The effect of treatment on health-related quality of life in patients with hypertension and renal artery stenosis

Abstract

The quality of life in patients with hypertension is considered to be impaired mainly by side effects of antihypertensive drug therapy. Since balloon angioplasty for renal artery stenosis has a medication-sparing effect, it may lead to an improvement in quality of life. The objective of the study is to compare the effect of antihypertensive drug therapy and balloon angioplasty on quality of life in patients with hypertension and renal artery stenosis. We compared the quality of life in 56 patients randomised to balloon angioplasty to that in 50 patients randomised to antihypertensive drug therapy after 3 and 12 months of follow-up. Quality of life was measured using a questionnaire on physical symptoms associated with hypertension and antihypertensive drugs, and two generic health questionnaires (MOS Survey and EuroQol instrument). After follow-up, the patients who underwent angioplasty used less antihypertensive drugs than the patients who were treated with antihypertensive drugs only (mean7s.d., 1.970.9 vs 2.571.0 drugs after 3 months, P ¼ 0.002). They reported similar physical complaints, however, and a similar quality of life. The results after 12 months of follow-up were the same. In conclusion, for patients with hypertension and renal artery stenosis, the decrease in antihypertensive medication after intervention is too small to lead to a detectable improvement in quality of life.

Clinical Prediction Models

“…241,460 Also, quality of life scales may be relevant to evaluate. 242 Such scales are strictly speaking only ordinal, but can for practical purposes often be treated as continuous outcomes. A specific issue is that quality of life scores have ceiling effects, because minimum and maximum scores apply.…”

The impact of depression and cardiophobia on quality of life in patients with essential hypertension

“…5,6 Factors leading to this effect have been considered both disease's complications and medication's side effects. 7,8 In addition, low levels of health-related quality of life (HRQOL) implicate the cardiovascular outcome in this group of patients. 9 Hypertensives tend to demonstrate impaired performance in various dimensions of HRQOL as in general well-being, functional capacity and symptoms of psychological distress.…”

Contemporary management of atherosclerotic renovascular disease

“…In a recent update, this same group reported that the reduction in medications did not result in any discernible increase in health-related quality of life. 154 All of these trials were relatively small and significantly underpowered to detect meaningful differences in "hard" outcomes such as survival, freedom from adverse cardiovascular events, and the development of dialysis-dependent renal failure. Furthermore, the study excluded patients with severe baseline renal function impairment, 26,151 suffered from extensive crossover between treatment groups, 150,151 did not incorporate renin-angiotensin-based antihypertensive agents into medical management, 26 and used angioplasty without stenting for procedural management.…”

“…The authors found no significant difference in event-free survival between treatment groups at a median follow-up of 74 months, but did note a trend towards decreased mortality in patients with renal insufficiency treated surgically. These surgical clinical trials also possess significant limitations: outdated endovascular technology was used, 149 medical treatment was incompletely described, 152,154 or statistical power was severely limited to assess meaningful survival and freedom from event outcomes. 149,152,154 These trials 149,152 were assessed as having poor quality data by the AHRQ review and in the compendium of data examined by the MedCAC.…”