| Objective This study aims to investigate the potential interaction between Psycho-cardiology and telmisartan in treating hypertension comorbidity anxiety and depressive state.The clinical efficacy and respective effects of these interventions will be analyzed.The findings of this study may provide novel insights into the treatment of these conditions.Methods This study selected patients with primary hypertension and comorbid anxiety and depression who received outpatient treatment at the Heavy Industry Community Hospital from December 2021 to December 2022.The study used a two-factor design with the factors being Psycho-cardiology and antihypertensive medication.The Psychocardiology factor was divided into two levels: "with" and "without," and the antihypertensive medications were amlodipine and telmisartan.The study employed a 2×2 factorial design randomized controlled trial method and the study subjects were divided into four groups using a stratified randomization method,namely group 1(amlodipine group),group 2(telmisartan group),group 3(Psycho-cardiology plus amlodipine group),and group 4(Psycho-cardiology plus telmisartan group).The patients’ systolic blood pressure(SBP),diastolic blood pressure(DBP),HAMA,and HAMD scores were recorded before treatment,1 month and 3 months after treatment to evaluate the treatment effects.The data was analyzed using both Excel and SPSS 26.0 software in order to enhance the accuracy of the results.Results 1.Comparison of general data of four groups of patientsIn this study,we enrolled 120 patients,six of whom dropped out.These patients were from the four different groups,with two dropouts in group 1,two in group 2,one in group 3,and one in group 4.In the end,a total of 114 subjects successfully completed the intervention.Prior to treatment,there were no significant differences(P>0.05)in gender,age,smoking history,alcohol consumption history,marital status,high-salt diet history,or BMI across the four patient groups.This indicates that the groups were comparable and suitable for comparison in the study.2.1 Systolic blood pressureRepeated measures ANOVA showed that there were statistically significant differences(P<0.001)in systolic blood pressure before and after treatment in each of the four groups: group 1(amlodipine group),group 2(telmisartan group),group 3(psychocardiology combined with amlodipine group),and group 4(psycho-cardiology combined with telmisartan group).Before treatment,there was no significant difference(P=0.129)in systolic blood pressure between the groups,indicating that they were comparable.However,after 1 month and 3 months of treatment,there were significant differences(P<0.001)in systolic blood pressure among the four groups.The therapeutic effects of each group were assessed by comparing their blood pressure reduction values after three months of treatment with their pre-treatment values.According to the analysis of variance。 there is an interaction between psycho-cardiology intervention and antihypertensive drugs.A more detailed examination of the individual effects indicated that the absence of psycho-cardiology intervention did not result in any statistically significant difference(P=0.617)between groups 1 and 2.Conversely,the inclusion of psycho-cardiology intervention revealed that group 4 had significantly superior therapeutic effects compared to group 3,with a statistically significant difference of(P<0.001).Under the same antihypertensive drug treatment,the comparison of blood pressure reduction values after treatment showed that group 3 had better effects than group 1,and the difference was statistically significant(P<0.001),while group 4 had better effects than group 2,and the difference was statistically significant(P<0.001).In conclusion,administering psycho-cardiology intervention alongside the same antihypertensive drugs can effectively enhance their antihypertensive effects.However,there was no significant difference in the reduction of blood pressure values between using telmisartan alone and using amlodipine alone.It can be concluded that the combination of psycho-cardiology intervention and telmisartan is the most effective in reducing systolic blood pressure,and there is a positive interaction between psycho-cardiology intervention and telmisartan in reducing systolic blood pressure。2.2 Diastolic pressureRepeated measures analysis of variance showed that there were statistically significant differences(P < 0.01)in diastolic blood pressure between the four groups: group 1(amlodipine group),group 2(telmisartan group),group 3(psycho-cardiology combined with amlodipine group),and group 4(psycho-cardiology combined with telmisartan group)before and after treatment.The groups showed comparability as there was no statistically significant difference(P=0.561)in diastolic blood pressure before treatment.After 1 and 3 months of treatment,there were statistically significant differences(P < 0.001)among the four groups.By comparing the values of diastolic blood pressure reduction after 3 months of treatment with those before treatment,the treatment effects of each group were evaluated.Through analysis of variance,the interaction effect between psycho-cardiology and antihypertensive drugs was 0.23,with no significant difference in statistics(P = 0.869),indicating no interaction effect.Therefore,the