Blockade of the angiotensin system improves mental health domain of quality of life: a meta-analysis of randomized clinical trials
journal contribution
posted on 2018-01-01, 00:00 authored by D J Brownstein, E Salagre, C Köhler, B Stubbs, J Vian, C Pereira, V Chavarria, Chandan KarmakarChandan Karmakar, Alyna TurnerAlyna Turner, J Quevedo, A F Carvalho, Michael BerkMichael Berk, Brisa Simoes FernandesOBJECTIVE: It is unclear whether blockade of the angiotensin system has effects on mental health. Our objective was to determine the impact of angiotensin converting enzyme inhibitors and angiotensin II type 1 receptor (AT1R) blockers on mental health domain of quality of life. STUDY DESIGN: Meta-analysis of published literature. DATA SOURCES: PubMed and clinicaltrials.gov databases. The last search was conducted in January 2017. STUDY SELECTION: Randomized controlled trials comparing any angiotensin converting enzyme inhibitor or AT1R blocker versus placebo or non-angiotensin converting enzyme inhibitor or non-AT1R blocker were selected. Study participants were adults without any major physical symptoms. We adhered to meta-analysis reporting methods as per PRISMA and the Cochrane Collaboration. DATA SYNTHESIS: Eleven studies were included in the analysis. When compared with placebo or other antihypertensive medications, AT1R blockers and angiotensin converting enzyme inhibitors were associated with improved overall quality of life (standard mean difference = 0.11, 95% confidence interval = [0.08, 0.14], p < 0.0001), positive wellbeing (standard mean difference = 0.11, 95% confidence interval = [0.05, 0.17], p < 0.0001), mental (standard mean difference = 0.15, 95% confidence interval = [0.06, 0.25], p < 0.0001), and anxiety (standard mean difference = 0.08, 95% confidence interval = [0.01, 0.16], p < 0.0001) domains of QoL. No significant difference was found for the depression domain (standard mean difference = 0.05, 95% confidence interval = [0.02, 0.12], p = 0.15). CONCLUSIONS: Use of angiotensin blockers and inhibitors for the treatment of hypertension in otherwise healthy adults is associated with improved mental health domains of quality of life. Mental health quality of life was a secondary outcome in the included studies. Research specifically designed to analyse the usefulness of drugs that block the angiotensin system is necessary to properly evaluate this novel psychiatric target.
History
Journal
Australian and New Zealand journal of psychiatryVolume
52Issue
1Pagination
24 - 38Publisher
SAGE PublicationsLocation
London, Eng.Publisher DOI
Link to full text
eISSN
1440-1614Language
engPublication classification
C Journal article; C1 Refereed article in a scholarly journalCopyright notice
2017, The Royal Australian and New Zealand College of PsychiatristsUsage metrics
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Categories
Keywords
Precision psychiatryangiotensin systemmental healthmeta-analysispersonalized medicinequality of lifeScience & TechnologyLife Sciences & BiomedicinePsychiatryMAJOR DEPRESSIVE DISORDERBLOOD-PRESSURE CONTROLDOUBLE-BLINDANTIHYPERTENSIVE THERAPYESSENTIAL-HYPERTENSIONELDERLY-PATIENTSCANDESARTAN CILEXETILMILD HYPERTENSIONNIFEDIPINE GITSSURVEY SF-36