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Quality of life and antihypertensive drugs in the elderly

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Abstract

Hypertension is common in the elderly with estimates of around 10–20% showing a sustained level of pressure, either systolic (@#@ ⩾160 mmHg), or diastolic (@#@ ⩾90 mmHg) or both. The benefits of treating subjects with raised diastolic pressure was shown by the trials of the European Working Party on High Blood Pressure in the Elderly (EWPHE), the Hypertension in Elderly Patients in Primary Care (HEP), and the Swedish Trial in Old patients with Hypertension (STOP- Hypertension). Evidence for the benefit of treating isolated systolic hypertension in the elderly was provided in one trial (SHEP: Systolic Hypertension in the Elderly Program), and the results of two others are awaited. However, it is important to provide data on all treatment effects, including adverse reactions as well as benefits. In addition to traditional measures of mortality, morbidity and side effects, the quality of life in patients on antihypertensive treatment should be considered. The methods of measuring quality of life in trials is discussed, and some results presented. (Aging Clin. Exp. Res. 4: 115- 123, 1992)

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References

  1. Bulpitt C.J.: Definition, prevalence and incidence of hypertension in the elderly. In: Amery A., Staessen J. (Eds.), Handbook of Hypertension. Hypertension in the Elderly, Vol. 12. Elsevier, Amsterdam, 1989, pp. 153–169.

    Google Scholar 

  2. McMahon S., Peto R., Cutler J., Collins R., Sorlie P., Neaton J., Abbott R., Godwin J., Dyer A., Stamber J.: Blood pressure, stroke and coronary heart disease. Part 1. Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 335: 765–774, 1990.

    Article  Google Scholar 

  3. Harris T., Cook E.F., Kännel W.B., Goldman L.: Proportional hazards analysis of risk factors for coronary heart disease in individuals aged 65 or older. The Framingham Heart Study. J. Am. Geriatr. Soc. 36: 1023–1028, 1988.

    PubMed  CAS  Google Scholar 

  4. Colandrea M.A., Friedman G.D., Nichaman M.Z., Lynd C.N.: Systolic hypertension in the elderly: an epidemiologic assessment. Circulation 41: 239–245, 1970.

    Article  PubMed  CAS  Google Scholar 

  5. Kannel W.B., Dawber T.R., McGee D.L.: Perspectives on systolic hypertension: the Framingham Study. Circulation 61: 1179–1182, 1980.

    Article  PubMed  CAS  Google Scholar 

  6. Forette F., De La Fuente X., Golmard J.L., Henry J.F., Hervy M.P.: The prognostic significance of isolated systolic hypertension in the elderly: results of a ten year longitudinal survey. Clin. Exp. Hypertens. 4: 1177–1191, 1982.

    Article  CAS  Google Scholar 

  7. Rutan G.H., Kuller L.H., Neaton J.D., Wentworth D.N., McDonald R.H., McFate Smith W.: Mortality associated with diastolic hypertension and isolated systolic hypertension among men screened for the Multiple Risk Factor Intervention Trial. Circulation 77: 504–514, 1988.

    Article  PubMed  CAS  Google Scholar 

  8. Garland C., Barrett-Connor E., Suarez L., Criqui M.H.: Isolated systolic hypertension and mortality after age 60 years: a prospective population-based study. Am. J. Epidemiol. 118: 365–376, 1983.

    PubMed  CAS  Google Scholar 

  9. SHEP Cooperative Research Group: Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 265: 3255–3264, 1991.

    Article  Google Scholar 

  10. Amery A., Birkenhäger W., Bulpitt C.J., Clément D., De Leeuw P., Dollery CT., Fagard R., Fletcher A., Forette F., Leonetti G., O’Brien E.T., O’Malley K., Rodicio J.L., Rosenfeld J., Staessen J., Strasser T., Terzoli L., Thijs L., Tuomilehto J., Webster J.: Syst-Eur. A multicentre trial on the treatment of isolated systolic hypertension in the elderly: Objectives, protocol and organization. Aging Clin. Exp. Res. 3: 287–302, 1991.

