Factors affecting the reporting of symptoms by hypertensive patients.

Abstract

Patients diagnosed as hypertensive have a high complaint rate, both on and off treatment and this has been postulated to be due to either their disease process, their being labelled as hypertensive, or to their treatment. Data from 6637 hypertensive patients being entered into clinical trials in general practice have been analysed to determine the relationship between the patient's age, sex, concurrent illnesses, concurrent medication, whether they were on antihypertensive treatment and the frequency of their reporting symptoms. The analysis was conducted using a multivariate technique. The frequency of reporting symptoms was greater in females than males. Those receiving antihypertensive therapy reported more symptoms than those who were not. This was notable with those receiving a beta‐adrenoceptor blocker (47% of such patients complaining). Patients receiving concurrent medication were more likely to report a symptom than those not (48 compared to 37%). This was particularly noticeable if central nervous system‐acting drugs were prescribed where the prevalence of symptoms was 52%. Patients already on antihypertensive treatment were more likely to be taking other medication for other conditions (37 vs 31%) than those not receiving antihypertensive treatment. Females were more likely to be taking other tablets than males (38 compared to 30%). The only symptoms which were less prevalent in those receiving treatment were headache, dizziness and breathlessness. All other symptoms were increased or unchanged in patients on antihypertensive therapy. This study indicates that present treatment for hypertension produces a high complaint rate from patients and that, when patients so complain, the possibility of their symptoms being due to their concurrent medication should be considered.

Prevalence of hypertension-attributed symptoms in routine clinical practice: a general practitioners-based study

“…19 Symptoms reported by the patients while undergoing antihypertensive treatment could be explained by the adverse events related to the medication, inadequate blood pressure control and the consequent emergence of symptoms of hypertension, or due to interactions with concomitant treatment. 18 The nature of the symptoms and their increasing incidence with the severity of hypertension in this study suggest that these symptoms were the result of inadequate blood pressure control rather than side effects of the medication. No differences were found between different medications.…”

“…It has previously been reported that Prevalence of hypertension-attributed symptoms M Middeke et al hypertensive patients receiving medication tend to report more symptoms than those who are not. 18 This may be psychologically, due to the labelling of patients and recognizing that they have 'a disease' that needs treatment, and/or patients' fearing of side effects. However, we found a strong correlation between the severity of blood pressure and reported symptoms.…”

“…10 Other investigators, however, have reported that the incidence of headache was lower in treated hypertensive patients. 18 A Swedish study conducted in middle-aged women showed that dizziness, in particular, was more prevalent in women who started taking antihypertensive therapy. 16 Another finding of the same study was that headache was more common in patients with the highest quintile of hypertension who did not receive antihypertensives.…”

Headaches and the Treatment of Blood Pressure

“…Data from 7 randomized double-blind trials of 1 blood pressure-lowering drug, irbesartan, showed that it prevented headache 25 ; a large randomized controlled trial (not double blind) of doctors using any drug to lower blood pressure showed fewer headaches in treated patients 26 ; and 2 nonrandomized intervention studies showed that when patients diagnosed as hypertensive received treatment, headache became less prevalent. 7,27 The randomized double-blind trial data, however, relate to only 1 drug, 25 and the other results are susceptible to bias.…”

Headache in Mild-to-Moderate Hypertension and Its Reduction by Irbesartan Therapy

“…[11][12][13][14] Additional indirect evidence was provided by Cooper et al,5 who found that headache frequency increased following drug withdrawal from all classes of antihypertensive agents except calcium channel blockers, indicating that BP control with well-tolerated agents may reduce the frequency of headache. The recently developed angiotensin II receptor blockers (ARBs) may reduce BP as effectively as other antihypertensive medications, while providing a tolerability profile similar to that of placebo, [15][16][17][18][19][20] thus offering the means to test the hypothesis as to whether the reduction of BP without the imposition of adverse events reduces the frequency of headache in hypertension.…”