This article examines whether integrating depression treatment into care for hypertension improves adherence to antidepressant and antihypertensive medications, depression outcomes and blood pressure control among older primary care patients.
Older adults prescribed pharmacotherapy for depression and hypertension from physicians at a large primary care practice in West Philadelphia were randomly assigned to an integrated care intervention or usual care. Outcomes were assessed at baseline, two, four, and six weeks using the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depression, an electronic monitor to measure blood pressure, and the Medication Event Monitoring System to assess adherence.
In all, 64 participants aged 50 to 80 years participated. Participants in the integrated care intervention had fewer depressive symptoms, lower systolic blood pressure, and lower diastolic blood pressure compared with participants in the usual care group at six weeks. Compared with the usual care group, the proportion of participants in the intervention group who had 80 percent or greater adherence to an antidepressant medication and to an antihypertensive medication was greater at six weeks.
A pilot, randomized controlled trial integrating depression and hypertension treatment was successful in improving patient outcomes. Integrated interventions may be more feasible and effective in real-world practices, where there are competing demands for limited resources.