Assessing quality of life during antihypertensive therapy

Many patients with asymptomatic mild hypertension are now given drug therapy, which may have a beneficial effect but may also result in detrimental adverse effects . Therefore , the effect of drugs on the vague concept of 'quality of life' should be considered , although this parameter is very difficu lt to measure objectively.

Specific adverse effects are well known . Beta­blockers occasionally cause experiences such as nightmares, insomnia, hallucinations , depression and lassitude. Similar events are less common with diuretic therapy , but impotence may present in up to 20% of male patients . Hydralazine has few adverse effects on well-being , as do calcium antagonists . ACE inhibitors have been reported to elevate mood but this effect has not been substantiated and this class of drug can cause cough, rash , headache, dizziness and fatigue .

A need for a more precise method of assessing the effects antihypertensive drugs have on quality of life has been identified and such a method has been developed . The 'instrument' involves correlating patient responses to a large number of mood adjectives , thus giving an indication of hedonic tone, activity and relaxation. CNS-related and/ or vegetative functions are then assessed by a visual analogue scale technique. The tes t should preferably be conducted in a double-blind , crossover manner with repeated tests and a careful check on other life events . When tested in a healthy population, parameters of well -being were related to gender, but not to age. A small pi lot study on 34 patients demonstrated an increase in well-being upon substitution of placebo for previous therapy (beta-blocker usually with 1 or 2 other drugs), and a further slight increase when placebo was replaced by enalapril.

The assessments show that subjective symptoms correlate with well-being and ' ... the pilot experiments so far conducted indicate that the validity of this instrument is promising'. Jern S. Danish Medical Bullel ln 24 (Suppl 1 ) 1-3, Dec 1987 "60

0157-7271 / 88/ 0312-0003/ 0$0 1.00/ 0 © ADIS Press REACTIONS' 12 March 1988 3