Antihypertensive pharmacotherapy side effects: Behavioral measurement and quality-of-life issues in clinical trials.

Abstract

Large numbers of hypertensive patients drop out of antihypertensive pharmacotherapy annually, thereby increasing their health risks from elevated blood pressure. Many studies show that adverse side effects (a large number related to behavioral functioning) are pivotal in discouraging patients from continuing with medication regimens. Multidimensional quality-of-life assessment batteries in clinical trials have begun to incorporate objective measures of behavioral functioning in addition to the more typical self-report assessments of symptoms and mood states. This article addresses several experimental design and methodology issues resulting from the use of behavioral assessment procedures in the context of antihypertensive quality-of-life trials, including (a) objective vs. subjective assessments of side effects, (b) time course of side effects after medication onset, (c) practice and placebo effects, and (d) laboratory vs. field assessments. This research aims to aid physicians in selecting optimal treatments among equieffective antihypertensive agents and in assessing the necessary trade-offs between treatment of disease and the creation of new symptoms. Patients in turn can be educated about the extent and duration of likely impairments once they begin treatment.

Biopsychosocial Determinants of Self-Management in Culturally Diverse South African Patients with Essential Hypertension

“…It also confirms the notion, derived from social learning theory, that behaviour is guided by expected outcomes. In this regard, the current results support the findings of Duggin and Tiller (1990), Green and Shellenberger (1991), Kaplan (1990), Shapiro (1996) and Turkkan (1993).…”

“…Non self-management has been attributed to: the asymptomatic nature of EH (Edwards, 1992a); adverse medication effects like electrolyte changes, impotence, dizziness, headaches, diarrhoea, skin disorders and depression (Green & Shellenberger, 1991;Turkkan, 1993); idiosyncratic health beliefs, particularly in multicultural South Africa (Edwards, 1992a); and unsatisfactory doctor-patient communication (Dunbar-Jacob, Dunning, & Dwyer, 1993).…”

Neuroticism, Side Effects, and Health Perceptions Among HIV-Infected Individuals on Antiretroviral Medications

“…The most common side effects from ART are gastro-intestinal problems such as diarrhea, nausea and vomiting, fat redistribution, and dermatological problems such as rashes. Additional "unseen" negative effects that become apparent over time include cardiac and liver problems, and increased triglyceride levels.Research with patients undergoing treatments for a wide range of medical problems strongly links side effects to lower levels of quality of life (QOL) (Arana, 2000;Beisecker et al, 1997;Cameron, Leventhal, & Leventhal, 1993;Carruth & Boss, 1990;Johnson, Stallworth, & Neilands, 2003;Larsen & Gerlach, 1996;McElroy, Keck, & Friedman, 1995;Mohr et al, 1998;Ray-Chaudhuri, Abbott, & Millac, 1991;Richards & Martinson, 1987;Ritsner et al, 2002;Shapiro, Boggs, Rodrigue, & Urry, 1997;Turkkan, 1993). Side effects are often cited when evaluating the impact of ART on the HIV treatment arena (Bates, 1996;Johnson & Gerber, 2000;Volberding, 2003).…”