European Journal of Clinical Pharmacology

, Volume 41, Issue 5, pp 397–400 | Cite as

The effects of two centrally-acting anti-hypertensive drugs on the quality of life

  • A. E. Fletcher
  • D. G. Beevers
  • C. T. Dollery
  • R. Wilkinson
  • C. J. Bulpitt


The objectives of this study were to compare the effects of two centrally-acting antihypertensive drugs on measures of quality of life in a three-month double-blind trial of hypertensive patients randomized to methyldopa (n=79) or rilmenidine (n=78).

We studied men and women aged over 21 y attending eight hospital out-patient clinics in the United Kingdom. They had average diastolic blood pressures between 95 and 110 mm Hg and systolic pressures below 210 mm Hg after a 4-week placebo run-in period. The doses ranged from 1 to 2 mg daily of rilmenidine and 500 mg to 1 g of methyldopa. Hydrochlorothiazide (25 mg daily) was added after 8 weeks when the diastolic blood pressure remained at 90 mm Hg or more in 29% of patients on rilmenidine and 35% of those on methyldopa. Quality of life was assessed from self-completed questionnaires using standardized instruments.

Both drugs reduced blood pressure, but at the end of the trial the fall in the methyldopa group (19.3/13.0 mm Hg) was significantly greater than in the rilmenidine group (13.2/10.0 mm Hg). Ten patients in the methyldopa group withdrew from the trial compared with three in the rilmenidine group, primarily because of adverse effects. In both groups there was a significant increase in the overall reporting of adverse effects. Reports of dry mouth increased on both drugs, and sleepiness on rilmenidine but not methyldopa. There was no significant difference between the drugs in the overall reporting of adverse effects or of individual adverse effects.

Psychological well-being tended to improve on rilmenidine, but was adversely affected by methyldopa, with increases in reports of depression and cognitive impairment. However, at the end of the trial there were no significant differences in overall psychological well-being between the two groups.

Key words

Antihypertensive therapy Quality of life centrally-acting drugs clinical trials adverse effects 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Benraad AH, Schoenaker AH (1985) Thrombopenia after use of methyldopa. Lancet II: 292Google Scholar
  2. Bird AS, Blizard RA, Mann AH (1990) Treating hypertension in the older person: an evaluation of the association of blood pressure level and its reduction with cognitive performance. J Hypertens 8: 147–152Google Scholar
  3. Bulpitt CJ, Dollery CT (1973) Side effects of hypotensive agents evaluated by a self administered questionnaire. Br Med J 3: 485–490Google Scholar
  4. Bulpitt CJ, Dollery CT, Carne S (1974) A symptom questionnaire for hypertensive patients. J Chron Dis 27: 309–323Google Scholar
  5. Bulpitt CJ, Fletcher AE (1985) Quality of life in hypertensive patients on different antihypertensive treatments: rationale for methods employed in a multicenter randomized controlled trial. J Cardiovasc Pharmacol 7: S137-S145Google Scholar
  6. Bulpitt CJ, Fletcher AE (1988) Effect of treatment on the quality of life in hypertension and congestive heart failure. Cardiology 75 [Suppl 1]: 53–60Google Scholar
  7. Bulpitt CJ, Fletcher AE (1990) The measurement of quality of life in hypertensive patients: a practical approach. Br J Clin Pharmacol 30: 353–64Google Scholar
  8. Bulpitt CJ, Hoffbrand BI, Dollery CT (1979) Contribution of drug treatment to symptoms of hypertensive patients. In: Mild Hypertension: Natural History and Management. F Gross, Strasser T (eds). Pitman Medical, Tunbridge Wells, pp 291–302Google Scholar
  9. Croog SH, Levine S, Testa M, Brown B, Bulpitt CJ, Jenkins CD, Klerman GK, Williams GH (1986) The effects of antihypertensive therapy on quality of life. N Engl J Med 314: 1657–1664Google Scholar
  10. Dollery CT, Davies DS, Duchier J, Pannier B, Safar M (1988) Dose and concentration effect relations for rilmenidine. Am J Cardiol 61: 60D-66DGoogle Scholar
  11. Fanshel S, Bush JW (1970) A health status index and its application to health services outcomes. Operat Res 18: 1021–1026Google Scholar
  12. Farmer ME, White LR, Abbott RD, Kittner SJ, Kaplan E, Wolz MM, Brody JA, Wolf PA (1987) Blood pressure and cognitive performance. The Framingham study. Am J Epidemiol 126: 1103–14Google Scholar
  13. Fletcher AE, Chester PC, Hawkins CMA, Latham AN, Pike LA, Bulpitt CJ (1989) The effects of verapamil and propranolol on quality of life in hypertension. J Hum Hypertens 3: 125–130Google Scholar
  14. Fletcher AE, Amery A, Birkenhäger W, Bulpitt C, Clement D, de Leeuw P, Deruyterre ML, de Schaepdryver A, Dollery C, Fagard R, Forette F, Forte J, Henry JF, Koistinen A, Leonetti G, Lund-Johansen P, Nissinen A, O'Brien E, O'Malley K, Pelemans W, Petrie JC, Staessen J, Terzoli L, Thys L, Tuomilehto J, Webster J, Williams BO (1991) Risks and benefits in the European Working Party on High Blood Pressure in the Elderly Trial. J Hypertens 9: 225–230Google Scholar
  15. Goldstein G, Materson BJ, Cushman WC, Reda DJ, Freis ED, Ramirez EA, Talmers FN, White TJ, Nunn S, Chapman RH, Khatri I, Schnaper H, Thomas JR, Henderson WG, Fye C (1990) Treatment of hypertension in the elderly: II. Cognitive and behavioral function. Results of a Department of Veterans Affairs Cooperative Study. Hypertension 15: 361–369Google Scholar
  16. Hogan MJ, Wallin JD, Baer RM (1981) Antihypertensive therapy and male sexual dysfunction. Psychosomatics 21: 234–237Google Scholar
  17. Husserl FE, Messerli FH (1981) Adverse effects of antihypertensive drugs. Drugs 22: 188–210Google Scholar
  18. Kellner R, Sheffield BF (1973) A self rating scale of distress. Psychol Med 3: 88–100Google Scholar
  19. Potash ALC, Black HR, Gold MS (1981) Psychiatric complications of antihypertensive medications. J Nerv Ment Dis 169: 430–438Google Scholar
  20. Schultz NR, Dineen JT, Elias MR, Pentz CA, Wood WG (1979) WAIS performance for different age groups of hypertensive and control subjects during administration of a diuretic. J Gerontol 34: 246Google Scholar
  21. Solomon S, Hotchkiss E, Saravay SM, Bayer C, Ramsey P, Blum RS (1983) Impairment of memory function by antihypertensive medication. Arch Gen Psych 40: 1109–1112Google Scholar
  22. UK Working Party on Rilmenidine (1990). Rilmenidine in mild to moderate hypertension. Curr Ther Res 47: 194–211Google Scholar
  23. Worrledge SM (1966) Autoimmune haemolytic anaemia associated with methyldopa therapy. Lancet II: 135–139Google Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • A. E. Fletcher
    • 1
  • D. G. Beevers
    • 2
  • C. T. Dollery
    • 1
  • R. Wilkinson
    • 3
  • C. J. Bulpitt
    • 1
  1. 1.Department of Medicine, Royal Postgraduate Medical SchoolHammersmith HospitalLondonUK
  2. 2.Department of MedicineDudley Road HospitalBirminghamUK
  3. 3.Department of MedicineFreeman HospitalNewcastle upon TyneUK

Personalised recommendations