Popular hypertension drug linked with suicide

Matt Woodley

17/10/2019 3:12:25 PM

Angiotensin receptor blockers may be associated with a higher risk of suicide than alternative medications, a new study has found.

Man receiving a blood pressure test
The findings suggest a possible increased risk of suicide associated with the use of ARBs.

Led by researchers from St Michael’s Hospital in Ontario, Canada, the study compared records taken over an 18-year period of 964 suicide cases among people given either angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs).  
It then compared them with another 3856 controls who had been prescribed either of the drugs but did not go on to commit suicide.
A higher proportion of cases were exposed to ARBs (26%) were exposed to ARBs than ACEIs (18.4%), leading to an adjusted odds ratio of 1.63.
‘The effect of these drugs on mental health outcomes, particularly suicide, is of increasing interest because of the bidirectional association between depression and cardiovascular disease,’ the authors, led by Dr Muhammad Mamdani, wrote.
‘Our findings suggest a possible increased risk of suicide associated with the use of ARBs compared with ACEIs among adults aged 66 years and older.
‘Given their high prevalence of use, the severity of the outcome, and the similar efficacy of these drug classes in treating the same conditions, clinicians may opt for preferential use of ACEIs over ARBs where possible.’
The study included people aged 66 years and older who died by suicide within 100 days of being prescribed an ACEI or ARB, matched to controls who had died of other causes. The median age of the study participants was 76, nearly 80% of whom were male.
The most commonly prescribed ACEIs were ramipril (38.8%) and enalapril (15%), whereas the most frequently prescribed ARBs were valsartan (16.7%), telmisartan (16.7%), and candesartan (16.7%).
According to an accompanying editorial submitted by psychiatrist Professor Ira Katz, while the study’s conclusions should be viewed as preliminary, the findings are ‘important’ and worthy of further follow-up research.
‘This is the sort of finding – the identification of a serious but rare adverse drug effect – that could only come from real-world data,’ Professor Ira Katz wrote.
‘While additional information about brain and behavioural mechanisms could strengthen the reported findings, validated evidence about adverse drug effects from studies based on real-world data should be considered in practice and policy, even when no mechanisms are apparent.
‘The strength of the methods, the importance of preventing suicide, and the number of people exposed to ARBs all support the need to encourage additional studies and to translate the combined findings into guidance about prescribing.’

angiotensin converting enzyme inhibitors angiotensin receptor blockers cardiovascular disease chronic disease hypertension mental health research suicide

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