The issue of quality of life in antihypertensive therapy

The treatment of hypertension is based on an assessment of the balance between the effects of therapy on survival on the one hand and effects of the patient's symptoms and well-being on the other. The concept of quality of life is used to summarise the latter effects. Preservation of quality of life involves both the prevention of hypertensive complications and detrimental effects on well-being induced by drugs. However, scientific accumulation of data in this area has been severely hampered by the lack of consensus as to how quality of life should be defined and measured. The scientific power of the quality of life concept has also yet to be proven. Although recent studies indicate that specific aspects of quality of life could be adequately assessed the relative importance of minor shifts in questionnaire or test scores remains an unresolved scientific and clinical issue. Despite these shortcomings a series of studies now available suggests that there are only minor differences between the first-line antihypertensive drugs (e.g. beta-blockers and ACE inhibitors) regarding their effect on quality of life.