Skip to main content
SpringerLink
Log in

Effect of Antihypertensive Agents on Quality of Life in the Elderly

  • Review Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Management of hypertension in the elderly should take into account, in particular, the possible negative impact of antihypertensive drugs on the patient’s quality of life, the deterioration of which may result in a loss of independence and reduced treatment compliance. Quality of life is recognised as a multifactorial variable and can be subdivided into different domains (symptomatic well-being, emotional, physical, work-social, cognitive and life satisfaction), which are generally explored by means of specific questionnaires or scales. When evaluating elderly patients with hypertension, it is necessary to pay particular attention to specific domains such as symptomatic well-being, cognitive function, activity and sexual function, which have already been diminished by the age itself and the disease. The results of some large trials that specifically evaluated the quality of life effects of long-term therapy of hypertension in older people (Medical Research Council’s [MRC] Trial of Hypertension in Older Adults, Systolic Hypertension in the Elderly Program [SHEP], Systolic Hypertension in Europe [Syst-Eur], Study on COgnition and Prognosis in the Elderly [SCOPE]) have shown that antihypertensive treatment as a whole either had no negative impact on quality of life, or even produced some improvement. The question whether some classes of antihypertensive agents are more beneficial or harmful than others in terms of quality-of-life effects remains largely unanswered.

Results from long-term trials suggest that treatment with diuretics is not associated with adverse effects on quality of life. Nevertheless, chlortalidone and other diuretics have been more often associated with sexual dysfunction in men, including decreased libido, erectile dysfunction and difficult ejaculation, than other drug classes. Nonselective lipophilic β-adrenoceptor antagonists, such as propranolol, have been reported to exert some negative effect on quality of life and have been associated with depression, impairment of memory function and adverse effects such as erectile problems. A less unfavourable impact has been described with β1-adrenoceptor antagonists and those with vasodilating properties. Calcium channel antagonists have generally been associated with a positive effect on quality of life, although some trials have shown high rates of adverse effects and withdrawals, particularly with first-generation dihydropyridines. Concern has also been raised about the potential for adverse cognitive effects associated with the use of calcium channel antagonists, but studies on this topic are not univocal. ACE inhibitors have usually been reported to exert favourable effects on quality of life. These drugs seem to be effective in maintaining, or even improving, cognitive function through mechanisms other than blood pressure control. In addition, a number of studies reported favourable impact of ACE inhibitors on sexual function. Angiotensin II receptor antagonists have been associated with good tolerability and low withdrawal rate. They have been demonstrated not to interfere with or even improve cognitive function as well as sexual performance.

Although no class of antihypertensive agents presents a clearly superior effect over the others in terms of quality of life, the current impression is that ACE inhibitors and angiotensin II receptor antagonists may offer some advantage, at least in regard to effects on cognitive function and sexual activity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Table III

Similar content being viewed by others

References

  1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause, 1990–2020: Global Burden of Disease Study. Lancet 1997; 349: 1498–504

    Article  PubMed  CAS  Google Scholar 

  2. Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population: results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension 1995; 25: 305–13

    Article  PubMed  CAS  Google Scholar 

  3. Chobanian AV, Bakris GL, Black HR. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (the JNC VII report). JAMA 2003; 289: 2560–72

    Article  PubMed  CAS  Google Scholar 

  4. Kannel WB, Gordon T. Evaluation of cardiovascular risk in the elderly: the Framingham Study. Bull NY Acad Med 1978; 54: 573–91

    CAS  Google Scholar 

  5. Kannel WB. Fifty years of Framingham Study contribution to understanding hypertension. J Hum Hypertens 2000; 14: 83–90

    Article  PubMed  CAS  Google Scholar 

  6. Kannel WB. Elevated systolic blood pressure as a cardiovascular risk factor. Am J Cardiol 2000; 15: 251–5

    Article  Google Scholar 

  7. Fletcher AE, Bulpitt CJ. Quality of life and antihypertensive drugs in the elderly. Aging 1992; 4: 115–23

    PubMed  CAS  Google Scholar 

  8. Curb JD, Borhani NO, Blaszkowski TP, et al. Long-term surveillance for adverse effects of antihypertensive drugs. JAMA 1985; 253: 3263–8

