Abstract
OBJECTIVE: To investigate the effects of different antihypertensive agents on psychiatric symptoms and blood pressure control in elderly patients with hypertension. METHODS: This retrospective study included 300 elderly patients with hypertension. Patients were categorized based on their antihypertensive medication regimen: divided into the monotherapy group (n=70) and combination therapy group (n=230), with each further subdivided by medication type. The monotherapy group comprised angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) (n=10), calcium channel blockers (CCBs) (n=33), β-blockers (β-Bs) (n=22), and diuretic (n=5) subgroups. The combination therapy group included ACEIs/ARBs + diuretic (n=12), CCBs + diuretic (n=9), β-Bs + diuretic (n=21), ACEIs/ARBs + CCBs (n=36), CCBs + β-Bs (n=69), ACEIs/ARBs + β-Bs (n=26), and ACEIs/ARBs + β-Bs + CCBs (n=57) subgroups. Blood pressure, anxiety, depression, and sleep quality were evaluated before and after 8 weeks of treatment. Multivariate logistic regression was used to identify factors associated with poor treatment efficacy. RESULTS: The Combination therapy group achieved superior blood pressure control compared with the monotherapy group (75.65% vs. 47.14%). Both the ACEIs/ARBs and the ACEIs/ARBs + CCBs groups had significantly improved anxiety, depression, and sleep quality (all P<0.05). In contrast, the β-Bs and β-Bs + diuretics groups had aggravated psychiatric symptoms. The incidence of adverse events was comparable among groups (all P>0.05). After adjustment for confounding factors, combination therapy remained a protective factor for treatment efficacy (P<0.05). CONCLUSION: Combination therapy is more effective for blood pressure control in elderly patients with hypertension. ACEIs/ARBs, alone or combined with CCBs, alleviate psychiatric symptoms, whereas β-blockers, especially when combined with diuretics may exacerbate them. The efficacy advantage of combination therapy is independent of potential confounders.