main effects of psycho-cardiology and antihypertensive drugs were analyzed.The main effect of antihypertensive drugs was 2.26,with no significant difference in statistics(P = 0.098),while the main effect of psycho-cardiology was 21.48,with significant differences in statistics(P < 0.001).Both psycho-cardiology and antihypertensive drugs can reduce diastolic blood pressure,but the effect of psycho-cardiology on diastolic blood pressure reduction is greater than that of antihypertensive drugs.3.HAMA and HAMD scores of four groups of patients3.1 HAMA scoreRepeated measures ANOVA showed significant differences in Hamilton Anxiety Scale(HAMA)scores between pre-treatment and post-treatment in each of the four groups: group 1(amlodipine group),group 2(telmisartan group),group 3(amlodipine and psycho-cardiology combination group),and group 4(telmisartan and psychocardiology combination group)(P <0.001).There was no significant difference in HAMA scores between the groups before treatment(P =0.936),indicating comparability. However,significant differences were observed among the four groups at 1 and 3 months after treatment(P <0.001).By comparing the difference in HAMA scores before and after treatment for 3 months,the efficacy of each group was evaluated.The results of the repeated measures analysis of variance showed that there was a significant interaction effect between psycho-cardiology and antihypertensive medication(P<0.05),as shown in Table 11.Upon conducting a more detailed examination of the individual effects,it was found that there was no significant difference between group 1 and group 2 without the intervention of psycho-cardiology(P=0.444).while with the intervention of psycho-cardiology,group 4 had a better effect than group 3(P<0.001).Under the premise of using the same antihypertensive medication,group 3 had a better effect than group 1(P<0.001),and group 4 had a better effect than group 2(P<0.001).It can be concluded that the application of psycho-cardiology can effectively improve the treatment of anxiety under the same antihypertensive medication,but there was no significant difference in the effect of HAMA score reduction between the use of telmisartan alone and amlodipine alone.It can be inferred that the combination of psycho-cardiology and telmisartan has the best effect on anxiety treatment,and there is a positive interaction effect between psychocardiology and telmisartan on the reduction of HAMA scores.3.2 HAMD scoreRepeated measures analysis of variance showed significant differences in Hamilton Depression Rating Scale(HAMD)scores between pre-and post-treatment in each of the four groups: Group 1(amlodipine group),Group 2(telmisartan group),Group 3(amlodipine plus dual heart-care group),and Group 4(telmisartan plus dual heart-care group),with statistical significance(P<0.001).There was no statistically significant difference in pre-treatment HAMD scores among the four groups(P =0.240),indicating comparability.After 1 and 3 months of treatment,there were significant differences among the four groups(P <0.001).The treatment effects of different groups were evaluated by comparing the difference between the HAMD scores after 3 months of treatment and before treatment.A factorial analysis of variance showed a significant interaction between psychocardiology and antihypertensive medication(P<0.05).Subsequently,the simple effects were discussed.Under the condition of no psycho-cardiology intervention,there was no significant difference in the decrease of HAMD scores between group 1 and group 2(P=0.177).Under the condition of psycho-cardiology intervention,group 4 showed a better effect than group 3,with a significant difference(P < 0.001).Under the premise of the same antihypertensive medication,group 3 had a significantly better effect than group 1(P < 0.001),and group 4 had a significantly better effect than group 2(P < 0.001)in terms of the decrease in HAMD scores after treatment.It can be concluded that the application of psycho-cardiology can effectively improve the treatment effect of depression under the premise of the same antihypertensive medication.However,there was no significant difference in the effect on the decrease of HAMD scores between the use of telmisartan alone and the use of amlodipine alone.It can be inferred that the combination of psycho-cardiology and telmisartan has the best efficacy for depression,and there is a positive interaction between psycho-cardiology and telmisartan in terms of the decrease in HAMD scores.Conclusion 1.Psycho-cardiology can significantly alleviate the symptoms of comorbid anxiety and depression in patients with hypertension,and lower blood pressure,with better efficacy than conventional antihypertensive drug treatment,and the effect is significant.There is no significant difference in alleviating anxiety and depression symptoms between using telmisartan alone and using amlodipine alone.2.The combination of Psycho-cardiology and telmisartan has a synergistic effect in the treatment of patients with hypertension and comorbid anxiety and depression.This combination may has demonstrated better efficacy in reducing systolic blood pressure and relieving symptoms of anxiety and depression compared to the combination of Psycho-cardiology and amlodipine. |
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