Relationships of Quality-of-Life Measures to Long-term Lifestyle and Drug Treatment in the Treatment of Mild Hypertension Study

doi:10.1001/archinte.1997.00440270080007

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Vol. 157 No. 6, 24 MARCH 1997

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Relationships of Quality-of-Life Measures to Long-term Lifestyle and Drug Treatment in the Treatment of Mild Hypertension Study

Richard H. Grimm, Jr, MD, PhD; Gregory A. Grandits, MS; Jeffrey A. Cutler, MD, MPH; Anita L. Stewart, PhD; Robert H. McDonald, MD; Ken Svendsen, MS; Ronald J. Prineas, MD, PhD; Philip R. Liebson, MD

Arch Intern Med. 1997;157(6):638-648.

Abstract

Objectives
To compare 5 antihypertensive drugs and placebo for changesin quality of life (QL). To assess the relationship of lifestylefactors and change in lifestyle factors to QL in participantswith stage I diastolic hypertension.

Methods
The Treatment of Mild Hypertension Study (TOMHS) was a randomized,double-blind, placebocontrolled clinical trial with minimumparticipant follow-up of 4 years. It was conducted at 4 hypertensionscreening and treatment academic centers in the United States.The cohort consisted of 902 men and women with hypertension,aged 45 to 69 years, with diastolic blood pressures less than100 mm Hg. Informed consent was obtained from each participantafter the nature of the procedures had been fully explained.Sustained nutritional-hygienic intervention was administeredto all participants to reduce weight, to reduce dietary sodiumand alcohol intake, and to increase physical activity. Participantswere randomized to take (1) acebutolol (n=132); (2) amlodipinemaleate (n=131); (3) chlorthalidone (n=126); (4) doxazosin mesylate(n=134); (5) enalapril maleate (n=135); or placebo (n=234).Changes in 7 QL indexes were assessed based on a 35-item questionnaire:(1) general health; (2) energy or fatigue; (3) mental health;(4) general functioning; (5) satisfaction with physical abilities;(6) social functioning; and (7) social contacts.

Results
At baseline, higher QL was associated with older age, more physicalactivity, lower obesity level, male gender, non-African Americanrace, and higher educational level. Improvements in QL wereobserved in all randomized groups, including the placebo groupduring follow-up; greater improvements were observed in theacebutolol and chlorthalidone groups and were evident throughoutfollow-up. The amount of weight loss, increase in physical activity,and level of attained blood pressure control during follow-upwere related to greater improvements in QL.

Conclusions
In patients with stage I hypertension, antihypertensive treatmentwith any of 5 agents used in TOMHS does not impair QL. The diureticchlorthalidone and the cardioselective β-blocker acebutololappear to improve QL the most. Success with lifestyle changesaffecting weight loss and increase in physical activity relateto greater improvements in QL and show that these interventions,in addition to contributing to blood pressure control, havepositive effects on the general well-being of the individual.

Arch Intern Med. 1997;157:638-648

Footnotes

The affiliations of the authors appear in the acknowledgmentsection of this article. A complete list of the members of theTreatment of Mild Hypertension Study Research Group appearson page 641.

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