    Article  PubMed  CAS  Google Scholar 

  9. Dusing R, Weisser B, Mengden T, et al. Changes in antihypertensive therapy: the role of adverse events and compliance. Blood Press 1998; 7: 313–5

    Article  PubMed  CAS  Google Scholar 

  10. Ambrosioni E, Leonetti G, Pessina AC, et al. Patterns of hypertension management in Italy: results of a pharmacoepidemiological survey on antihypertensive therapy. J Hypertens 2000; 18: 1691–9

    Article  PubMed  CAS  Google Scholar 

  11. Cohen JS. Adverse drug effects, compliance and initial doses of antihypertensive drugs recommended by the Joint National Committee vs the Physicians’ Desk Reference. Arch Intern Med 2001; 161: 880–5

    Article  PubMed  CAS  Google Scholar 

  12. Bergner M. Measurement of health status. Med Care 1985; 23: 696–704

    Article  PubMed  CAS  Google Scholar 

  13. World Health Organization. Constitution in basic documents. Geneva: World Health Organization, 1948

    Google Scholar 

  14. Caiman KC. Quality of life in cancer patients: an hypothesis. J Med Ethics 1984; 10: 124–7

    Article  Google Scholar 

  15. Patrick DL, Erickson P. Assessing health-related quality of life in general population surveys: series 2. Report from the National Center for Health Statistics. Hyattsville (MD): National Center for Health Statistics, 1988

    Google Scholar 

  16. James MA, Potter JF. The effect of antihypertensive treatment on the quality of life of later years. Drug Ther 1993; 1: 26–39

    Google Scholar 

  17. Kitler ME. Elderly hypertensives and quality of life: some methodological considerations. Eur Heart J 1993; 14: 113–21

    Article  PubMed  CAS  Google Scholar 

  18. Bulpitt CJ, Fletcher AE. The measurement of quality of life in hypertensive patients: a practical approach. Br J Clin Pharmacol 1990; 30: 353–64

    Article  PubMed  CAS  Google Scholar 

  19. Leonetti G, Comerio G, Cuspidi C. Evaluating quality of life in hypertensive patients. J Cardiovasc Pharmacol 1994; 23Suppl. 5: S54–8

    Article  PubMed  CAS  Google Scholar 

  20. Bulpitt CJ, Dollery CT, Carne S. A symptom questionnaire for hypertensive patients. J Chronic Dis 1974; 27: 309–23

    Article  PubMed  CAS  Google Scholar 

  21. Hsueh WA. Sexual dysfunction with aging and systemic hypertension. Am J Cardiol 1988; 61: 18–23H

    Article  Google Scholar 

  22. Jaffe A, Chen Y, Kisch ES, et al. Erectile dysfunction in hypertensive subjects: assessment of potential determinants. Hypertension 1996; 28: 859–62

    Article  PubMed  CAS  Google Scholar 

  23. Rosen RC, Kostis JB, Jekelis A, et al. Sexual sequelae of antihypertensive drugs: treatment effects on self-report and physiological measures in middle-aged male hypertensives. Arch Sex Behav 1994; 23: 135–52

    Article  PubMed  CAS  Google Scholar 

  24. Kochar M, Mazur LI, Patel A. Sexual dysfunction: uncovering a connection with hypertension and antihypertensive therapy. Postgrad Med 1999; 106: 149–57

    PubMed  CAS  Google Scholar 

  25. Fogari R, Zoppi A. Effects of antihypertensive therapy on sexual activity in hypertensive men. Curr Hypertens Rep 2002; 4: 202–10

    Article  PubMed  Google Scholar 

  26. Degl’Innocenti A, Elmfeldt D, Hansson L, et al. Cognitive function and health-related quality of life in elderly patients with hypertension: baseline data from the Study on COgnition and Prognosis in the Elderly (SCOPE). Blood Press 2002; 11: 157–65