    CAS  Google Scholar 

  11. Staessen J., Fagard R., Amery A.: Isolated systolic hypertension in the elderly: implications of SHEP for clinical practice and for the ongoing trials. J. Hum. Hypertens. 5: 469–474, 1991.

    PubMed  CAS  Google Scholar 

  12. Aronow W.S., Herzig A.H., Etienne F., D’Alba P., Ronquillo J.: 41-month follow-up of risk factors correlated with new coronary events in 708 elderly patients. JAGS 37: 501–506, 1989.

    CAS  Google Scholar 

  13. Mattila K., Haavisto M., Rajala S., Heikinheimo R.: Blood pressure and five year survival in the very old. Br. Med. J. 296: 887–889, 1988.

    Article  CAS  Google Scholar 

  14. Coope J., Warrender T.S., McPherson K.: The prognostic significance of blood pressure in the elderly. J. Hum. Hypertens. 2: 79–88, 1988.

    PubMed  CAS  Google Scholar 

  15. Amery A., Birkenhäger W., Brixko P., Bulpitt C, Clément D., Deruyttere M., De Schaepdryver A., Dollery C., Fagard R., Forette F., Forte J., Hamdy R., Henry JF, Joossens J.V., Leonetti G., Lund-Johansen P., O’Malley K., Petrie J.C., Strasser T., Tuomilehto J., Williams B.: Mortality and morbidity results from the European working party on high blood pressure in the elderly trial. Lancet I: 1349–1354, 1985.

    Article  Google Scholar 

  16. Coope J., Warrender T.S.: Randomised trial of treatment of hypertension in elderly patients in primary care. Br. Med. J. 293: 1145–1151, 1986.

    Article  CAS  Google Scholar 

  17. Dahlof B., Lindholm L.H., Hansson L., Schersten B., Ekbom T., Wester P-O.: Morbidity and mortality in the Swedish trial in old patients with hypertension. Lancet 338: 1281–1285, 1991.

    Article  PubMed  CAS  Google Scholar 

  18. Collins R., Peto R., McMahon S., Herbert P., Riebach N.H., Gerbein K.A., Godwin J., Quizilbash N., Taylor J.O., Hennekens C.H.: Blood pressure, stroke and coronary heart disease. Part 2. Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 335: 827–838, 1990.

    Article  PubMed  CAS  Google Scholar 

  19. Staessen J., Van Hoof R., Fagard R., Amery A.: Epidemiology of treated and untreated hypertension in the elderly. In: Amery A., Staessen J. (Eds.), Handbook of Hypertension. Hypertension in the Elderly, Vol. 12. Elsevier, Amsterdam, 1989, pp. 320–351.

    Google Scholar 

  20. Medical Research Council Working Party: MRC trial of treatment of mild hypertension: principal results. Br. Med. J. 291: 97–104, 1985.

    Article  Google Scholar 

  21. Fletcher A.E., Amery A., Birkenhäger W. Bulpitt C., Clément D., De Leeuw P., Deruytter M., De Schaepdryver A., Dollery C., Fagard R., Lund-Johansen P., Nissinen A., O’Brien E., O’Malley K., Pelemans W., Petrie J.C., Staessen J., Strasser T., Terzoli L., Thijs L., Tuomilehto J., Webster J., Williams B.O.: Risks and benefits in the trial of the European Working Party on High Blood Pressure in the Elderly. J. Hypertens. 9: 225–230, 1991.

    Article  PubMed  CAS  Google Scholar 

  22. Gurland B.J., Teresi J., McFate Smith W., Black D., Hughes G., Edlavitch S.: Effects of Treatment for Isolated Systolic Hypertension on Cognitive Status and Depression in the Elderly. J. Am. Geriatr. Soc. 36: 1015–1022, 1988.

    PubMed  CAS  Google Scholar 

  23. Gurland B.J., Golden R.R., Teresi J., Challop J.: The SHORT-CARE: an efficient instrument for the assessment of depression, dementia and disability. J. Gerontol. 39: 166–169, 1984.

