Gender features of left ventricular myocardial remodeling in patients with arterial hypertension and anxiety and depressive disorders and possibilities of complex antihypertensive and psychocorrective pharmacotherapy

Abstract

Relevance. Anxiety-depressive disorders are a frequent companion of arterial hypertension (AH). It is known about the deterioration of the prognosis in patients with a combination of these conditions. At the same time, it is unclear whether complex antihypertensive therapy (AHT) with the inclusion of an antidepressant will improve the control of hypertension, slow down target organ damage, and whether it will be equally effective in men and women.The aim of the study – identify gender characteristics of the structural and functional state of the myocardium of the left ventricle (LV) and the effect of antihypertensive therapy with and without the inclusion of an antidepressant on left ventricular myocardial remodeling in patients with AH and ADD, taking into account the gender of the patient.Materials and methods. The study included 182 patients: 62 with AH (32 men and 30 women) and 120 – with AH and anxiety-depressive disorders (30 men – group 1, 30 women – group 2). Patients with AH and anxiety-depressive disorders were randomized into 2 subgroups (A and B). Patients of subgroup A received a fixed combination of an angiotensin II receptor blocker and a diuretic, a beta-blocker and an antidepressant, patients of subgroup B received similar antihypertensive therapy without including an antidepressant. All patients at inclusion in the study and after 24 weeks underwent a general clinical examination, office measurement of blood pressure (also after 4,8,12 weeks), 24-hour blood pressure monitoring, echocardiography, testing on the HADS, CES-D scales, and a psychiatrist's consultation.Results. Men and women with AH and anxiety-depressive disorders, the negative changes in the main parameters of the LV structural and functional state were more significant than in patients with a normal psychoemotional status. At the same time, in women with anxiety-depressive disorders, LV hypertrophy (LVH) was more pronounced than in men. Target levels of blood pressure were achieved faster in the groups treated with antidepressant, however, intergroup differences reached the level of statistical significance only in women. Complex pharmacotherapy led to a more significant improvement in LV structural and functional state than traditional AHT, especially in women. The use of an antidepressant led to a reduction in anxiety and depressive symptoms, which was not observed in patients only with AHT groups.Conclusions. Patients with AH and anxiety-depressive disorders develop more pronounced remodeling of the LV myocardium than patients with AH with a normal psychoemotional status, especially in women. The combined use of sertraline and antihypertensive drugs contributes to a more rapid achievement target levels of blood pressure, a significant improvement in LV structural and functional state, which is more pronounced in women than in men. It is also important to normalize the psycho-emotional status against the background of an integrated approach to the pharmacotherapy of patients with AH and anxiety-depressive disorders.