    Article  PubMed  Google Scholar 

  27. Meyer JS, McClintic KL, Rogers RL, et al. Aetiological considerations and risk factors for multi-infarct dementia. J Neurol Neurosurg Psychiatry 1988; 51: 1489–97

    Article  PubMed  CAS  Google Scholar 

  28. Kilander L, Nyman H, Boberg M, et al. Hypertension is related to cognitive impairment: a 20-year follow-up of 999 men. Hypertension 1998; 31: 780–6

    Article  PubMed  CAS  Google Scholar 

  29. Harrington F, Saxby BK, McKeith IG, et al. Cognitive performance in hypertensive and normotensive older subjects. Hypertension 2000; 36: 1079–82

    Article  PubMed  CAS  Google Scholar 

  30. Starr JM, Whalley LJ. Senile hypertension and cognitive impairment: an overview. J Hypertens Suppl 1992; 10(2): S31–42

    PubMed  CAS  Google Scholar 

  31. Schipper H. Guidelines and caveats for quality of life measurement in clinical practice and research. Oncology 1990; 4: 51–7

    PubMed  CAS  Google Scholar 

  32. Bulpitt CJ, Fletcher AE. Antihypertensive drugs and quality of life in the elderly. J Cardiovasc Pharmacol 1989; 14Suppl. 10: S21–6

    PubMed  Google Scholar 

  33. Jachuck SJ, Brierley H, Jachuck S, et al. The effect of hypotensive drugs on the quality of life. J R Coll Gen Pract 1982; 32: 103–5

    PubMed  CAS  Google Scholar 

  34. Testa MA, Hollenberg NK, Anderson RB, et al. Assessment of quality of life by patient and spouse during antihypertensive therapy with atenolol and nifedipine gastrointestinal therapeutic system. Am J Hypertens 1991; 4: 363–73

    PubMed  CAS  Google Scholar 

  35. Hollenberg NK, Testa M, Williams GH. Quality of life as therapeutic end-point: an analysis of therapeutic trials in hypertension. Drug Saf 1991; 6: 83–93

    Article  PubMed  CAS  Google Scholar 

  36. Prisant LM, Moser M. hypertension in the elderly: can we improve results of therapy? Arch Intern Med 2000; 160: 283–9

    Article  PubMed  CAS  Google Scholar 

  37. Staessen JA, Gasowski J, Wang JG, et al. Risks of untreated and treated isolated systolic hypertension in the elderly: a meta-analysis of outcome trials. Lancet 2000; 355: 865–72

    Article  PubMed  CAS  Google Scholar 

  38. Moser M, Cheitlin MD, Gifford R. Treatment of high blood pressure: a position paper from the Society of Geriatric Cardiology. Am J Geriatr Cardiol 1998; 7: 41–2

    PubMed  Google Scholar 

  39. Bulpitt CJ. Controlling hypertension in the elderly. Q J Med 2000; 93: 203–5

    Article  CAS  Google Scholar 

  40. Whelton PK, Appel LJ, Espeland MA, et al., for the TONE Collaborative Research Group. Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled Trial of Nonpharmacologic Interventions in the Elderly (TONE). JAMA 1998; 279: 839–46

    Article  PubMed  CAS  Google Scholar 

  41. Prince MJ, Bird AS, Blizard RA, et al. Is the cognitive function of older patients affected by antihypertensive treatment: results for 54 months of the MRC’s trial of hypertension in older adults. BMJ 1996; 312: 801–5

    Article  PubMed  CAS  Google Scholar 

  42. Inglis A. A paired-associated learning test for use with elderly psychiatric patients. J Mental Sci 1959; 105: 440–3

    CAS  Google Scholar 

  43. Reitan RM. Validity of the trail making test as an indicator of organic brain damage. Percept Mot Skills 1958; 8: 271–6

