Quality of life in treatment of hypertension. A metaanalysis of clinical trials

Abstract

A metaanalysis was performed to determine the effects on quality of life (QL) in hypertension as reported in published clinical trials of antihypertensive drug therapy. All studies included compared active treatment to baseline (placebo or no treatment) with the patients as their own control and used blinded, randomized trials. Change was measured by self and/or interviewer-assisted evaluation, standardized psychomotor/cognitive tests, or sleep laboratory observations. After an exhaustive literature search (1970 to 1990), nine published trials of 27 population groups (n = 1620) using 14 drugs from six pharmacological groups met selection criteria and were analyzed for five QL constructs: sexual function, sleep, psychomotor, general well-being, and mood. Small positive effect size (d) improvement with treatment was seen for sleep (d = 0.106), psychomotor (d = 0.283), general well-being (d = 0.139), and mood (d = 0.167) while no effect could be determined for sexual function (d = -0.030) based on 95% confidence intervals. Either a comparably small improvement with treatment or no effect was seen among various pharmacological drug groups; no negative effect with treatment was identified. A larger positive effect could be postulated if the drug choice was individualized to the patient rather than randomized as in clinical trial methodology. Although none of the drug groups had a clearly superior effect, a more frequent positive effect with angiotensin converting enzyme inhibitors and beta-blockers was seen for all constructs. Narrower demographics and smaller sample sizes may have biased similar positive effects in calcium-channel blockers and diuretics.