Beta blockers and quality of life

Hypertension is an asymptomatic conditions which can be life threatening. It is thus important that hypertensive patients maintain compliance with their therapy. This can be put at risk if the patient experiences adverse affects or if the patient's lifestyle is significantly altered in some way. The ability to perform daily activities and derive satisfaction is referred to as quality of life. With this in mind the published literature is reviewed here with regard to comparative studies involving beta-blockers. The balance of the evidence reviewed indicates that there are differences in quality of life between ACE inhibitors and the non-selective, lipophilic beta blocker, propranolol, favouring the former. However, this is clearly not a class difference as atenolol, which is beta 1 selective and hydrophilic, results in a similar quality of life profile to that with either captopril or enalapril. This difference between atenolol and propranolol probably arises out of their differing pharmacology, as opposed to any fundamental difference in their blood pressure lowering ability. There are probably too few studies to compare beta blockers and either calcium antagonists or diuretics definitively with regard to quality of life. What little evidence there is suggests a difference between propranolol and verapamil, with the latter giving the better quality of life. However, no difference was observed between verapamil SR and atenolol. Although data are very limited it appears that atenolol impacts more favourably than thiazide diuretics.