    Article  PubMed  CAS  Google Scholar 

  24. Wechsler D.: The measurement and appraisal of adult intelligence scale. Psychological corporation, New York, 1955.

    Google Scholar 

  25. Reitan R.M.: Validity of the trail making test as an indicator of organic brain damage. Percept. Mot. Skills 8: 271–276, 1958.

    Google Scholar 

  26. Schultz N.R., Dineen J.T., Elias M.F., Pentz C.A., Gibson Wood W.: WAIS performance for different age groups of hypertensive and control subjects during the administration of a diuretic. J. Gerontol. 34: 246–253, 1979.

    Article  PubMed  Google Scholar 

  27. Medical Research Council Working Party on Mild to Moderate Hypertension: Adverse reactions to bendrofluazide and propranolol for the treatment of mild hypertension. Lancet II: 539–543, 1981.

    Google Scholar 

  28. Wassertheil-Smoller S., Blaufox D., Oberman A., Davis B.R., Swencionis C, Knerr M.O., Hawkins C.M., Langford H.G.: Effect of antihypertensives on sexual function and quality of life. The TAIM Study. Ann. Intern. Med. 114: 613–620, 1991.

    Article  PubMed  CAS  Google Scholar 

  29. Cartwright A., Smith C.: Elderly people, their medicines, and their doctors. Routledge, London & New York, 1988.

    Google Scholar 

  30. Croog S.H., Levine S., Testa M.A.: The Effects of Antihypertensive Therapy on the Quality of Life. N. Engl. J. Med. 314: 1657–1664, 1986.

    Article  PubMed  CAS  Google Scholar 

  31. Fletcher A., Chester P.C., Hawkins C.M.A., Latham A.N., Pike L.A., Bulpitt C.J.: The effects of verapamil and propranolol on quality of life in hypertension. J. Human Hypertens. 3: 125–130, 1989.

    CAS  Google Scholar 

  32. Fletcher A.E., Bulpitt C.J., Hawkins C.M.: Quality of life on antihypertensive therapy: a randomised double blind controlled trial of captopril and atenolol. J Hypertens. 8: 463–466, 1990.

    Article  PubMed  CAS  Google Scholar 

  33. Werning C., Weitz T., Ludwig B.: Assessment of Indapamide in Elderly Hypertensive Patients with Special Emphasis on Well-Being. Am. J. Med. 84 (Suppl. 1B): 104–108, 1988.

    PubMed  CAS  Google Scholar 

  34. Mossey J.M., Shapiro E.: Self-rated health: a predictor of mortality among the elderly. Am. J. Public Health 72: 800–808, 1982.

    Article  PubMed  CAS  Google Scholar 

  35. Kaplan G.A., Camacho T.: Perceived health and mortality: a nine year follow-up of the human population laboratory cohort. Am. J. Epidemiol. 117: 292–304, 1983.

    PubMed  CAS  Google Scholar 

  36. Grand A., Grosclaude P., Bocquet H., Pous J., Albardee J.L.: Disability, psychosocial factors and mortality among the elderly in a rural French population. J. Clin. Epidemiol. 43: 773–782, 1990.

    Article  PubMed  CAS  Google Scholar 

  37. Bulpitt C.J., Dollery C.T., Carne S.: A symptom questionnaire for hypertensive patients. J. Chronic Dis. 27: 309–323, 1974.

    Article  PubMed  CAS  Google Scholar 

  38. Bulpitt C.J., Dollery C.T., Came S.: Change in symptoms of hypertensive patients after referral to hospital clinic. Br. Heart J. 38: 121–128, 1976.

    Article  PubMed  CAS  Google Scholar 

  39. Bergner M., Bobbit R.A., Carter W.B. Gilson B.S.: The Sickness Impact Profile: development and final revision of a health status measurement. Med. Care 19: 787–805, 1981.

    Article  PubMed  CAS  Google Scholar 

  40. Fanshel S., Bush J.W.: A health status index and its application to health services out-come. Oper. Res. 18: 1021–1066, 1970.

    Article  Google Scholar 

  41. Bulpitt C.J.: Quality of life in hypertensive patients. In: Amery A., Fagard R., Lijnen P., Staessen J. (Eds.), Hypertensive Cardiovascular Disease: Pathophysiology and Treatment. The Hague, Martinus Nijhoff, 1982, pp. 929–948.

