Effects of Venlafaxine ER on Blood Pressure during the Acute Treatment of Major Depressive Patients

Seo, Ho Jun; Suh, Jae Won; Jung, Young Eun; Kim, Seok Beom; Chae, Jeong Ho; Jun, Tae Youn; Kim, Kwang Soo; Bahk, Won Myong

Abstract

OBJECTIVE
Venlafaxine is an antidepressant with a dual action of blocking reuptake of both serotonin and norepinephrine at therapeutic dose like some tricyclic antidepressants. However it may share the relative safety of SSRIs in overdosage and cardiotoxicity. One common concern for 1st line use of venlafaxine is the risk of hypertension. There have been some controversies about this adverse effect. In present study, we evaluate the effects of venlafaxine on blood pressure in therapeutic dose in acute treatment of major depressive patients.
METHODS
The sample consisted of 65 major depressive patients who taken venlafaxine and 65 patients taken paroxetine, respectively. Blood pressure and other variables were evaluated in these subjects at baseline, 1 week, and 4 week of acute phase therapy, and mean blood pressure was compared each other by analysis of covariates. The incidence of sustained elevation of blood pressure during the study period was evaluated and stratified by age, sex, past history of hypertension, obesity, and dose of medication. These data were compared in two groups by chi square test and Fisher's Exact Test.
RESULTS
At 1 week point, there were no significant differences between the two groups in mean blood pressure and other variables when controlling the baseline data. But at 4 week point, there was significant difference in mean diastolic pressure change between the two groups (venlafaxine group, -0.20+/- 6.98 mmHg;paroxetine group, 0.82+/-6.75 mmHg, p=0.020). When stratified by obesity (BMI>25), there was also significant difference in mean systolic and diastolic pressure change between the two groups at 4 week point (p=0.002;p=0.026). When comparing the incidence rate of sustained elevation of blood pressure during the study periods, only in venlafaxine group, three subjects developed elevation of blood pressure. When stratified the venlafaxine group with various factors, the incidence rate in the subjects who used high dose of venlafaxine (225 mg/day) was significantly different with those who used lower dose (below 225 mg/day).
CONCLUSION
Our findings suggest that the use of venlafaxine can be associated with sustained elevation of blood pressure though used in therapeutic dose, but it can be detected with close monitoring and managed by reducing dose or hold the drug. In the future, to find out the risk factor of sustained elevation of blood pressure associated with venlafaxine use, large scaled and well controlled trials are needed.