Authors: Hillary R. Bogner, MD, MSCE and Heather F. de Vries, MSPH, Department of Family Medicine and Community Health, School of Medicine, University of Pennsylvania, Philadelphia

PURPOSE
We wanted to examine whether integrating depression treatment into care for hypertension improved adherence to antidepressant and anti-hypertensive medications, depression outcomes, and blood pressure control among older primary care patients.

METHODS
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, 2, 4, and 6 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.

RESULTS
In all, 64 participants aged 50 to 80 years participated. Participants in the integrated care intervention had fewer depressive symptoms (CES-D mean scores, intervention 9.9 vs usual care 19.3; P <.01), lower systolic blood pressure (intervention 127.3 mm Hg vs usual care 141.3 mm Hg; P <.01), and lower diastolic blood pressure (intervention 75.8 mm Hg vs usual care 85.0 mm Hg; P <.01) compared with participants in the usual care group at 6 weeks. Compared with the usual care group, the proportion of participants in the intervention group who had 80% or greater adherence to an antidepressant medication (intervention 71.9% vs usual care 31.3%; P <.01) and to an antihypertensive medication (intervention 78.1% vs usual care 31.3%; P <.001) was greater at 6 weeks.

CONCLUSION
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.

MY COMMENTS
I am very pleased with the outcomes of this trial, and surprised by how low the adherence rates were for the usual care group. Usual care group was 31.3% adherent! That is horrible. I never thought of the connection between hypertension and depression, but in that age group, I can see the fit. I wonder if there is a similar study running for increasing adherence with diabetes and depression medications?