CYP3A4 and hypertensive disorder: CYP3A4 poor metabolizers (particularly those with CYP3A4*22 alleles) demonstrate reduced metabolic capacity that could prolong esketamine exposure, potentially exacerbating dose-dependent adverse effects including dissociation, hypertension, and hepatotoxicity, while functionally significant CYP2B6 variants (notably the CYP2B6*6 haplotype associated with reduced enzyme activity) may further modulate therapeutic outcomes through altered ketamine metabolism pathways.