Quality of life and cost-effectiveness in the treatment of hypertension.

By and large, the results of the different studies on quality of life in hypertension suggest that among beta-blockers only the nonselective beta-blocker propranolol has a negative effect on well-being, being associated with depression and side-effects. The findings on diuretics are comparatively few, and mainly observed as an adverse impact on sexual function. If one broadens the treatment scenario to include mortality and morbidity, evidence of a beneficial impact has only been proven for beta-blockers and diuretics. With the primary aim of antihypertensive drug therapy given as a reduction in cardiovascular risk factors, the aim with regard to quality of life is that quality of life be maintained. The new guidelines on the management of mild hypertension issued in the United States highlight the danger of relaxing the concern for risk reduction and costs in favour of surrogate end-points, even though these may carry great significance in the individual patient.