    Google Scholar 

  44. Waldstein SR, Ryan CM, Manuck SB. Learning and memory function in men with untreated blood pressure elevation. J Consult Clin Psychol 1991; 59: 513–7

    Article  PubMed  CAS  Google Scholar 

  45. SHEP Cooperative Research Group. Prevention of stroke by hypertensive drug therapy in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265: 3255–64

    Article  Google Scholar 

  46. Applegate WB, Pressel S, Wittes J, et al. Impact of the treatment of isolated systolic hypertension on behavioral variables: results from the systolic hypertension in the elderly program. Arch Intern Med 1994; 154: 2154–60

    Article  PubMed  CAS  Google Scholar 

  47. Applegate WB. Quality of life during antihypertensive treatment: lessons from the systolic hypertension in the elderly program. Am J Hypertens 1998; 11: 57–61S

    Article  Google Scholar 

  48. Staessen JA, Fagard R, Thijs L, et al., on behalf of the Syst-Eur Investigators. Morbidity and mortality in the European Trial of isolated systolic hypertension in the elderly. Lancet 1997; 350: 757–64

    Article  PubMed  CAS  Google Scholar 

  49. Fletcher AE, Bulpitt CJ, Thijs L, et al. Quality of life on randomized treatment for isolated systolic hypertension: results from the Syst-Eur Trial. J Hypertens 2002; 20: 2069–79

    Article  PubMed  CAS  Google Scholar 

  50. Adshead F, Cody DD, Pitt B. BASDEC: a novel screening instrument for depression in elderly medical in-patients [letter]. BMJ 1992; 305: 397

    Article  PubMed  CAS  Google Scholar 

  51. Bergner M, Bobbit RA, Carter WB, et al. The sickness impact profile: development and final revision of a health status measurement. Med Care 1981; 19: 787–805

    Article  PubMed  CAS  Google Scholar 

  52. Bulpitt CJ, Beckett NS, Fletcher AE, et al., for the Syst-Eur Investigators. Withdrawal from treatment in the Syst-Eur Trial. J Hypertens 2002; 20: 339–46

    Article  PubMed  CAS  Google Scholar 

  53. Forette F, Seux ML, Staessen JA, et al. Prevention of dementia in randomized double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 1998; 352: 1347–51

    Article  PubMed  CAS  Google Scholar 

  54. Lithell H, Hansson L, Skoog I, et al. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens 2003; 21: 875–86

    Article  PubMed  CAS  Google Scholar 

  55. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive status of patients for the clinician. J Psychiatr Res 1975; 12: 189–98

    Article  PubMed  CAS  Google Scholar 

  56. Tombaug TH, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 1992; 40: 922–35

    Google Scholar 

  57. Dupuy HJ. The Psychological General Weil-Being (PGWB) index. In: Wenger NK, Mattson ME, Furberg CF, et al., editors. Assessment of quality of life in clinical trials of cardiovascular therapies. New York: Le Jacq, 1984: 170–83

    Google Scholar 

  58. Dimenas E, Dahlof C, Olofsson B, et al. An instrument for quantifying subjective symptoms among untreated and treated hypertensives: development and documentation. J Clin Res Pharmacoepidemiol 1990; 4: 205–17

    Google Scholar 

  59. Dolan P. Modeling valuations for EuroQol health states. Med Care 1997; 35: 1095–108

    Article  PubMed  CAS  Google Scholar 

  60. Guidelines subcommittee of the World Health Organization-International Society of Hypertension (WHO-ISH) Mild Hypertension Liaison Committee. 1999 WHO-ISH guidelines for the management of hypertension. J Hypertens 1999; 17: 151–83

    Google Scholar 

  61. Fletcher A. Quality of life in the management of hypertension. Clin Exp Hypertens 1999; 21: 961–72

    Article  PubMed  CAS  Google Scholar 

  62. Amery A, Birkenhaeger WH, Bulpitt CJ, et al. The European Working Party on high blood pressure in the elderly. Am J Med 1991; 90Suppl. 3A: 1–70S

