Quality of life perception during antihypertensive treatment: a comparative study of bisoprolol and enalapril

The well-being of hypertensive patients may be adversely affected by the disease itself, its complications, and other concomitant processes such as anxiety, sedation, and side effects of prescribed drugs. Some recently developed antihypertensive agents have been suggested to be devoid of these deleterious effects on well-being expressed as quality of life. We compared the effect on quality of life of the angiotensin-converting enzyme (ACE) inhibitor enalapril to the effect of bisoprolol as a representative of a new class of selective beta 1-adrenoreceptor blocking agents. Fifty-seven patients with mild to moderate hypertension were eligible to enter an 18-week cross-over study, consisting of a single-blind 2-week run-in period and two 8-week double-blind cross-over periods. At the end of the run-in period and the two cross-over periods, both systolic and diastolic blood pressure (SBP, DBP) were assessed, as was quality of life perception by the Inventory of Subjective Health. During bisoprolol treatment, supine BP decreased from 163 +/- 2/102 +/- 1 to 144 +/- 3/86 +/- 1 mm Hg. The antihypertensive effect was at least as good with bisoprolol as with enalapril. Quality of life perception as measured with the Inventory of Subjective Health was comparable for the two drugs. Spontaneously mentioned adverse effects were more frequent (74%) during enalapril than during bisoprolol treatment. At the end of the study, 69% of patients chose to continue antihypertensive treatment with bisoprolol. Our results show that the highly selective beta 1-adrenoreceptor blocking drug bisoprolol is at least as effective as enalapril and has no deleterious effects on well-being.