The Effects of Antihypertensive Therapy on the Quality of Life

• Published in: The New England journal of medicine Vol. 314; no. 26; pp. 1657 - 1664
• Main Authors: Croog, Sydney H, Levine, Sol, Testa, Marcia A, Brown, Byron, Bulpitt, Christopher J, Jenkins, C. David, Klerman, Gerald L, Williams, Gordon H
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 26.06.1986
• Subjects: Adult; Aged; Antihypertensive agents; Antihypertensives; Biological and medical sciences; Blood Pressure - drug effects; Captopril - administration & dosage; Captopril - adverse effects; Captopril - therapeutic use; Cardiovascular system; Clinical Trials as Topic; Double-Blind Method; Double-blind studies; Humans; Hydrochlorothiazide - administration & dosage; Hypertension - drug therapy; Hypertension - physiopathology; Hypertension - psychology; Male; Medical sciences; Methyldopa - administration & dosage; Methyldopa - adverse effects; Methyldopa - therapeutic use; Middle Aged; Pharmacology. Drug treatments; Propranolol - administration & dosage; Propranolol - adverse effects; Propranolol - therapeutic use; Quality of Life; Random Allocation; Hypertension; Antihypertensive agent; Cardiovascular disease; Chemotherapy; Quality of life
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198606263142602

We conducted a multicenter randomized double-blind clinical trial among 626 men with mild to moderate hypertension to determine the effects of captopril, methyldopa, and propranolol on their quality of life. Hydrochlorothiazide was added if needed to control blood pressure. After a 24-week treatment period, all three groups had similar blood-pressure control, although fewer patients taking propranolol required hydrochlorothiazide. Patients taking captopril alone or in combination with a diuretic were least likely to withdraw from treatment because of adverse effects (8 percent vs. 20 percent for methyldopa and 13 percent for propranolol). The treatment groups were similar in scores for sleep dysfunction, visual memory, and social participation. However, patients taking captopril, as compared with patients taking methyldopa, scored significantly higher (P<0.05 to <0.01) on measures of general well-being, had fewer side effects, and had better scores for work performance, visual–motor functioning, and measures of life satisfaction. Patients taking propranolol also reported better work performance than patients taking methyldopa. Patients taking captopril reported fewer side effects and less sexual dysfunction than those taking propranolol and had greater improvement (P<0.05 to <0.01) on measures of general well-being. Our findings show that antihypertensive agents have different effects on the quality of life and that these can be meaningfully assessed with available psychosocial measures. (N Engl J Med 1986; 314:1657–64.) IN treating patients with hypertension, physicians who are successful in controlling blood pressure may be unaware of the negative effect that antihypertensive drugs can have on the quality of life 1 2 3 4 5 — on the physical state, emotional well-being, sexual and social functioning, and cognitive acuity — of their patients. Some patients perceive the use of antihypertensive medications to be more troubling than their seemingly symptomless disease, resulting in noncompliance and ineffectual long-term treatment. 6 7 8 Given the increasing array of antihypertensive drugs available, physicians are faced with many conflicting choices in selecting medications that are both effective and well tolerated. 9 The effects of . . .