Schoenberger J A, Croog S H, Sudilovsky A, Levine S, Baume R M
Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612.
Am J Hypertens. 1990 Feb;3(2):123-32. doi: 10.1093/ajh/3.2.123.
We report on the distress associated with physical symptoms in 761 male hypertensive patients enrolled in a clinical trial of the effects of captopril, methyldopa or propranolol on quality of life. Educational level at entry into the trial showed a negative association with a series of physical symptom distress items among patients not previously treated with antihypertensive medications but no association with symptoms among the previously treated. Over the 24 weeks of therapy captopril as monotherapy was associated with no change from baseline in distress in all symptoms examined. In contrast, distress increased in the methyldopa treated patients for dry mouth and blurred vision. Propranolol treated patients had increased "trouble getting breath," bradycardia, shortness of breath or wheezing, and blurred vision. Between group comparisons revealed significant differences favorably comparing captopril to both methyldopa and propranolol in regard to fatigue, and blurred vision, as well as to methyldopa alone for dry mouth and "feeling worn out." There were significant differences as well between captopril and propranolol with patients on propranolol worsening in bradycardia. Other comparisons of patients on propranolol and methyldopa monotherapy showed propranolol patients worsening in bradycardia and loss of taste, but methyldopa patients reported more dry mouth and feeling worn out than those on propranolol. The addition of hydrochlorothiazide to therapy worsened total physical symptom distress scores for methyldopa and propranolol patients. This study confirms the value of methods which assess the degree of distress associated with symptoms commonly reported by hypertensive patients receiving antihypertensive medications. This approach can be useful in establishing a treatment regimen least likely to cause distress and can be of value in preserving quality of life, preventing noncompliance, and withdrawal from treatment.
我们报告了761名参与卡托普利、甲基多巴或普萘洛尔对生活质量影响的临床试验的男性高血压患者中与身体症状相关的痛苦情况。进入试验时的教育水平与未接受过抗高血压药物治疗的患者的一系列身体症状痛苦项目呈负相关，但与接受过治疗的患者的症状无关。在24周的治疗中，卡托普利作为单一疗法，在所检查的所有症状中，痛苦程度与基线相比没有变化。相比之下，甲基多巴治疗的患者口干和视力模糊的痛苦增加。普萘洛尔治疗的患者出现“呼吸困难”、心动过缓、呼吸急促或喘息以及视力模糊的情况增多。组间比较显示，在疲劳、视力模糊方面，卡托普利与甲基多巴和普萘洛尔相比有显著优势，在口干和“感觉疲惫”方面，卡托普利仅与甲基多巴相比有显著优势。卡托普利和普萘洛尔之间也存在显著差异，普萘洛尔治疗的患者心动过缓情况恶化。普萘洛尔和甲基多巴单一疗法的其他患者比较显示，普萘洛尔治疗的患者心动过缓和味觉丧失情况恶化，但甲基多巴治疗的患者比普萘洛尔治疗的患者报告有更多的口干和感觉疲惫。在甲基多巴和普萘洛尔治疗的患者中，添加氢氯噻嗪会使总体身体症状痛苦评分恶化。这项研究证实了评估接受抗高血压药物治疗的高血压患者常见症状相关痛苦程度的方法的价值。这种方法有助于制定最不可能引起痛苦的治疗方案，对维持生活质量、防止不依从和退出治疗具有重要价值。