    Chapter  Google Scholar 

  42. Kellner R., Sheffield B.F.: A self-rating scale of distress. Psychol. Med. 3: 88–100, 1976.

    Article  Google Scholar 

  43. McNair D.N.L., Lorr M., Doppleman L.F.: Manual for the profile of mood states. San Diego Educational and Industrial Testing Service, 1971.

  44. Battersby C., Hartley K., Fletcher A.E., Markowe H.L.J., Brown R.G., Styles W., Sapper H., Bulpitt C.J.: Cognitive function and quality of life in hypertension — a community based study. Clin. Sci. 76: S16, 1989 (Abstract).

    Google Scholar 

  45. Fava G.A., Kellner R., Munari F., Pavan L.: The Hamilton Depression Rating Scale in normals and depressives. Acta Psychiatr. Scand. 66: 26–32, 1982.

    Article  PubMed  CAS  Google Scholar 

  46. Robin A., Curry S.H., Whelpton R.: Clinical and biochemical comparison of clorazepate and diazepam. Psychol. Med. 4: 388–392, 1974.

    Article  PubMed  CAS  Google Scholar 

  47. Bland J.M., Altman D.G.: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet I: 307–310, 1986.

    Article  Google Scholar 

  48. Chinn S., Burney P.G.: On measuring repeatability of data from self-administered questionnaires. Int. J. Epidemiol. 16: 121–127, 1987.

    Article  PubMed  CAS  Google Scholar 

  49. Bulpitt C.J., Hoffbrand B.I., Dollery C.T.: Contribution of drug treatment to symptoms of hypertensive patients. In: Gross F., Strasser T. (Eds.), Mild Hypertension: Natural History and Management. Pitman Medical, Bath, 1979, pp.291–302.

    Google Scholar 

  50. Kellner R., Rada R.T., Anderson T., Pathak D.: The effects of chlordiazepoxide on self-rated depression, anxiety and well-being. Psychopharmacology 64: 185–191, 1979.

    Article  PubMed  CAS  Google Scholar 

  51. Bulpitt C.J., Fletcher A.E.: The measurement of quality of life in hypertensive patients: a practical approach. Br. J. Clin. Pharmacol. 30: 353–364, 1990.

    Article  PubMed  CAS  Google Scholar 

  52. Fletcher A., McLoone P., Bulpitt C.: Quality of life on angina therapy — a randomised controlled trial of transdermal nitroglycerine against placebo. Lancet II: 4–8, 1988.

    Article  Google Scholar 

  53. Canadian Erythropoietin Study Group: Association between recombinant human erythropoietin and quality of life and exercise capacity of patients receiving haemodialysis. Br. Med. J. 300: 573–578, 1990.

    Article  Google Scholar 

  54. Abrahams J.P., Wallach H.F., Divens S.: Behavioural improvement in long-term geriatric patients during an age-integrated psychosocial rehabilitation program. JAGS 27: 218–221, 1979.

    CAS  Google Scholar 

  55. Yeo G., Ingram L., Skurnick J., Crapo L.: Effects of a geriatric clinic on functional health and well-being of elders. J. Gerontol. 42: 252–258, 1987.

    Article  PubMed  CAS  Google Scholar 

  56. Pitt B., Adshead F., Day Codey D.: BASDEC A novel screening instrument for depression in elderly medical in-patients. Br. Med. J. (in press).

  57. Fletcher A.: Cost effectiveness analyses in the treatment of high blood pressure. Report of the World Hypertension League on the economics of hypertension control, Barcelona, September 27–28 1991. J. Human Hypertens. (in press).

  58. Fletcher A.: Pressure to treat and pressure to cost: a review of cost effectiveness analysis. Editorial Review. J. Hypertens. 9: 193–198, 1991.

    Article  PubMed  CAS  Google Scholar 

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Fletcher, A., Bulpitt, C. Quality of life and antihypertensive drugs in the elderly. Aging Clin Exp Res 4, 115–123 (1992). https://doi.org/10.1007/BF03324077

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