Reflections on the impact of antihypertensive medications on mood, sedation, and neuropsychologic functioning.

All antihypertensive treatments, including placebo, are associated with cognitive side effects. These side effects are rarely clear-cut and involve mood, quality of sleep, daytime sedation, and various neuropsychologic functions. This review article reflects on the vast literature on this topic and comments on substantive findings, as well as methodologic difficulties in sorting through findings from quality-of-life studies. Hypertension itself is associated with many of the above changes, and some cognitive functions actually improve with treatment. Nonetheless, many medications are accused of causing side effects, despite the fact that side effects with placebo are common, particularly for nonspecific complaints, such as fatigue. Side effects are not limited to sympatholytic antihypertensive agents and are commonly reported even by patients who are treated with diuretics. It is not at all clear that side effects are more commonly reported in patients who are treated with lipophilic beta-blockers. The patient may be a relatively poor observer of these subtle changes. The spouse is an important source of additional information with regard to side effects. The virtual absence of any standardization in quality-of-life measures makes comparisons across studies extremely difficult.