Quality of life in the management of hypertension.

Results from long term trials suggest that first line treatment with the diuretic chlorthalidone is not associated with any adverse effects on quality of life including cognitive performance. Similar findings may be true for other diuretics but there is less evidence. However chlorthalidone and other diuretics do produce erectile problems in around 10% to 15% of middle aged men while the proportion of older men affected is not known. Beta blockers have mixed effects but recent drugs of this class have minor, if any adverse impacts. Calcium channel blockers, especially dihydropyridines, are associated with higher discontinuation rates. ACE inhibitors appear to cause minimal impairment to QoL; they do not interfere with cognitive function or sexual performance and are associated with a low withdrawal rate. Greater control of blood pressure is associated with improved quality of life as are strategies such as weight loss and increased physical exercise.