Croog S H, Kong B W, Levine S, Weir M R, Baume R M, Saunders E
Department of Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington 06032.
Arch Intern Med. 1990 Aug;150(8):1733-41. doi: 10.1001/archinte.150.8.1733.
A multicenter, randomized double-blind clinical trial was conducted among 306 black men and women with mild to moderate hypertension to determine effects of atenolol, captopril, and verapamil SR on measures of quality of life. Patients were randomly assigned to a stable or forced-dose titration sequence. After an 8-week treatment period, the rate of withdrawal from treatment because of adverse effects was low and did not differ by drug treatment group or titration level. Patients taking verapamil SR showed a significantly greater reduction in mean blood pressures than patients treated with atenolol or captopril. Along with absence of worsening on any quality of life total scale scores examined over the treatment period, we found either improvement or no change in the total scale scores for all three treatment groups. Among both male and female patients, comparisons between drug treatment groups showed no differences in degree of change on the total scale scores. In comparisons within each treatment group, improvement in scores of male patients after 8 weeks appeared among those taking atenolol in general well-being and physical symptoms reduction; among male patients taking captopril in general well-being, physical symptoms, and sexual performance; and among male patients receiving verapamil SR in scores in irritability, sleep, and the Digit Span test. Improvement in scores among female patients taking atenolol was found in scores on general well-being, physical symptoms, and sleep; among women taking captopril on general well-being, physical symptoms, and irritability; and among women taking verapamil SR on general well-being. Patients in all treatment groups improved on measures of visuomotor functioning. The research shows that with the three newer generation antihypertensive medications studied, blood pressure control was achieved during the treatment period without negative effects on quality of life scales, along with findings of improvement on some measures. Given the special clinical features of hypertension in black patients, the study underlines as well the potential and utility of systematic tracking of measures of quality of life, while monitoring blood pressures in this patient population.
对306名患有轻至中度高血压的黑种男性和女性进行了一项多中心、随机双盲临床试验，以确定阿替洛尔、卡托普利和缓释维拉帕米对生活质量指标的影响。患者被随机分配到稳定剂量或强制剂量滴定序列。经过8周的治疗期，因不良反应而退出治疗的比例较低，且在药物治疗组或滴定水平之间没有差异。服用缓释维拉帕米的患者平均血压下降幅度明显大于服用阿替洛尔或卡托普利的患者。在整个治疗期间检查的任何生活质量总体量表评分均未恶化，我们发现所有三个治疗组的总体量表评分均有改善或无变化。在男性和女性患者中，药物治疗组之间在总体量表评分的变化程度上没有差异。在每个治疗组内部的比较中，服用阿替洛尔的男性患者在总体幸福感和身体症状减轻方面，8周后评分有所改善；服用卡托普利的男性患者在总体幸福感、身体症状和性功能方面评分有所改善；接受缓释维拉帕米的男性患者在易怒、睡眠和数字广度测试评分方面有所改善。服用阿替洛尔的女性患者在总体幸福感、身体症状和睡眠评分方面有所改善；服用卡托普利的女性患者在总体幸福感、身体症状和易怒评分方面有所改善；服用缓释维拉帕米的女性患者在总体幸福感评分方面有所改善。所有治疗组的患者在视觉运动功能指标方面均有改善。研究表明，在所研究的三种新一代抗高血压药物治疗期间，实现了血压控制，且对生活质量量表没有负面影响，同时在一些指标上有改善的发现。鉴于黑人患者高血压的特殊临床特征，该研究还强调了在监测该患者群体血压的同时，系统跟踪生活质量指标的潜力和实用性。
