EVALUATING QUALITY-OF-LIFE IN HYPERTENSIVE PATIENTS

The treatment of arterial hypertension is symptomatic in 90-95% of pat ients; and therefore it must be administered throughout life. At the b eginning of pharmacologic treatment when only patients with severe or malignant hypertension are treated, the goal is almost exclusively lim ited to blood pressure reduction. Thereafter, when the treatment is ex tended to patients with mild and moderate hypertension, other aims in addition to blood pressure reduction, are evaluated and among these is the impact of pharmacologic blood pressure lowering on the quality of life. The quality of life is recognized as a multifactorial variable and can be subdivided into six domains. The methodology used to evalua te the quality of life should use valid, repeatable, and sensitive too ls, A metaanalysis of well selected and comparable trials has shown th at antihypertensive treatment, as a whole, has a small but positive im pact on many domains of the quality of life. Furthermore, it appears t hat converting-enzyme inhibitors, beta-blockers, calcium antagonists, and diuretics cause a statistically significant improvement of quality of life, while centrally acting alpha(1)-agonists and direct vasodila tors show only a positive trend. Although the comparison among two or more drugs with regard to quality of life is more difficult, it appear s from a personal review that converting-enzyme inhibitors and calcium antagonists cause a greater improvement, These two classes of antihyp ertensive agents have been shown to improve the quality of life in eld erly hypertensive patients, together with significant blood pressure r eduction, Finally, the incidence of drop-outs and side effects cannot be considered a valid means of evaluation of the quality of life.