Relation between clinical and therapeutic variables and quality of life in hypertension

Abstract

Hypertensive patients have significantly poorer QoL than normotensive subjects, even with adjustment for differences. In hypertensives, QoL is affected by some clinical variables that might help us to identify those with worse QoL. Intensification of antihypertensive therapy produced a positive impact on QoL.

Hypertension labelling was associated with poorer self-rated health in the Third US National Health and Nutrition Examination Survey

“…First, we replicated a number of similar studies testing labelling effects. [9][10][11][12][13][14]25 Second, we extended this work by showing that labelling effects on SRH are independent of potential confounding by known SRH predictors, such as concurrent chronic disease, 36 SES, 37 and BMI. Since high BMI is associated with hypertension and poorer SRH, it is an especially potent rival hypothesis for labelling effects.…”

“…For example, some studies show that labelling increases work absenteeism [5][6][7] while others show that labelled hypertensives have lower selfrated health (SRH) than normotensives. [8][9][10][11][12][13][14][15] This apparent SRH effect of labelling has been reported in comparisons of labelled and unlabelled (unaware hypertensive) persons 11 and may occur in individuals mislabelled (i.e., normotensive persons misdiagnosed as hypertensive). 9 Therefore, even though screening and detection of hypertension is necessary to prevent the complications of hypertension, it may also adversely impact global SRH through labelling effects.…”

“…41,42 Finally, the sample was substantially larger than in previous reports and representative of the adult US population, reinforcing findings from other populationbased studies showing adverse hypertensive labelling effects on quality of life. 13,15 To the extent that a hypertensive label negatively affects SRH, among truly hypertensive individuals this is offset by the health benefits of subsequent antihypertensive treatment. On the other hand, normotensive persons mislabelled as hypertensive enjoy no such benefit.…”

“…4 Thus, quality of life on a population level is operationally defined in part by global self-health appraisals like those shown to be sensitive to hypertension labelling. 8,9,[11][12][13]25 If blood pressure screening and concomitant hypertensive labelling reduce SRH, then success in some elements of public health promotion (blood pressure screening and hypertension control) may erode progress in others (quality of life), particularly for those who are mislabelled.…”

“…Prior studies have utilized clinic 10,25 or otherwise restricted samples, 9,12 enrolled unusually hypertensive subgroups, 25,26 lacked normotensive controls, 27 and/or did not covary potential confounding factors such as antihypertensive treatments, 8 socioeconomic status, 10,12,27 body mass index (BMI), 26,28 and concurrent chronic disease. 10,25 Population-based studies with adequate controls were either small 11,13 or lacked independent blood pressure measurements, 8,15 and none have enrolled sufficient numbers of racial/ethnic subgroups to evaluate the consistency of labelling effects across non-Hispanic white, non-Hispanic black, and Hispanic subpopulations. Finally, in order to distinguish labelling effects from the effects of hypertension status it is necessary to examine large samples including hypertensive and normotensive individuals, both labelled and unlabelled (or mislabelled, as the case may be).…”