Peculiarities of the mental state of patients with ischemic heart disease and concomitant arterial hypertension and its impact on the quality of life and the course of the disease

Abstract

Introduction. Coronary artery disease (CAD) is the most common disease of the century, which dominates the structure of morbidity and is the main cause of mortality. Among all causes of mortality from diseases of the circulatory system, CAD accounts for 68.1%, and in more than two-thirds of cases, death occurs suddenly. In the structure of the prevalence and incidence of diseases of the circulatory system in Ukraine, CAD accounts for 34.4% and 27.5%, respectively. The close relationship between cardiovascular diseases and mental health disorders is a negative prognostic factor for both conditions. Mental health has a significant impact on the functioning of the cardiovascular system and the general well-being of people with chronic diseases of the circulatory system. Mental health screening is advisable for patients with chronic CAD, which actually became the subject of our scientific work. There are difficulties in determining a single generally accepted physiological indicator of stress due to individual differences in perception and physiological reactions. Nevertheless, there is an obvious connection between the pathophysiological mechanism of the development of mental stress and clinically manifested cardiovascular diseases. Aim. To study the features of the course of coronary artery disease with concomitant arterial hypertension or its absence in patients who have suffered a myocardial infarction, depending on the existing concomitant signs of depression or anxiety.
Materials and methods. 50 patients with diagnoses of CAD: stable angina pectoris, II-III functional class (FC), chronic heart failure (CHF) I-IIa, FC II-III, with concomitant AH: II-III stages, 2-3 degrees were examined. Patients were divided into 2 groups depending on the previously performed coronary artery revascularization due to myocardial infarction — 37 patients who underwent stenting and 13 patients without stents, respectively. During the study, a comparison of the basic clinical manifestations of the underlying disease was carried out according to the individual quality of life. The patient's mental state was assessed by two criteria: the severity of depression, which was determined using the patient health questionnaire PHQ-9; the level of anxiety, using the GAD-7 questionnaire. Results. The number of stented patients with a high level of anxiety/depression with stable coronary artery disease and concomitant hypertension (74%) prevails over the number of patients without stents with stable coronary artery disease and concomitant hypertension (26%). According to the results of 6-minute walk test in patients with stable CAD, it was found that patients with mild or absent symptoms of anxiety covered greater distances thanpatients with moderate or severe signs of anxiety/depression. It was found that the average quality of life (according to the MacNEW and SAQ questionnaires) was significantly lower in patients with moderate or severe symptoms of anxiety and depression compared to those in whom these symptoms were absent or mild. Conclusions
In patients with a diagnosis of stable CAD and concomitant hypertension without a history of coronary interventions, the level of depression and anxiety is lower compared to the group of patients with a diagnosis of stable CAD and concomitant hypertension who underwent stenting of infarction-dependent coronary arteries. In our opinion, this fact may be partly due to the insufficient level of awareness of patients regarding the features of the stenting procedure. The presence of a foreign body (stent) in the body is perceived by patients as a potentially threatening fact, which leads to increased levels of anxiety and depression, even with better overall treatment effectiveness. These data confirm the pathophysiological relationship between the development of ischemic heart disease with progressive arterial hypertension and the influence of significant factors represented by anxiety and stress.