RELATIONSHIPS OF QUALITY-OF-LIFE MEASURES TO LONG-TERM LIFE-STYLE ANDDRUG-TREATMENT IN THE TREATMENT OF MILD HYPERTENSION STUDY

Objectives: To compare 5 antihypertensive drugs and placebo for change s in quality of life (QL). To assess the relationship of lifestyle fac tors and change in lifestyle factors to QL in participants with stage I diastolic hypertension. Methods: The Treatment of Mild Hypertension Study (TOMHS) was a randomized, double-blind, placebo-controlled clini cal trial with minimum participant follow-up of 4 years. It was conduc ted at 4 hypertension screening and treatment academic centers in the United States. The cohort consisted of 902 men and women with hyperten sion, aged 45 to 69 years, with diastolic blood pressures less than 10 0 mm Hg. Informed consent was obtained from each participant after the nature of the procedures had been fully explained. Sustained nutritio nal-hygienic intervention was administered to all participants to redu ce weight, to reduce dietary sodium and alcohol intake, and to increas e physical activity. Participants were randomized to take (1) acebutol ol (n = 132); (2) amlodipine maleate (n = 131); (3) chlorthalidone (n = 126), (4) doxazosin mesylate (n = 134); (5) enalapril maleate (n = 1 35): or placebo (n = 234). Changes in 7 QL indexes were assessed based on a 35-item questionnaire: (1) general health; (2) energy or fatigue ; (3) mental health; (4) general functioning; (5) satisfaction with ph ysical abilities; (6) social functioning; and (7) social contacts. Res ults: At baseline, higher QL was associated with older age, more physi cal activity, lower obesity level, male gender, non-African American r ace, and higher educational level. Improvements in QL were observed in all randomized groups, including the placebo group during follow-up; greater improvements were observed in the acebutolol and chlorthalidon e groups and were evident throughout follow-up. The amount of weight l oss, increase in physical activity, and level of attained blood pressu re control during follow-up were related to greater improvements in QL . Conclusions: In patients with stage I hypertension, antihypertensive treatment with any of 5 agents used in TOMHS does not impair QL. The diuretic chlorthalidone and the cardioselective beta-blocker acebutolo l appear to improve QL the most, Success with lifestyle changes affect ing weight loss and increase in physical activity relate to greater im provements in QL and show that these interventions, in addition to con tributing to blood pressure control, have positive effects on the gene ral wellbeing of the individual.