Quality of Life and Antihypertensive Drug Therapy

Joel Handler, MD

In This Article

Abstract and Introduction

Quality of life on antihypertensive therapy is an important consideration because clinicians are asked to initiate drug therapy and follow mostly asymptomatic patients for long periods of time on agents that are fairly equivalent in both blood-pressure-lowering capacity and the reduction of adverse clinical events. There is, however, evidence to show that hypertension is not always an asymptomatic condition; therefore, the reduction of blood pressure makes people not previously knowledgeable of their hypertensive state feel better. Labeling a patient hypertensive may have negative quality-of-life consequences. Clinicians need to be well informed regarding side-effect profiles as well as anxiety conditions that may lead to subjective complaints that are blamed on medication. Additionally, medication information given to patients may have an important effect on adverse effect reporting. Specific intolerance profiles to the thiazides, angiotensin-converting enzyme inhibitors, ß blockers, calcium channel blockers, and angiotensin receptor blockers are discussed in this review. Medication compliance requires a multi-tiered strategy. Low-dose thiazide is well tolerated.

If we are going to treat patients with a relatively asymptomatic disease for decades on medications that are quite similar as far as blood pressure (BP)-lowering capacity and in terms of reaching important clinical end points, then quality of life (QOL) on these medications becomes an important consideration. Patients should be on drugs that are well tolerated for long periods of time. This review will discuss QOL as it applies to the drug therapy of hypertension and summarize some of the inevitable side effects that may be noted with these agents.

Questions to be addressed include: How is health-related QOL defined? Is hypertension truly an asymptomatic disease? What are the results of the QOL drug comparison trials? How can we assess the adverse effects of specific drug classes? And lastly, the bottom line: How can we improve patient compliance to medications?

Health-related QOL is a sense of total well being, psychosocial and physical. It involves the total impact of intervention on the biomedical, social, and behavioral status of the patient. Its measures are a set of response variables beyond biomedical events involving patient capabilities, limitations, and perceptions.[1]

In 1983, a task force from the National Heart, Lung, and Blood Institute issued guidelines to assess QOL issues in hypertension and other disease states.[1] Databases for placebo-controlled trials, expert opinions, and QOL studies were evaluated. Six important QOL domains were identified: 1) physical capabilities such as mobility and self care; 2) emotional status including mood changes, anger, guilt, hostility, and depression; 3) social interaction including sexual and marital satisfaction; 4) intellectual functioning involving memory, alertness, and judgment; 5) economic status such as consideration of premature retirement that may have been precipitated by illness, and health insurance eligibility; and 6) self-perceived health status involving self-evaluation of disease severity and level of impairment.