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Researchers say people prescribed medication for hypertension, heart failure, kidney disease, and diabetes should consult with their doctor. Getty Images
  • Researchers say certain types of medications used for blood pressure, kidney disease, heart failure, and diabetes could increase suicide risk.
  • Researchers say people using angiotensin receptor II blockers (ARBs) are 1.5 times more likely to die by suicide than people who take angiotensin converting enzyme inhibitors (ACE inhibitors).
  • They note the research is preliminary and needs follow-up studies, but they say people with mental health issues should consult with their physicians before taking these types of medications.

New research suggests there could be a connection between commonly prescribed drugs and whether they could contribute to the likelihood of suicide.

The study, published today in JAMA Network Open, suggests more research is needed into the connection between drugs prescribed for high blood pressure and other conditions, and whether they increase a person’s risk for suicide.

Specifically, researchers looked for connections between older adults who died by suicide after being prescribed angiotensin receptor II blockers (ARBs) or angiotensin converting enzyme inhibitors, more commonly referred to as ACE inhibitors.

Both are classes of drugs most often prescribed to people for hypertension, chronic kidney disease, heart failure, and diabetes.

That’s because the medications allow otherwise narrow blood vessels to open and blood to flow more freely.

But researchers note that ARBs work in the brain differently than ACE inhibitors. Specifically, they block angiotensin, a protein associated with higher blood pressure.

Researchers theorize that action could affect a person’s mental health.

In this new study, a predominantly Canadian research team with several researchers from the University of Toronto performed a population-based, case-control study using data from more than 3,800 adults aged 66 years and older.

They utilized databases such as the Ontario Drug Benefit and the Canadian Institute for Health Information Discharge Abstract Database.

Of the people whose data was selected for the study, 964 had died by suicide within 100 days of receiving ARBs or ACE inhibitors from the beginning of 1995 to the end of 2015.

The researchers stated that people who were prescribed ARBs were more than 1.5 times likely to die by suicide compared to those who were given ACE inhibitors.

“The use of ARBs may be associated with an increased risk of suicide compared with ACEIs,” the researchers said in the study. “Preferential use of ACEIs over ARBs should be considered whenever possible, particularly in patients with severe mental health illness.”

The data showed most commonly used ACE inhibitors were ramipril (Altace) and enalapril (Vasotec). The most common ARBs were valsartan (Diovan), telmisartan (Micardis), and candesartan (Atacand).

The study does note that those who died by suicide were also more likely than those who didn’t to have been prescribed drugs related to mental health, including antipsychotics, benzodiazepines, and mood stabilizers.

The researchers were also quick to warn that their study had some shortcomings.

First, they noted their research was observational. They looked for how things occur, not whether one thing caused another. Second, more research is also needed to back up their findings.

Researchers say they didn’t have access to important records regarding other factors that could contribute to a premature death, including substance use or emergency room visits.

Also, as the study’s participants were overwhelmingly older men living in Ontario, it’s unknown whether their results would be the same for other populations.

Dr. Sanjiv Patel, a cardiologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in California, calls the findings from the observational study “interesting.”

“We need to keep in mind that they are preliminary findings, and since obvious, randomized control data is best, it would be interesting to hear psychiatrists’ clinical opinions about it,” he told Healthline.

Patel says it’s always good for patients and their physicians to discuss any concerns regarding new studies.

“If a patient has a history of mental illness, we as physicians need to seriously consider the potential implications of prescribing them certain medications that can potentially exacerbate their current mental and physical condition,” he said.

Dr. Nicole Weinberg, a cardiologist at Providence Saint John’s Health Center in California, says that while the research can make a person carefully consider the associations between the drugs and suicide, the new study isn’t enough to warrant warning the vast majority of people who she’s starting on this class of drugs.

But, as the study noted, there was an increased likelihood of suicide in people who had a history of alcohol misuse, anxiety, sleep disorders, psychosis, agitation, and other mental health issues.

“For this group of patients,” Weinberg told Healthline, “I think it is more appropriate to discuss the potential risks of using these classes of drugs.”

Here are the drugs in these categories approved for use in the United States:


  • azilsartan (Edarbi)
  • candesartan (Atacand)
  • eprosartan
  • irbesartan (Avapro)
  • losartan (Cozaar)
  • olmesartan (Benicar)
  • telmisartan (Micardis)
  • valsartan (Diovan)

ACE inhibitors

  • benazepril (Lotensin)
  • captopril (Capoten)
  • enalapril (Vasotec)
  • fosinopril (Monopril)
  • lisinopril (Prinivil, Zestril)
  • perindopril (Aceon)
  • quinapril (Accupril)
  • ramipril (Altace)
  • trandolapril (Mavik)