Personification of treatment of patients with arterial hypertension with different levels of anxiety and depression

Recent advances in the treatment of arterial hypertension (AH) have been obvious, but the complication rate of the disease remains at a high level. The latter is influenced by many factors, including low adherence to antihypertensive therapy and difficult environmental conditions that contribute to increased anxiety and a tendency to depression. At the same time, blood pressure is influenced by the activity of cortical processes in the central nervous system and parts of the ANS, the condition of which is not always taken into account. Aim. Based on the results of clinical and laboratory studies, to establish the most effective option of antihypertensive therapy in patients with hypertension with different levels of anxiety and depression. Material and methods. Design: outpatient, single-center, cohort, prospective, controlled, non-randomized, long-term clinical trial. From 2010 to 2021, patients with stage II HD, grade 2, risk 3 (n = 328) and healthy (n = 164) men (54.6 ± 0.6 years old) were divided by type of higher nervous activity into equal groups with a predominance in the central nervous system of excitatory (sympathicotonia) or inhibitory (parasympathicotonia and activation of renin-angiotensin-aldosterone system) processes with high and low anxiety. Reactive and personal anxiety, quality of life were determined using the “Well-being, activity, mood” method (WAM test), the coefficient of oxygen utilization by tissues, the degree of dyscirculatory encephalopathy was determined using a valid technique, the speed of a simple sensorimotor reaction, as well as the level of complications of hypertension. Some groups of high- and low-anxiety patients took the empirical option, while others of the same groups of the corresponding activity of the central nervous system and parts of the autonomic nervous system took a personalized version of antihypertensive therapy. The latter included correction of sympathicotonia in individuals with a predominance of excitatory processes and blockade of mineralocorticoid receptors in individuals with a predominance of inhibitory processes. Results and discussion. In contrast to empirical therapy, against the background of personalized antihypertensive therapy, the values of personal (reactive) anxiety, a tendency to depression, quality of life (according to WAM), as well as the value of the oxygen utilization coefficient by tissues were the same as in healthy individuals with the corresponding activity of the central nervous system and the balance of the autonomic nervous system. The rate of arterial hypertension complications due to acute cerebral blood flow disorders in the groups of patients taking the personalized antihypertensive therapy option was significantly lower than in the groups taking the empirical treatment option. Conclusion. The expediency of randomized clinical trials of this approach has been revealed.

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