    Article  Google Scholar 

  63. Ogihara T, Kuramoto K. Effect of long-term treatment with antihypertensive drugs on quality of life of elderly patients with hypertension: a double-blind comparative study of a calcium-antagonist and a diuretic. National Intervention Cooperative Study in Elderly Hypertensive (NICS-EH) Study Group. Hypertens Res 2000; 23: 33–7

    Article  PubMed  CAS  Google Scholar 

  64. Report of Medical Research Council Working Party on Mild to Moderate Hypertension. Adverse reaction to bendrofluazide and propranolol for the treatment of mild hypertension. Lancet 1981; II: 539–43

    Google Scholar 

  65. Wassertheil-Smoler S, Blaufox MD, Oberman A, et al. Effect of antihypertensives on sexual function and quality of life: the TAIM study. Ann Intern Med 1991; 114: 613–20

    Google Scholar 

  66. Grimm R, Grandits GA, Prineas RJ, et al., for the TOMHS Research Group. Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women: Treatment of Mild Hypertension Study (THOMS). Hypertension 1997; 29: 8–14

    Article  PubMed  CAS  Google Scholar 

  67. Messerli FH, Grossman E, Goldbourt U. Are beta-blockers efficacious as first-line therapy for hypertension in the elderly: a systematic review. JAMA 1998; 279: 1903–7

    Article  PubMed  CAS  Google Scholar 

  68. Solomon S, Hotchkiss E, Saraway S, et al. Impairment of memory function by antihypertensive medication. Arch Gen Psychiatry 1983; 40: 1109–12

    Article  PubMed  CAS  Google Scholar 

  69. Ghoneim MM, Hinrichs JV, Noyes R, et al. Behavioral effects of diazepam and propranolol in patients with panic disorder and agoraphobia. Neuropsychobiology 1984; 11: 229–35

    Article  PubMed  CAS  Google Scholar 

  70. Richardson PJ, Wyke MA. Memory function: effects of different antihypertensive drugs. Drugs 1988; 35: 80–5

    Article  PubMed  Google Scholar 

  71. Desai N, Taylor-Davies A, Barnett DB. The effects of diazepam and oxprenolol on short-term memory in individuals of high and low state of anxiety. Br J Clin Pharmacol 1983; 15: 197–202

    Article  PubMed  CAS  Google Scholar 

  72. Perez-Stable E, Halliday R, Gardiner P, et al. The effects of propranolol on cognitive function and quality of life: a randomized trial among patients with diastolic hypertension. Am J Med 2000; 108: 359–65

    Article  PubMed  CAS  Google Scholar 

  73. Fogari R, Mugellini A, Zoppi A, et al. Influence of losartan and atenolol on cognitive function in very elderly hypertensive patients. J Hum Hypertens 2003; 17(11): 781–5

    Article  PubMed  CAS  Google Scholar 

  74. Palac DM, Cornish R, McDonald W, et al. Cognitive function in hypertensives treated with atenolol or propranolol. J Gen Intern Med 1990; 5: 310–8

    Article  PubMed  CAS  Google Scholar 

  75. Schulz Jr NR, Elias MF, Robbins MA, et al. A longitudinal study of the performance of hypertensive and normotensive subjects of the Wechsler Adult Intelligence Scale. Psychol Ageing 1989; 4: 496–9

    Article  Google Scholar 

  76. Goldstein G, Materson BJ, Cushman WC, et al. Treatment of hypertension in the elderly (II): cognitive and behavioral function. Hypertension 1990; 15: 361–9

    Article  PubMed  CAS  Google Scholar 

  77. McAinsh J, Cruickshanck JM. Beta-blockers and central nervous system side-effects. Pharmacol Ther 1990; 4: 163–97

    Article  Google Scholar 

  78. Thiessen BQ, Wallace SM, Blackburn JL, et al. Increased prescribing of antidepressants subsequent to beta-blocker therapy. Arch Intern Med 1990; 150: 2286–90

