FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 328:907-913 April 1, 1993 Number 13 Next

	Full Text Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background We conducted a multicenter trial comparing two angiotensin-converting-enzyme inhibitors to determine whether effects on quality of life during antihypertensive therapy are uniform within this pharmacologic class of agents, and to relate the effects of the drugs on quality of life to objective adverse events, such as the loss of a job or the death of a spouse.

Methods After a four-week washout period when they received placebo, 379 men with mild-to-moderately-severe hypertension were randomly assigned to receive captopril (25 to 50 mg twice daily, with or without hydrochlorothiazide) or enalapril (5 to 20 mg per day, with or without hydrochlorothiazide) for 24 weeks. Blood pressure, quality of life, and life events were monitored. Differences between treatments were evaluated by calibrating measures of quality of life with objective life events.

Results Throughout the treatment period, no differences were found in blood pressure, frequency of withdrawal of patients from the study, or major side effects. Patients treated with captopril had more favorable changes in overall quality of life, general perceived health, vitality, health status, sleep, and emotional control (P<0.05 for each). The changes varied according to the quality of life at base line (P<0.001); patients with a low quality of life at base line remained stable or improved with either drug, whereas those with a higher quality of life remained stable with captopril but worsened with enalapril. The quality-of-life scales correlated with life events and symptom distress (P<0.001), and calibration analysis indicated that differences between treatments were clinically important.

Conclusions Two angiotensin-converting-enzyme inhibitors, captopril and enalapril, indistinguishable according to clinical assessments of efficacy and safety, had different effects on quality of life. Calibration with life events showed that drug-induced changes are substantial and that the different effects of these two agents on quality of life can be clinically meaningful.

Source Information

From the Department of Biostatistics, Harvard School of Public Health, Boston (M.A.T.); Phase V Technologies, Inc., Wellesley Hills, Mass. (R.B.A., J.F.N.); and the Departments of Radiology and Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (N.K.H.). Dr. Anderson and Ms. Nackley are employees of Phase V Technologies, which served as the data coordinating center for the trial. Drs. Testa and Hollenberg are paid consultants for Phase V Technologies. Dr. Hollenberg has served as a paid consultant to Bristol-Myers Squibb and Merck Sharp & Dohme, the companies that manufacture the drugs used in this study.The members of the study group are listed in Appendix 1.

Address reprint requests to Dr. Testa at the Department of Biostatistics, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02115.

Full Text of this Article

Related Letters:

Captopril, Enalapril, and Quality of Life
Santanello N. C., Guess H., Heyse J. F., Kaplan N. M., Waud D. R., Fletcher A., Ware J. E., Testa M. A., Hollenberg N. K.
Extract | Full Text  
N Engl J Med 1993; 329:505-507, Aug 12, 1993. Correspondence

This article has been cited by other articles:

