A bidirectional relationship exists between hypertension and psychiatric disorders, including unipolar and bipolar depression, anxiety, post-traumatic stress disorder (PTSD), psychosis, schizophrenia, mania, and dementia/cognitive decline. Repurposing of antihypertensive drugs to treat mental disorders is thus being explored. A systematic knowledge of the mechanisms of action and clinical consequences of the use of antihypertensive agents on neuropsychiatric functions has not been achieved yet. In this article, we review the putative role of antihypertensive agents in psychiatric disorders, discuss the targets and mechanisms of action, and examine how and to what extent specific drug classes/molecules may trigger, worsen, or mitigate psychiatric symptoms. In addition, we review pharmacokinetics (brain penetration of drugs) and pharmacogenetics data that add important information to assess risks and benefits of antihypertensive drugs in neuropsychiatric settings. The scientific literature shows robust evidence of a positive effect of α1 blockers on PTSD symptoms, nightmares and sleep quality, α2 agonists on core symptoms, executive function and quality of life in Attention-Deficit/Hyperactivity Disorder, PTSD, Tourette’s syndrome, and β blockers on anxiety, aggression, working memory, and social communication. Renin-angiotensin system modulators exert protective effects on cognition, depression, and anxiety, and the loop diuretic bumetanide reduced the core symptoms of autism in a subset of patients. There is no evidence of clear benefits of calcium channel blockers in mood disorders in the scientific literature. These findings are mainly from preclinical studies; clinical data are still insufficient or of anecdotal nature, and seldom systematic. The information herewith provided can support a better therapeutic approach to hypertension, tailored to patients with, or with high susceptibility to, psychiatric illness. It may prompt clinical studies exploring the potential benefit of antihypertensive drugs in selected patients with neuropsychiatric comorbidities that include outcomes of neuropsychiatric interest and specifically assess undesirable effects or interactions.

中文翻译：

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抗高血压药物和脑功能：有益和有害的神经精神治疗作用的潜在机制

高血压和精神疾病之间存在双向关系，包括单相和双相抑郁、焦虑、创伤后应激障碍（PTSD）、精神病、精神分裂症、躁狂症和痴呆/认知能力下降。因此，正在探索重新利用抗高血压药物来治疗精神障碍。关于使用抗高血压药物对神经精神功能的作用机制和临床后果尚未获得系统的了解。在本文中，我们回顾了抗高血压药物在精神疾病中的假定作用，讨论了作用靶点和机制，并研究了特定药物类别/分子如何以及在多大程度上可能引发、恶化或减轻精神症状。此外，我们还回顾了药代动力学（药物的脑渗透）和药物遗传学数据，这些数据为评估神经精神病学环境中抗高血压药物的风险和益处添加了重要信息。科学文献表明，α1 受体阻滞剂对 PTSD 症状、噩梦和睡眠质量具有积极作用，α2 受体激动剂对注意力缺陷/多动障碍、创伤后应激障碍、图雷特氏综合症的核心症状、执行功能和生活质量具有积极作用，β 受体阻滞剂关于焦虑、攻击性、工作记忆和社交沟通。肾素-血管紧张素系统调节剂对认知、抑郁和焦虑发挥保护作用，袢利尿剂布美他尼减轻了部分患者自闭症的核心症状。科学文献中没有证据表明钙通道阻滞剂对情绪障碍有明显的益处。这些发现主要来自临床前研究；临床数据仍然不足或只是轶事性质，而且很少系统化。此处提供的信息可以支持针对患有精神疾病或高度易感精神疾病的患者制定更好的高血压治疗方法。它可能会促使临床研究探索抗高血压药物对选定的患有神经精神合并症的患者的潜在益处，包括神经精神学兴趣的结果，并专门评估不良影响或相互作用。