    Article  PubMed  CAS  Google Scholar 

  79. Bulpitt CJ, Connor M, Schulte M, et al., on behalf of the European Bisoprolol Trial Investigators. Bisoprolol and nifedipine retard in elderly hypertensive patients: effect on quality of life. J Hum Hypertens 2000; 14: 205–12

    Article  PubMed  CAS  Google Scholar 

  80. Bulpitt CJ, Fletcher AE. Quality of life evaluation of antihypertensive drugs. Pharmacoeconomics 1992; 2: 95–102

    Article  Google Scholar 

  81. Croog SH, Levine S, Sudilovsky A, et al. Sexual symptoms in hypertensive patients: a clinical trial of antihypertensive medications. Arch Intern Med 1998; 148: 788–94

    Article  Google Scholar 

  82. Veterans Administration Cooperative Study Group on Antihypertensive Agents. Propranolol in the treatment of essential hypertension. JAMA 1977; 88: 716–7

    Google Scholar 

  83. Bauer GE, Baker J, Hunyor SN, et al. Side-effects of antihypertensive treatment: a placebo-controlled study. Clin Sci Mol Med Suppl 1978; 4: 341–4

    Google Scholar 

  84. Suzuki H, Tominaga T, Kumagai H, et al. Effects of first-line antihypertensive agents on sexual function and sex hormones. J Hypertens 1988; 6: S649–51

    Article  CAS  Google Scholar 

  85. Fogari R, Zoppi A, Corradi L, et al. Sexual function in hypertensive males treated with lisinopril or atenolol: a cross-over study. Am J Hypertens 1998; 11: 1244–7

    Article  PubMed  CAS  Google Scholar 

  86. Fogari R, Zoppi A, Poletti L, et al. Sexual activity in hypertensive men treated with valsartan or carvedilol: a cross-over study. Am J Hypertens 2001; 14: 27–31

    Article  PubMed  CAS  Google Scholar 

  87. Fogari R, Preti P, Derosa G, et al. Effect of antihypertensive treatment with valsartan or atenolol on sexual activity and plasma testosterone in hypertensive men. Eur J Clin Pharmacol 2002; 58: 177–80

    Article  PubMed  CAS  Google Scholar 

  88. Palmer A, Fletcher A, Hamilton G, et al. A comparison of verapamil and nifedipine on quality of life. Br J Clin Pharmacol 1990; 30: 365–70

    Article  PubMed  CAS  Google Scholar 

  89. Fletcher AE. Quality of life on antihypertensive therapy: a double-blind trial comparing quality of life on pinacidil and nifedipine in combination with a thiazide diuretic. J Cardiovasc Pharmacol 1992; 20: 108–14

    PubMed  CAS  Google Scholar 

  90. Maxwell CJ, Hogan DB, Erby EM. Calcium channel blockers and cognitive function in elderly people. CMAJ 1999; 161: 501–6

    PubMed  CAS  Google Scholar 

  91. Heckbert SR. The association of antihypertensive agents with MRI white matter findings and with modified mini-mental state examination in older adults. J Am Geriatr Soc 1997; 45: 1423–33

    PubMed  CAS  Google Scholar 

  92. Fletcher AE. Quality of life with three antihypertensive treatments cilazapril, atenolol, nifedipine. Hypertension 1992; 19: 499–507

    Article  PubMed  CAS  Google Scholar 

  93. Anderson RB, Hollenberg NK, Williams GH. Physical symptoms distress index: a sensitive tool to evaluate the impact of pharmacologic agents on quality of life. Arch Intern Med 1999; 159: 693–700

    Article  PubMed  CAS  Google Scholar 

  94. Testa MA, Turner RR, Simonson DC, et al., and the Nifedipine GITS Study Group. Quality of life and calcium channel blockade with nifedipine GITS versus amlodipine in hypertensive patients in Spain. J Hypertens 1998; 16: 1938–47

