Assessment of psychiatric comorbidities and serotonergic or noradrenergic medication use on blood pressure using 24‐hour ambulatory blood pressure monitoring

Abstract

In this study, the authors aimed to assess both nighttime and daytime blood pressure (BP) variability using 24‐hour ambulatory BP monitoring (ABPM) in persons with and without psychiatric conditions and with or without selective serotonin reuptake inhibitors (SSRIs) or serotonin‐norepinephrine reuptake inhibitors (SNRIs) treatment. In this retrospective study, patients who underwent psychiatric evaluation and ABPM within 6 months of each other between January 1, 2012 and December 31, 2017 were identified using billing data. Participants were divided into three groups—participants with no psychiatric diagnosis and no psychiatric medicine (−Diagnosis/−Medication), those with psychiatric diagnosis and on SSRIs/SNRIs (+Diagnosis/+Medication), and psychiatric diagnosis but no psychiatric medications (+Diagnosis/−Medication). Day and nighttime systolic and diastolic BPs were compared between groups controlling for relevant variables using multivariable linear regression models. A total of 475 participants met inclusion criteria including 135 in the −Diagnosis/−Medication group, 232 in the +Diagnosis/+Medication group, and 108 in the +Diagnosis/−Medication group. In adjusted multivariable analysis, the +Diagnosis/+Medication group had higher nighttime systolic BP (median 120 vs 110 mm (Hg); p = .01) and nighttime diastolic BP (median 68 vs 63 mm (Hg); p = .006) as compared to −Diagnosis/−Medication. No statistically significant differences in BPs between the −Diagnosis/−Medication and +Diagnosis/−Medication groups were observed, after adjustment. Use of SSRIs/SNRIs was associated with significantly higher nocturnal systolic and diastolic BP among patients with psychiatric diagnosis using SSRIs/SNRIs but not associated with psychiatric diagnosis without SSRI/SNRI use. SSRIs/SNRIs use may be associated with higher BP levels and this merits future prospective studies using ABPM to assess day and nighttime BP changes with SSRIs/SNRIs use.

Serotonergic Modulation of Neurovascular Transmission: A Focus on Prejunctional 5-HT Receptors/Mechanisms

“…This effect is clearly dependent on SERT function, as SERT knock-out mice are less prone to the chronic 5-HT-induced drop in blood pressure [134]. Interestingly, some clinical studies have shown that chronic inhibition of 5-HT reuptake by SERT inhibitors reduced the risk of a myocardial infarction [135], but an increase in blood pressure was recorded at night [136]. In this regard, in dogs, chronic oral treatment with fluoxetine does not affect mean arterial blood pressure (measured at diurnal time), but the capsaicin-induced trigeminal CGRP release (resulting in vasodilatation) is diminished at the craniovascular (external carotid) level [137]; this finding may help explain the mechanism of action of some SERT inhibitors to treat migraine.…”