Relationships of Quality-of-Life Measures to Long-term Lifestyle and Drug Treatment in the Treatment of Mild Hypertension Study

Abstract

In patients with stage I hypertension, antihypertensive treatment with any of 5 agents used in TOMHS does not impair QL. The diuretic chlorthali-done and the cardioselective beta-blocker acebutolol appear to improve QL the most. Success with lifestyle changes affecting weight loss and increase in physical activity relate to greater improvements in QL and show that these interventions, in addition to contributing to blood pressure control, have positive effects on the general well-being of the individual.

Hypertension and current issues in compliance and patient outcomes

“…Grimm et al [16] conducted a 4-year study comparing the effects of five antihypertensive classes (angiotensin converting enzyme inhibitors, ␣-adrenergics, ␤-blockers, calcium channel blockers, diuretics) and placebo on HRQL (Treatment of Mild Hypertension Study [TOMHS]). All participants received lifestyle intervention that encouraged weight loss, increased physical activity, and reduced alcohol intake.…”

Old antihypertensive agents-diuretics and β-Blockers: Do we know how and in whom they lower blood pressure?

“…In addition, adding diuretics to existing regimens reduces the number of resistant hypertensive patients. Furthermore, although diuretics have been much maligned with respect to quality of life, careful examination shows that these agents do not seem to adversely affect quality-of-life measurements [53]. An appreciation of the dose-response relationship for diuretics and of the important adjunct role of these drugs as a component of fixed-dose combination antihypertensive therapy should help lessen the erosion in use of these compounds [34] The future of ␤-blockers seems bleaker.…”

Quality of life with nonpharmacologic treatment of hypertension

“…However, the authors concluded that placebo-controlled studies of long duration generally indicate no deterioration in QL with most classes of active drugs. Reporting on the follow-up of the TOMHS, Grimm et al [23] showed participants randomized to active treatment experienced improvement in most QL indexes compared with placebo, with significantly greater relative improvement for mental health, general functioning, and social functioning indexes and the global statistic.…”

“…Additionally, patients on long-term antihypertensive therapy have to contend with media reports on the possible adverse effects of drugs, physicians favoring newer products, the expectance that new drugs may be more effective and better toler- ated than their predecessors, and pharmacist lists of potential adverse effects for prescribed medications [26]. Unless substantial changes in lifestyle are achieved and maintained, hypertensive patients receiving medication will likely need treatment for a lifetime [23,27]. Furthermore, medications have been shown to reduce, but not eliminate, the risk of hypertension-related CVD [28].…”