Clinical efficacy and psychological benefits of combination therapy in elderly patients with hypertension.

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.