Quality of life with three antihypertensive treatments. Cilazapril, atenolol, nifedipine.

Abstract

A multicenter, randomized double-blind study of 6 months' duration was performed in 540 patients (average age 54 years, 57% male) with mild-to-moderate essential hypertension to determine the relative effects on quality of life of cilazapril, atenolol, and nifedipine retard. Quality of life was assessed by using both a self-administered and an interviewer-administered questionnaire; the assessment included a complaint score (symptoms checklist), Health Status Index, assessment of work satisfaction, Psychological General Well-being Index, Profile of Mood States subscales, and life satisfaction assessment Psychomotor function was measured by the Reitan Trail Making test B. At the end of the trial, diastolic blood pressure had fallen by an average of 15 mm Hg in all three groups, but significantly (p=0.01) more patients taking cilazapril required the addition of a diuretic (36%) compared with those taking atenolol (25%) or nifedipine retard (24%). No significant differences in quality of life were observed between cilazapril and atenolol during the trial. Symptomatic complaints increased on nifedipine retard (p=0.02) and contributed to a higher discontinuation rate (21% discontinued treatment compared with 13% and 14% taking atenolol and cilazapril, respectively,/?=0.04). However, a possible improvement in the fatigue subscale (p=0.04) was also observed on nifedipine retard. The 95% confidence intervals showed that none of the drugs in this trial produced an effect equivalent to that previously reported between captopril and methyldopa in the Psychological General Well Being Index or between captopril and methyldopa or propranolol in Trail Making test B. We conclude that cilazapril and atenolol have equivalent effects on quality of life, but nifedipine retard was associated with more symptomatic complaints and a higher discontinuation rate. (Hypertension 1992; 19:499-507) KEYWORDS • quality of life • antihypertensive therapy • angiotensin converting enzyme inhibitors • calcium channel blockers • 0-blockers

New approaches to the uses of beta blocking drugs in hypertension

“…However, what was later found with the non-selective lipid soluble propranolol did not apply to all beta-blockers. The beta 1 selective atenolol was found to have a similar quality of life score to ACE inhibitors, 41 while the nonselective propranolol was found to have poorer global score, confirming the findings of Croog et al 40 Further studies confirm that atenolol was similar to captopril, 42 and Fletcher et al 43 in a large doubleblind, randomised parallel group study, observed that cilazapril and atenolol were similar in quality of life assessment, both superior to nifedipine. The highly beta 1 -selective bisoprolol has been reported to be similar to enalapril, 44 while a combination of low dose (6.25 mg) hydrochlorothiazide and bisoprolol was found to have a similar quality of life to amlodipine with a trend to be better than enalapril.…”

Bisoprolol and nifedipine retard in elderly hypertensive patients: effect on quality of life

“…3 Both trials showed an excess of symptomatic complaints on nifedipine retard leading to a higher discontinuation rate on nifedipine. However, most importantly, in the smaller trial atenolol did not influence psychological well-being although the POMS was also employed in assessment.…”

“…3 Nevertheless dilevalol treatment was significantly better than bendrofluazide when assessed by the objective Digit Symbol Substitution and Symbol Copying tests. In the present trial objective tests of cognitive func-tioning did not reveal any differences between bisoprolol and nifedipine retard nor did subjective evaluation of memory and attention.…”

“…27 In addition, objective measures of cognitive functioning in one randomised trial did not reveal any difference between nifedipine retard, atenolol and cilazapril. 3 Whether or not nifedipine retard produces a real decline in cognitive function compared to other treatments is unknown, but treatment with a similar dihydropyridine drug, nitrendipine, is better than placebo in cardiovascular terms 28 and it is probable that the reported subjective effects are reversible on stopping the drug.…”

“…In the second trial 540 patients were randomised to 6 months treatment with either nifedipine retard, atenolol or cilazapril. 3 Symptomatic complaints and withdrawals increased with nifedipine retard but fatigue was lessened by this drug. Finally a small cross-over trial of 61 patients received 8 weeks of bisoprolol and 8 weeks of nifedipine retard.…”