    Article  Google Scholar 

  95. Pessina AC, Boari L, De Dominicis E, et al. Efficacy, tolerability and influence on “quality of life” of nifedipine GITS versus amlodipine in elderly patients with mild-moderate hypertension. Blood Press 2001; 10: 176–83

    Article  PubMed  CAS  Google Scholar 

  96. Leonetti G, Magnani B, Pessina AC, et al., on behalf of the COHORT Study Group. Tolerability of long-term treatment with lercanidipine versus amlodipine and lacidipine in elderly hypertensives. Am J Hypertens 2002; 15: 932–40

    Article  PubMed  CAS  Google Scholar 

  97. Amery A, Wasir H, Bulpitt C, et al. Aging and the cardiovascular system. Acta Cardiol 1978; 33: 443–67

    PubMed  CAS  Google Scholar 

  98. Israili ZH, Hall WD. ACE-inhibitors: differential use in elderly patients with hypertension. Drugs Aging 1995; 7: 355–71

    Article  PubMed  CAS  Google Scholar 

  99. Croog SH, Levine S, Testa MA, et al. The effects of antihypertensive therapy on the quality of life. N Engl J Med 1986; 314: 1657–64

    Article  PubMed  CAS  Google Scholar 

  100. Fletcher AF, Bulpitt CJ, Hawkins CM, et al. Quality of life of antihypertensive therapy: a randomised double-blind controlled trial of captopril and atenolol. J Hypertens 1990; 8: 463–6

    Article  PubMed  CAS  Google Scholar 

  101. Steiner SS, Friedhoff AJ, Wilson BL, et al. Antihypertensive therapy and quality of life: a comparison of atenolol, captopril, enalapril and propranolol. J Hum Hypertens 1990; 4: 217–25

    PubMed  CAS  Google Scholar 

  102. Palmer AJ, Fletcher AE, Rudge PJ, et al. Quality of life in hypertensives treated with atenolol and captopril: a doubleblind, cross-over trial. J Hypertens 1992; 10: 1409–16

    Article  PubMed  CAS  Google Scholar 

  103. Leonetti G, Comerio G, Cusfioli C, et al. Evaluating quality of life in hypertensive patients. J Cardiovasc Pharmacol 1994; 23Suppl. 5: S54–8

    Article  PubMed  CAS  Google Scholar 

  104. Starr JM, Whalley LJ. ACE-inhibitors: central actions. New York: Raven Press, 1994

    Google Scholar 

  105. Barnes JM, Barnes NM, Costall B, et al. ACE-inhibition and cognition. In: McGregor GA, Sever PS, editors. Current advances in ACE-inhibition. London: Churchill-Livingstone, 1989: 159–71

    Google Scholar 

  106. Allen AM, Moeller I, Jenkins TA, et al. Angiotensin receptors in the nervous system. Brain Res Bull 1998; 47: 17–28

    Article  PubMed  CAS  Google Scholar 

  107. Gard PR. The role of angiotensin II in cognition and behaviour. Eur J Pharmacol 2002; 438: 1–14

    Article  PubMed  CAS  Google Scholar 

  108. Costall B, Coughlan J, Horovitz ZP, et al. The effects of ACE-inhibitor captopril and SQ29,852 in rodent tests of cognition. Pharmacol Biochem Behav 1989; 33: 573–9

    Article  PubMed  CAS  Google Scholar 

  109. Mondadori C, Etienne P. Nootropic effects of ACE-inhibitors in mice. Psychopharmacology (Berl) 1990; 100: 301–7

    Article  CAS  Google Scholar 

  110. Raghavendra V, Chopra K, Kulkarni SK. Comparative studies on the memory enhancing actions of captopril and losartan in mice using inhibitory shock avoidance paradigm. Neuropeptides 2001; 35: 65–9

    Article  PubMed  CAS  Google Scholar 

  111. Dietrich B, Herrmann WM. Influence of cilazapril on memory functions and sleep behaviour in comparison with metoprolol and placebo in healthy subjects. Br J Clin Pharmacol 1989;27: 249–61S

