The term quality of life implies more than adverse effects that make treatment intolerable. It is not new but has only relatively recently become a parameter to be measured in patients treated for
cardiovascular disease. Lessons can be learned from other conditions in which the Karnovsky Index and the
Arthritis Impact Measurement Scale have been used. Several investigators have used questionnaires to assess quality of life during
antihypertensive therapy. However, assessment of the effect of
angiotensin converting enzyme (ACE) inhibition on quality of life has only been done recently. The largest and best known study, of 625 white men with mild
hypertension, reported that patients given
captopril showed a significant improvement after 6 months in general well-being, work performance, and those skills associated with cognitive function. No such improvement was found with
methyldopa and there was significant worsening in measures associated with depression, sexual dysfunction, and life satisfaction. The
propranolol group, while showing improvement in cognitive functioning and social participation, manifested worsening of sexual function and physical symptoms.
Diuretic therapy had a greater negative impact on the quality of life of hypertensive patients than
captopril,
propranolol, or
methyldopa alone. Whether these results will be seen in other patient populations, and the pharmacological basis for these results, remains to be determined. As newer agents become available (eg, beta-blockers with ancillary properties,
calcium channel blockers with allegedly more selective actions on various vascular beds), comparative studies between these agents and
ACE inhibitors old and new are awaited with interest.