Angiotensin converting enzyme inhibition and quality of life: A randomized controlled trial

A multicenter, crossover, randomized clinical trial was conducted on 120 patients with moderate essential hypertension to determine how captopril (25 mg twice daily [BID] or 50 mg BID), methyldopa (250 mg BID or 500 mg BID), metoprolol (100 mg BID), and reserpine (0.125 mg BID) may affect quality of life. Quality of life was assessed by means of a questionnaire checked by an investigator, in a single-blind manner. Hydrochlorothiazide (25 mg/day) was given concomitantly. All groups had similar blood pressure control, although patients taking captopril (25 mg twice daily) achieved better control. Patients taking captopril scored significantly higher on measures of general well-being (Δ%, 38.5) and work performance (Δ%, 60.4%), compared with patients taking methyldopa (Δ%, -24.5 and -29.2, for well-being and work performance, respectively) and metoprolol (Δ%, 4.9 and -29.2, respectively). There was a smaller difference between captopril and reserpine (Δ%, 25.2, well-being; 13.8, work performance). The treatment groups showed similar scores for anxiety; methyldopa Δ% -28.3%; reserpine Δ%, 3%; and metoprolol Δ%, 18.9%. Patients taking captopril reported better depression and social participation values (38.3%). Memory improved significantly only after captopril treatment. Patients taking captopril scored higher on measures of sexual function (Δ%, 20.8), compared with patients taking methyldopa (Δ%, 44.8), reserpine (Δ%, 1.2), and metoprolol (Δ%, 10.4). Captopril induced fewer side effects than other treatments. The hypokalemic effect of hydrochlorothiazide was balanced only by captopril (25 mg BID), as seen by analysis of variance (F = 10.23; P < 0.001). In conclusion, our findings show that antihypertensive agents have different effects on quality of life and that treatment with captopril is better tolerated by hypertensive patients.