (−2.01, −0.85) to −1.22 (−1.77, −0.67) in diastolic blood pressure change (B), with all showing statistical significances. Notes: (A) The sensitivity analysis showed the influence of omitting each study in turn in the meta-analysis of selective serotonin reuptake inhibitor versus serotonin and noradrenaline reuptake inhibitor on systolic blood pressure change. (B) The sensitivity analysis showed the influence of omitting each study in turn in the meta-analysis of selective serotonin reuptake inhibitor versus serotonin and noradrenaline reuptake inhibitor on diastolic blood pressure change. Abbreviations: SNRI, serotonin and noradrenaline reuptake inhibitor; WMDs, weighted mean differences.

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References

    1. Celano CM, Huffman JC. Depression and cardiac disease: a review. Cardiol Rev. 2011;19(3):130–142. - PubMed
    1. Dhar AK, Barton DA. Depression and the link with cardiovascular disease. Front Psychiatry. 2016;7:33. - PMC - PubMed
    1. Scuteri A. Depression and cardiovascular risk: does blood pressure play a role? J Hypertens. 2008;26(9):1738–1739. - PubMed
    1. Hildrum B, Mykletun A, Stordal E, Bjelland I, Dahl AA, Holmen J. Association of low blood pressure with anxiety and depression: the Nord-Trondelag Health Study. J Epidemiol Community Health. 2007;61(1):53–58. - PMC - PubMed
    1. Hildrum B, Mykletun A, Holmen J, Dahl AA. Effect of anxiety and depression on blood pressure: 11-year longitudinal population study. Br J Psychiatry. 2008;193(2):108–113. - PubMed

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