    Article  Google Scholar 

  112. Starr JM, Whalley LJ, Deary IJ. The effects of antihypertensive treatment on cognitive function: results from the HOPE study. J Am Geriatr Soc 1996; 44: 411–5

    PubMed  CAS  Google Scholar 

  113. Ebert U, Kirch W. Effects of captopril and enalapril on electroencephalogram and cognitive performance in healthy volunteers. Eur J Clin Pharmacol 1999; 55: 255–7

    Article  PubMed  CAS  Google Scholar 

  114. PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood pressure lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet 2001; 358: 1033–41

    Article  Google Scholar 

  115. Ruddy MC, Kostis JB. Angiotensin II receptor antagonists. In: Oparil S, Weber MA, editors. Hypertension: a companion to Brenner and Rector’s The Kidney. Philadelphia (PA); WB Saunders Company, 2000: 621–37

    Google Scholar 

  116. Llisterri JL, Lozano Vidal JV, Aznar Vicente J, et al. Sexual dysfunction in hypertensive patients treated with losartan. Am J Med Sci 2001; 321: 336–41

    Article  PubMed  CAS  Google Scholar 

  117. Barnes JM, Champaneria S, Costall B, et al. Cognitive enhancing actions of DuP 753 detected in a mouse habituation paradigm. Neuroreport 1990; 1: 239–42

    Article  PubMed  CAS  Google Scholar 

  118. Raghavendra V, Chopra K, Kulkarni SK. Involvement of cholinergic system in losartan induced facilitation of spatial and short-term working memory. Neuropeptides 1998; 32: 417–21

    Article  PubMed  CAS  Google Scholar 

  119. Tedesco MA, Ratti G, Mennella S, et al. Comparison of losartan and hydrochlorothiazide on cognitive function and quality of life in hypertensive patients. Am J Hypertens 1999; 12: 1130–4

    Article  PubMed  CAS  Google Scholar 

  120. Fogari R, Mugellini A, Zoppi A, et al. Effects of valsartan compared with enalapril on blood pressure and cognitive function in elderly patients with essential hypertension. Eur J Clin Pharmacol 2004; 59: 863–8

    Article  PubMed  CAS  Google Scholar 

  121. Morris JC, Heyman A, Mohs RC, et al. The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) [Pt 1]: clinical and neuropsychological assessment of Alzheimer’s disease. Neurology 1989; 39: 1159–65

    Article  PubMed  CAS  Google Scholar 

  122. Okuyama S, Sakagawa T, Inagami T. Role of the angiotensin II type 2 receptor in the mouse central nervous system. Jpn J Pharmacol 1999; 81: 259–63

    Article  PubMed  CAS  Google Scholar 

  123. Wright JW, Stubley LA, Pederson ES, et al. Contributions of the brain Ang IV-AT4 receptors subtype system to spatial learning. J Neurosci 1999; 19: 3959–61

    Google Scholar 

  124. Pederson ES, Krishnan R, Harding JW, et al. A role for the angiotensin AT4 receptor subtype in overcoming scopolamine induced spatial memory deficits. Regul Pept 2001; 102: 147–56

    Article  PubMed  CAS  Google Scholar 

  125. Hansson L, Lithell H, Skoog I, et al. Study on Cognition and Prognosis in the Elderly (SCOPE). Blood Press 1999; 8: 177–83

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

  1. Department of Internal Medicine and Therapeutics, Clinica Medica II, IRCCS Policlinico S. Matteo, University of Pavia, Piazza Golgi 2, 27100, Pavia, Italy

    Roberto Fogari & Annalisa Zoppi

Authors
  1. Roberto Fogari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Annalisa Zoppi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roberto Fogari.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fogari, R., Zoppi, A. Effect of Antihypertensive Agents on Quality of Life in the Elderly. Drugs Aging 21, 377–393 (2004). https://doi.org/10.2165/00002512-200421060-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-200421060-00003

Keywords

Search

Navigation