Patients suffering from both depression and hypertension respond more favorably to a combined therapeutic approach than if each condition is treated separately, according to research from the University of Pennsylvania. Depression is a risk factor for hypertension, and patients with both conditions are less likely to take their anti-hypertensive medications as instructed. Because of these connections, Dr. Hillary R. Bogner and colleagues at Penn decided to test the idea that integrating, or combining, depression management with the treatment of hypertension would have a more positive effect on both conditions than the usual standard of care.

Another important piece of the combined treatment process was an integrated care manager, who acted as a liaison between patients and primary care physicians.

The resulting pilot study, which was published in July/August issue of the Annals of Family Medicine, enrolled 64 adults between the ages of 50 and 80 who suffered from both hypertension and depression. Half were randomly assigned to receive integrated care in addition to standard primary care services, while half were given usual care alone.

Both groups had similar symptoms of hypertension and depression at the start of the study, but after six weeks, patients in the integrated care group had significantly lower systolic and diastolic blood pressure and significantly fewer symptoms of depression. Not surprisingly, those in the integrated care group also were more than twice as likely as those in the usual care group to take their medications for both conditions as prescribed. Compliance was measured using prescription bottle caps equipped with microelectronic monitoring devices, which recorded each time a pill bottle was opened.

Another important piece of the combined treatment process was an integrated care manager, who acted as a liaison between patients and primary care physicians. This person educated patients about depression and hypertension, including the importance of taking medications as directed, and assisted with patient management. Although a research coordinator was trained as an integrated care manager for the purposes of the study, the authors suggested that ancillary health practitioners, such as office staff or nurses who are already working in a primary care office could receive the same training in order to be more economical.

The age of the study subjects and the fact that the majority (81.2%) were African American may have contributed to the intervention's success. Previous studies have shown that integrated care is particularly effective in older primary care patients and in those who are African American.