Croog S H, Levine S, Testa M A, Brown B, Bulpitt C J, Jenkins C D, Klerman G L, Williams G H
N Engl J Med. 1986 Jun 26;314(26):1657-64. doi: 10.1056/NEJM198606263142602.
We conducted a multicenter randomized double-blind clinical trial among 626 men with mild to moderate hypertension to determine the effects of captopril, methyldopa, and propranolol on their quality of life. Hydrochlorothiazide was added if needed to control blood pressure. After a 24-week treatment period, all three groups had similar blood-pressure control, although fewer patients taking propranolol required hydrochlorothiazide. Patients taking captopril alone or in combination with a diuretic were least likely to withdraw from treatment because of adverse effects (8 percent vs. 20 percent for methyldopa and 13 percent for propranolol). The treatment groups were similar in scores for sleep dysfunction, visual memory, and social participation. However, patients taking captopril, as compared with patients taking methyldopa, scored significantly higher (P less than 0.05 to less than 0.01) on measures of general well-being, had fewer side effects, and had better scores for work performance, visual-motor functioning, and measures of life satisfaction. Patients taking propranolol also reported better work performance than patients taking methyldopa. Patients taking captopril reported fewer side effects and less sexual dysfunction than those taking propranolol and had greater improvement (P less than 0.05 to less than 0.01) on measures of general well-being. Our findings show that antihypertensive agents have different effects on the quality of life and that these can be meaningfully assessed with available psychosocial measures.
我们在626名轻度至中度高血压男性中开展了一项多中心随机双盲临床试验，以确定卡托普利、甲基多巴和普萘洛尔对其生活质量的影响。必要时加用氢氯噻嗪以控制血压。经过24周的治疗期后，尽管服用普萘洛尔的患者需要加用氢氯噻嗪的较少，但三组的血压控制情况相似。单独服用卡托普利或与利尿剂联合服用的患者因不良反应而退出治疗的可能性最小（分别为8%，而甲基多巴组为20%，普萘洛尔组为13%）。治疗组在睡眠障碍、视觉记忆和社会参与方面的得分相似。然而，与服用甲基多巴的患者相比，服用卡托普利的患者在总体幸福感测量方面得分显著更高（P小于0.05至小于0.01），副作用更少，工作表现、视觉运动功能和生活满意度测量得分更高。服用普萘洛尔的患者工作表现也比服用甲基多巴的患者更好。与服用普萘洛尔的患者相比，服用卡托普利的患者报告的副作用和性功能障碍更少，在总体幸福感测量方面改善更大（P小于0.05至小于0.01）。我们的研究结果表明，抗高血压药物对生活质量有不同影响，并且可以通过现有的社会心理测量方法进行有意义的评估。
