Psychological Disorders in Patients With Resistant Hypertension and the Effect of Psychotherapy Combined With Antidepressant/Anxiolytics

Abstract OBJECTIVE To explore the clinical characteristics and related influencing factors of psychological disorders in patients with resistant hypertension (RH), and to analyze the therapeutic effect of psychotherapy combined with antidepressant/anxiolytics. METHODS A total of 247 patients with RH were consecutively selected from the Cardiovascular Department of Xiangya Hospital, Central South University from May 2021 to August 2023. The general demographic data were collected, and the psychological disorders were evaluated by the generalized anxiety disorder-7 items scale (GAD-7), patient health questionnaire-9 items scale (PHQ-9), and patient health questionnaire-15 items scale (PHQ-15). The patients with RH complicated with psychological disorders were treated with psychotherapy combined with flupentixol melitracen-based drugs for 3 months on the basis of the original antihypertensive scheme. The antihypertensive efficacy, the number of antihypertensive drugs, and the changes in GAD-7, PHQ-9, and PHQ-15 were analyzed. RESULTS The detection rates of RH combined with anxiety, depression, and somatization were 41.7%, 38.5%, and 68.8%, respectively, and the total detection rate of mental disorders was 71.3%. Multivariate logistic regression analysis showed that life stress (odds ratio [OR] = 3.842, 95% confidence interval [CI] 1.752–8.427), PHQ-9 score (OR = 1.183, 95% CI 1.085–1.290), and PHQ-15 score (OR = 1.284, 95% CI 1.146–1.440) were independent risk factors for anxiety state, and the long course of disease (OR = 1.693, 95% CI 1.086–2.639), GAD-7 score (OR = 1.181, 95% CI 1.084–1.286), and PHQ-15 score (OR = 1.390, 95% CI 1.231–1.569) were independent risk factors for depression. The GAD-7 score (OR = 1.206, 95% CI 1.036–1.404) and PHQ-9 score (OR = 1.419, 95% CI 1.152–1.748) were independent risk factors for somatic symptoms. Somatic symptom score was significantly positively correlated with GAD-7 (rs = 0.705, P < 0.001) and PHQ-9 (rs = 0.742, P < 0.001), respectively. After treatment, the total effective rate was 94.9%, the blood pressure control rate was 83.5%, and in 51.3% of patients, the number of antihypertensive drugs taken decreased by ≥1. After treatment, the scores of GAD-7, PHQ-9, PHQ-15, and blood pressure were all decreased (all P < 0.001). CONCLUSIONS RH patients have a high incidence of psychological disorders, with somatization symptoms as a prominent manifestation. Anxiety, depression, and somatization symptoms interact and influence each other. Psychotherapy combined with antidepressant/anxiolytic therapy can improve the antihypertensive effect, and improve their anxiety, depression, and somatization symptoms in RH patients with mental disorders.