• Testa, M. A., Simonson, D. C. (2007). Satisfaction and Quality of Life With Premeal Inhaled Versus Injected Insulin in Adolescents and Adults With Type 1 Diabetes. Diabetes Care 30: 1399-1405 [Abstract] [Full Text]  
• Kennedy, D. J., Burket, M. W., Khuder, S. A., Shapiro, J. I., Topp, R. V., Cooper, C. J. (2006). Quality of life improves after renal artery stenting.. Biol Res Nurs 8: 129-137 [Abstract]  
• Hollenberg, N. K., Williams, G. H., Anderson, R., Akhras, K. S., Bittman, R. M., Krause, S. L. (2003). Symptoms and the Distress They Cause: Comparison of an Aldosterone Antagonist and a Calcium Channel Blocking Agent in Patients With Systolic Hypertension. Arch Intern Med 163: 1543-1548 [Abstract] [Full Text]  
• Reddy, B. K., Kennedy, D. J., Colyer, W. R., Burket, M. W., Thomas, W. J., Khuder, S. A., Shapiro, J. I., Topp, R. V., Cooper, C. J. (2003). Compliance with Antihypertensive Therapy after Renal Artery Stenting. Biol Res Nurs 5: 37-46 [Abstract]  
• Dart, R. A., Gregoire, J. R., Gutterman, D. D., Woolf, S. H. (2003). The Association of Hypertension and Secondary Cardiovascular Disease With Sleep-Disordered Breathing. Chest 123: 244-260 [Abstract] [Full Text]  
• Grossman, E., Messerli, F. H., Neutel, J. M. (2000). Angiotensin II Receptor Blockers: Equal or Preferred Substitutes for ACE Inhibitors?. Arch Intern Med 160: 1905-1911 [Full Text]  
• Hollenberg, N. K., Williams, G. H., Anderson, R. (2000). Medical Therapy, Symptoms, and the Distress They Cause: Relation to Quality of Life in Patients With Angina Pectoris and/or Hypertension. Arch Intern Med 160: 1477-1483 [Abstract] [Full Text]  
• Anderson, R. B., Hollenberg, N. K., Williams, G. H. (1999). Physical Symptoms Distress Index: A Sensitive Tool to Evaluate the Impact of Pharmacological Agents on Quality of Life. Arch Intern Med 159: 693-700 [Abstract] [Full Text]  
• Testa, M. A., Simonson, D. C. (1998). Health Economic Benefits and Quality of Life During Improved Glycemic Control in Patients With Type 2 Diabetes Mellitus: A Randomized, Controlled, Double-Blind Trial. JAMA 280: 1490-1496 [Abstract] [Full Text]  
• Pae, W. E. Jr, Anderson, J. M., Blackstone, E. H., Boroevetz, H. S., Ciarkowski, A., Copeland, J. G. III, Costanzo-Nordin, M. R., Daase, K., Dew, M. A., Domanski, M. J., Eidleman, B. H., Evans, R. W., Farrar, D. J., Frazier, O.H., Griffith, B. P., Hahn, C.-J., Hill, J. D., Hunt, S., Kendell, K., Kormos, R. L., Levin, H. R., Mancini, D. M., McCarthy, P. M., McNamara, D., O'Rourke, F. K., Parker, L., Pennington, D. G., Poirier, V. L., Portner, P. M., Rose, E. A., Sapirstein, W., Schron, E., Shanker, R., Subramanian, R., Wallwork, J., Stevenson, L. W., Pennington, D. G., Copeland, J. G. III, Frazier, O. H., Griffith, B. P., Hahn, C.-J., Hill, J. D., Kaiser, L. R., Magovern, G. J., Pae, W. E. Jr, Rose, E. A. (1998). Bethesda conference: conference for the design of clinical trials to study circulatory support devices for chronic heart failure. Ann. Thorac. Surg. 66: 1452-1465 [Full Text]  
• Bulpitt, C J, Fletcher, A E, Dössegger, L, Neiss, A, Nielsen, T, Viergutz, S (1998). Quality of life in chronic heart failure: cilazapril and captopril versus placebo. Heart 79: 593-598 [Abstract] [Full Text]  
• Raiden, S., Giordano, M., Andonegui, G., Trevani, A. S., López, D. H., Nahmod, V., Geffner, J. R. (1997). Losartan, a Selective Inhibitor of Subtype AT1 Receptors for Angiotensin II, Inhibits the Binding of N-Formylmethionyl-leucyl-phenylalanine to Neutrophil Receptors. J. Pharmacol. Exp. Ther. 281: 624-628 [Abstract] [Full Text]  
• Testa, M. A., Simonson, D. C. (1996). Assessment of Quality-of-Life Outcomes. NEJM 334: 835-840 [Full Text]  
• Piette, J., Wachtel, T. J., Mor, V., Mayer, K. (1995). The Impact of Age on the Quality of Life in Persons with HIV Infection. J Aging Health 7: 163-178 [Abstract]  
• Monane, M., Glynn, R. J., Gurwitz, J. H., Bohn, R. L., Levin, R., Avorn, J. (1995). Trends in Medication Choices for Hypertension in the Elderly : The Decline of the Thiazides. Hypertension 25: 1045-1051 [Abstract] [Full Text]  
• Santanello, N. C., Guess, H., Heyse, J. F., Kaplan, N. M., Waud, D. R., Fletcher, A., Ware, J. E., Testa, M. A., Hollenberg, N. K. (1993). Captopril, Enalapril, and Quality of Life. NEJM 329: 505-507 [Full Text]  
• (1993). CAPTOPRIL YIELDS BETTER QUALITY OF LIFE THAN ENALAPRIL. JWatch General 1993: 1-1 [Full Text]  
• Oparil, S. (1993). Antihypertensive Therapy -- Efficacy and Quality of Life. NEJM 328: 959-961 [Full Text]