Williams G H, Croog S H, Levine S, Testa M A, Sudilovsky A
J Hypertens Suppl. 1987 Feb;5(1):S29-35.
Six hundred and twenty-six male patients with mild to moderate hypertension were enrolled in a multicentre randomized double-blind clinical trial to determine the effect of methyldopa, captopril and propranolol on the quality of life of these patients. During the 6-month trial hydrochlorothiazide was added to the treatment programme of those patients whose blood pressure was not normalized. More individuals in the captopril group (33%) required hydrochlorothiazide than in the propranolol group (22%). As a group, those individuals who required a diuretic were heavier and had higher basal and end-of-study blood pressure than those individuals requiring only monotherapy. However, the basal quality-of-life indices were similar in the six treatment subgroups. The withdrawal rate from the study was twice as high for those patients treated with propranolol and methyldopa as for those treated with captopril, whether a diuretic was added or not. More individuals requiring a diuretic experienced sexual dysfunction and a substantial worsening of their general well-being and of physical symptom indices over the 24 weeks of the study (P less than 0.01), particularly in the captopril and propranolol treatment subgroups. In summary, the present results suggest that diuretic therapy may have a greater negative impact on the quality of life of hypertensive patients than captopril, propranolol or methyldopa alone.
626名轻至中度高血压男性患者参与了一项多中心随机双盲临床试验，以确定甲基多巴、卡托普利和普萘洛尔对这些患者生活质量的影响。在为期6个月的试验中，血压未恢复正常的患者在治疗方案中加用了氢氯噻嗪。卡托普利组（33%）比普萘洛尔组（22%）需要加用氢氯噻嗪的患者更多。总体而言，那些需要利尿剂的患者比仅接受单一疗法的患者体重更重，基础血压和研究结束时的血压更高。然而，六个治疗亚组的基础生活质量指标相似。无论是否加用利尿剂，接受普萘洛尔和甲基多巴治疗的患者退出研究的比例是接受卡托普利治疗患者的两倍。在研究的24周内，更多需要利尿剂的患者出现性功能障碍，总体健康状况和身体症状指标显著恶化（P<0.01），尤其是在卡托普利和普萘洛尔治疗亚组中。总之，目前的结果表明，利尿剂治疗对高血压患者生活质量的负面影响可能比单独使用卡托普利、普萘洛尔或甲基多巴更大。
