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Evaluating quality of life in hypertensive patients
G Leonetti1, G Comerio, C Cuspidi
1Ospedale S. Luca, Centro Auxologico Italiano Milano, Cattedra di Terapia Medica, Università di Milano.
Insights
Antihypertensive medications generally improve quality of life, with converting-enzyme inhibitors and calcium antagonists showing the greatest benefits. This positive impact is observed alongside blood pressure reduction, particularly in elderly patients with hypertension.
Area of Science:
- Cardiology
- Pharmacology
- Quality of Life Research
Background:
- Arterial hypertension treatment is lifelong for most patients, initially focusing on blood pressure reduction.
- As treatment expands to milder hypertension, impact on quality of life (QoL) becomes a crucial consideration.
- QoL is a complex, multifactorial variable encompassing six distinct domains.
Purpose of the Study:
- To evaluate the impact of pharmacologic blood pressure lowering on the quality of life in hypertensive patients.
- To compare the QoL effects of different classes of antihypertensive medications.
Main Methods:
- A meta-analysis of well-selected and comparable trials was conducted.
- Evaluation of QoL utilized valid, repeatable, and sensitive tools.
- A personal review compared specific drug classes regarding QoL improvements.
Main Results:
- Antihypertensive treatment, overall, demonstrates a small but positive impact across multiple QoL domains.
- Converting-enzyme inhibitors, beta-blockers, calcium antagonists, and diuretics significantly improve QoL.
- Centrally acting alpha 1-agonists and direct vasodilators show a positive trend in QoL improvement.
- Converting-enzyme inhibitors and calcium antagonists appear to offer greater QoL enhancement.
- These two drug classes also improve QoL in elderly hypertensive patients alongside blood pressure reduction.
Conclusions:
- Pharmacologic treatment for arterial hypertension positively impacts patient quality of life.
- Specific drug classes, notably converting-enzyme inhibitors and calcium antagonists, yield superior QoL benefits.
- Quality of life improvements are an important adjunct to blood pressure control in hypertension management.
Abstract:
The treatment of arterial hypertension is symptomatic in 90-95% of patients, and therefore it must be administered throughout life. At the beginning of pharmacologic treatment when only patients with severe or malignant hypertension are treated, the goal is almost exclusively limited to blood pressure reduction. Thereafter, when the treatment is extended to patients with mild and moderate hypertension, other aims in addition to blood pressure reduction, are evaluated and among these is the impact of pharmacologic blood pressure lowering on the quality of life. The quality of life is recognized as a multi-factorial variable and can be subdivided into six domains. The methodology used to evaluate the quality of life should use valid, repeatable, and sensitive tools. A metaanalysis of well selected and comparable trials has shown that antihypertensive treatment, as a whole, has a small but positive impact on many domains of the quality of life. Furthermore, it appears that converting-enzyme inhibitors, beta-blockers, calcium antagonists, and diuretics cause a statistically significant improvement of quality of life, while centrally acting alpha 1-agonists and direct vasodilators show only a positive trend. Although the comparison among two or more drugs with regard to quality of life is more difficult, it appears from a personal review that converting-enzyme inhibitors and calcium antagonists cause a greater improvement. These two classes of antihypertensive agents have been shown to improve the quality of life in elderly hypertensive patients, together with significant blood pressure reduction. Finally, the incidence of drop-outs and side effects cannot be considered a valid means of evaluation of the quality of life.