Cardiovascular haemodynamic profile among users of psychotropic medication: a cohort-based matched analysis in the African-PREDICT study

Background

Psychotropic medication use may influence blood pressure (BP), potentially via autonomic cardiovascular regulation and cardiometabolic pathway influences. Although findings are inconsistent between populations and vary by clinical presentation, evidence suggests that antidepressant use, rather than depressive symptoms alone, is associated with hypertension risk in young adults. Selective serotonin reuptake inhibitors (SSRIs) can decrease BP, though elevations in BP have also been reported, highlighting the complex interrelationship of psychotropic use and cardiovascular health. In low‑ and middle‑income countries, where the burden of psychiatric and cardiovascular disease is on the rise, data on psychotropic use and early cardiovascular changes unfortunately remain limited. Therefore, we aimed to characterize cardiovascular haemodynamic parameters and cardiometabolic indicators in young adults using psychotropic medications relative to matched non‑users, all screened to be free of overt cardiovascular disease.

Methods

Participants, aged 20–30 years, from the African-PREDICT study (2013-2017), conducted in the North West Province of South Africa, were included. Psychotropic medication users (n = 50) were matched 1:1 by age, sex, ethnicity, and socioeconomic status with non-users (n = 50). Twenty four-hour (24-h) ambulatory and brachial BP measures were undertaken, and depression was assessed with the Patient Health Questionnaire (PHQ)-9. Anthropometric measurements and biochemical analyses included body composition, inflammatory biomarkers, fasting glucose, insulin and lipids. Statistical analysis included chi-square tests, independent t-tests, and analysis of covariance (ANCOVA; adjusted for depressive symptoms) to compare systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), pulse pressure (PP), heart rate (HR) and cardiometabolic indicators between psychotropic medication users and non-users. Effect sizes (practical significance) were calculated with Cohen’s d.

Results

Participants using psychotropic medication (mean age of 25 years) were predominantly female (73.5%) and of white race (93.9%). Antidepressants were most commonly used (63.3%), followed by anticonvulsants (18.4%), anxiolytics (benzodiazepines; 16.3%), and atypical antipsychotics (10.2%). Polypharmacy (use of two or more psychotropic medications) was observed in 33% of these individuals. Among those using antidepressants, SSRIs were the most prescribed (67.7%), followed by serotonin–noradrenaline reuptake inhibitors (25.8%) and dopamine–noradrenaline reuptake inhibitors (19.4%). Compared with non-users, psychotropic medication users exhibited small to moderately (d ≈ 0.33–0.61) greater depression symptom severity (p = 0.004), 24-h DBP (p = 0.028), nighttime DBP (p = 0.018), 24-h HR (p = 0.005) and daytime HR (p < 0.001. In contrast, nighttime PP (p = 0.029) and office PP (p = 0.043) were lower (d ≈ 0.36–0.43). These differences remained significant even after adjusting for depression symptom severity. Cardiometabolic indicators were comparable between groups.

Conclusions

In this cohort of young adults, higher DBP and HR, along with lower PP, persisted in psychotropic users after adjustment for depressive symptoms. These hemodynamic differences appear closely related to psychotropic medication exposure and may suggest a shift toward higher diastolic and lower pulsatile pressure alongside increased chronotropic demand. This pattern may reflect an early subclinical cardiovascular profile which, if sustained over time, could have implications for future cardiovascular risk, highlighting the importance of routine BP and HR monitoring of individuals treated with these medicines.

References

No references