Analysing psychiatric side-effects of beta-blockers using large computerized data bases

Impact of hypertension on health-related quality of life in a population-based study in Shanghai, China

OBJECTIVES

The purpose of this study was to examine the relationship between hypertension and health-related quality of life (HRQL) in a general representative Chinese population, and to explore the impacts of comorbidity on people with hypertension.

STUDY DESIGN

Population-based cross-sectional survey.

METHODS

A self-administered questionnaire survey including demographic questions and the Mandarin version of 36-item Short Form (SF-36) was conducted in a general population in Shanghai, China. In total, 1034 subjects participated. The SF-36 dimension scores of hypertensive subjects were compared with those of normotensive subjects. Independent association of hypertension with each quality-of-life domain was analysed using a multiple linear regression model, so were the effects of comorbidity on the HRQL of hypertensive subjects.

RESULTS

Nine hundred and nineteen respondents were included in the analysis, and 16.97% reported hypertension. Respondents with hypertension scored lower than those without hypertension in at least five SF-36 dimensions. The dimension of role limitations due to physical problems was the most affected, whereas the mental health dimension was the least affected. Hypertensive subjects with comorbidity experienced lower SF-36 scores than hypertensive subjects without comorbidity.

CONCLUSIONS

Hypertension markedly impairs quality of life in terms of both physical and mental health. Comorbidity further deteriorates HRQL among people with hypertension. The findings suggest that people with hypertension represent a vulnerable population, and it is important to prevent and treat comorbidity of hypertension.

Hypertension and health-related quality of life: an epidemiological study in patients attending hospital clinics in China

OBJECTIVE

To examine the relationship between hypertension and health-related quality of life in patients attending hospital clinics in China.

DESIGN AND METHODS

A cross-sectional survey. Patients over the age of 35 years attending outpatient clinics in 18 hospitals of eight major cities of northern and southern China were interviewed between June and July, 1999. Trained fieldworkers completed questionnaires regarding demographics, hypertension knowledge and awareness, treatment history and quality of life issues. Qualified physicians performed blood pressure assessments.

RESULTS

A total of 9703 volunteers were enrolled; 4510 (46.5%) had hypertension. The results showed that hypertensive subjects scored lower in the multiple linear regression analyses in most questions on the quality of life questionnaire than those without hypertension after controlling for age, sex, sociodemographic factors, and co-morbidity. There was a strikingly high prevalence of physical complaints or symptoms. Among the variables considered, age, sex, hypertension, body mass index, educational level, smoking, history of cholesterol, family history of cardiovascular diseases and history of diabetes were statistically significantly correlated with health-related quality of life. Subjects aware of having high blood pressure had a lower health-related quality of life score than subjects with high blood pressure but unaware of the diagnosis. Among treated subjects, those with controlled hypertension had higher health-related quality of life scores than those with poorly controlled hypertension.

CONCLUSIONS

Hypertensive individuals represent a vulnerable population that merits special attention from healthcare providers and systems. This is especially important given that low health-related quality of life can be a risk factor for subsequent cardiovascular events or complications.

Hypertension and health-related quality of life. an epidemiological study in Sweden

The aim of this study was to describe the relationship between hypertension and health-related quality of life (HRQL) in a Swedish general population using the 36-item short form questionnaire (SF-36). The study is based on a postal questionnaire that was sent to a random sample of 8000 inhabitants aged 20-84 years (response rate 68%) in Uppsala County, Sweden, in 1995. The results showed that those with hypertension scored lower in the linear regression analyses in most of the eight domains of the SF-36 than those without hypertension after controlling for age, sex, sociodemographic factors, and comorbidity. Diabetes and angina pectoris were related to lower scores in most of the domains of the SF-36. Previous myocardial infarction was associated with lower general health and vitality. Those with a previous stroke had lower scores in physical functioning, general health, vitality, and social functioning. The findings suggest that hypertensives represent a vulnerable population that merits special attention from health care providers and systems. This is especially important given that low HRQL can be a risk factor for subsequent cardiovascular events or complications.

Self-rated health among cardiovascular drug users in a study of Swedish twins

The aim of this study was to analyse the relationship between self-perceived health and cardiovascular disease with and without drug treatment. Mental health and genetic effects were controlled for in the analyses. The data for these analyses were collected in 1984 as part of the Swedish Adoption/Twin Study of Aging (SATSA). In the first set of analyses, 1147 persons (mean age 60 years, 72% older than 50 years) were included. In the second part of the study, twin pairs discordant with respect to having a cardiovascular disease and/or drug use were included in the analyses. Cardiovascular disease was related to poor, self-rated health among both men and women. The proportion with bad health was largest among those with a drug-treated disease. In multivariate analyses, a strong relationship between cardiovascular disease, drug therapy and low self-rated health remained after controlling for mental health. The co-twin control analyses indicate that cardiovascular drugs have at most a marginal negative effect on health beyond the effects of the disease and genetic liability to self-perceived poor health.

Antidepressant-treated patients in ambulatory care long-term use of non-psychotropic and psychotropic drugs

BACKGROUND

Despite the problems involved in treating depression and concomitant medical disease, there are virtually no longitudinal studies on drug utilisation among depressed patients.

METHOD

Use of prescription drugs among all first-time users of antidepressants in a defined population five years before and six years after the index (first) treatment was compared to a referent group without antidepressant treatment. The generalised estimating equations (GEE) method was used for analysis.

RESULTS

The antidepressant-treated group used considerably more non-psychotropic drugs during the whole study period than the referent group. They also used more psychotropic drugs, a use which increased in connection with the initiation of antidepressant treatment, and stayed high for a further five years.

CONCLUSIONS

The high use of prescription drugs indicated widespread somatic and psychiatric health problems during the whole study period. Antidepressant-treated patients are at risk for drug interactions and adverse effects, and would benefit from a closer collaboration between psychiatry and medicine.