Blockade of the angiotensin system improves mental health domain of quality of life: A meta-analysis of randomized clinical trials

Brownstein, Daniel J.; Salagre, Estela; Köhler, Cristiano A.; Stubbs, Brendon; Vian, João; Pereira, Círia; Chavarría, V.; Karmakar, Chandan; Turner, Alyna; Quevedo, Joao L De; Carvalho, André F.; Berk, Michael; Fernandes, Brisa Simões

doi:10.1177/0004867417721654

Cited by 35 publications

(31 citation statements)

References 92 publications

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“…Examples include statins, aspirin and angiotensin antagonists 788, 789, 790, 791, 792, 793. The implications are that clinicians should be actively engaged in the management of these disorders, and should select therapies from those agents that may have benefit in mood symptoms.…”

Section: Specific Populationsmentioning

confidence: 99%

“…Clozapine and olanzapine are associated with the greatest level of risk, followed by quetiapine (particularly in higher doses) and risperidone, with a more minimal impact of aripiprazole, ziprasidone, asenapine, and lurasidone 810. Lithium and divalproex are also associated with weight gain 791. All patients on atypical antipsychotics should be monitored for changes in blood glucose and lipid profiles as indicated previously in this section, and if disturbances are detected, the atypical antipsychotic should be discontinued if possible and appropriate treatment initiated if necessary.…”

Section: Safety and Monitoringmentioning

confidence: 99%

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Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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Section: Specific Populationsmentioning

confidence: 99%

Section: Safety and Monitoringmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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“…There may have been a lack of adequate power to demonstrate such an association as we have already reported a lower incidence of new-onset diabetes as well as improved quality of life among individuals randomized to receive the ACEI-based regimen (Chowdhury et al, 2015). Recently, Brownstein et al in a meta-analysis of randomized clinical treatment trials in hypertensive patients showed that use of these ACEI-based regimens was associated with an improved mental health domain of quality of life scales (Brownstein et al, 2018).…”

Section: Physical Activities (In Two Weeks Prior Randomization)mentioning

confidence: 88%

“…Similarly, an association between depression and angiotensin converting enzyme (ACE) polymorphisms has also been reported (Ancelin et al, 2013). In addition, people taking either ACEIs or angiotensin receptor blocking agents (ARBs) as antihypertensive drugs may have improved quality of life (Brownstein et al, 2018). Thus, the relationship between agents blocking the reninangiotensin system and depression requires further investigation.…”

Section: Introductionmentioning

confidence: 99%

Association of depression with mortality in an elderly treated hypertensive population

Chowdhury

Berk

Nelson

et al. 2018

Int. Psychogeriatr.

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“…The lower rate of adverse events and the perception of health benefit from the treatment add up to potential psychotropic effects that have been described in RAAS blockers. A recent meta-analysis indicates that treatment of healthy adults with hypertension with ACEIs or ARBs is associated with improved mental health quality of life, although this was a secondary outcome in the included studies and thus the benefit may only be hypothesized [14].…”

Section: Angiotensin Receptor Blockers and Angiotensin Converting Enzmentioning

confidence: 99%

Angiotensin Receptor Blockers Versus Angiotensin Converting Enzyme Inhibitors for the Treatment of Arterial Hypertension and the Role of Olmesartan

Omboni

Volpe

2018

Adv Ther

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Blood pressure lowering by all classes of antihypertensive drugs is accompanied by significant reductions of stroke and major cardiovascular (CV) events. Drugs acting on the renin–angiotensin–aldosterone system, such as angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), showed similar benefit on major CV events to other antihypertensive medications. In real-world practice, ARBs reduced by 10% the incidence of CV mortality, non-fatal myocardial infarction, non-fatal stroke and provided superior protection against CV events than ACEIs in high-risk patients. Despite similar antihypertensive properties and a favourable safety profile for both ACEIs and ARBs, evidence indicates that patients treated with ARBs have lower rates of withdrawal for adverse events and greater persistence to therapy than those treated with ACEIs. Among ARBs, olmesartan is one of the latest generation compounds introduced in clinical practice for treating hypertension: head-to-head comparative trials suggest that the efficacy of olmesartan is superior to that of commonly prescribed ACEIs (ramipril and perindopril). The drug, administered as a monotherapy or in combination with a dihydropyridine calcium channel blocker or a thiazide diuretic, has proved to be effective in maintaining blood pressure stability over 24 h, with a favourable safety profile and low discontinuation rates. These properties are pivotal for considering olmesartan as a useful antihypertensive agent especially for high-risk patients (e.g. elderly, diabetics, patients with metabolic syndrome).Funding: Article preparation and open access fee were funded by Menarini International Operations Luxembourg S.A. (M.I.O.L.)

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Blockade of the angiotensin system improves mental health domain of quality of life: A meta-analysis of randomized clinical trials

Cited by 35 publications

References 92 publications

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Association of depression with mortality in an elderly treated hypertensive population

Angiotensin Receptor Blockers Versus Angiotensin Converting Enzyme Inhibitors for the Treatment of Arterial Hypertension and the Role of Olmesartan

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