Quality of life evaluation of antihypertensive drugs

Eleven studies (10 randomised controlled trials and 1 large open study) that evaluated quality of life (QOL) are reviewed. The areas of QOL measured by the studies are compared and a consensus is reported that health-related QOL measures in patients with hypertension should include: symptomatic and psychological well-being, activity (work, leisure, sleep, sexual activity and social participation), cognitive function and life satisfaction. Recommended methods for measuring these aspects of QOL are noted. Seven studies included atenolol as 1 of the treatments and the effects of this drug on QOL are reviewed. The drug appears to maintain QOL as well as the angiotensin converting enzyme (ACE) inhibitors captopril, enalapril and cilazapril. One trial also suggests that verapamil maintains QOL as well as atenolol, although this was not suggested by the nonrandomised study. Nifedipine slow release (SR) and propranolol both fared worse than atenolol in 2 separate trials, but 1 trial suggested that nifedipine gastrointestinal therapeutic system (GITS) was preferred to atenolol in terms of QOL. In the latter study, however, only patients completing the prescribed therapy revealed a preference for nifedipine GITS; this was absent in an intention-to-treat analysis. The rate of discontinuation of nifedipine therapy was high, underlining the necessity for an intention-to-treat analysis in trials assessing QOL.