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A randomized double-blind study lasting 2 months was performed with either 25 mg captopril twice a day or 50 mg atenolol once a day in 125 patients with established diastolic hypertension (diastolic blood pressure>95 mmHg) identified during a population screening programme of subjects aged<65 years. Quality of life was assessed from self-completed questionnaires. A significant fall in diastolic blood pressure occurred with both captopril (106.7 ± 7.0 to 98.6 ± 8.6 mmHg) and atenolol (107.4 dh 7.5 to 98.2 ± 8.1 mmHg) but there was no difference between the two drugs in the size of the fall. A measure of the number of symptomatic complaints, the symptom complaint rate, decreased with both drugs, by 1.3% for captopril and 3.1% for atenolol, but the difference between the drugs was not significant 1.8%; 95% confidence interval (Cl-13%, 4.9%. There was a significant increase in the reporting of cough and runny nose in those on captopril compared with atenolol. A health index increased by 1.1% with captopril in comparison with no change on atenolol (difference 1.1%; 95% Cl — 2.0%, 4.2%). Psychological well-being was measured using the Symptom Rating Test. The improvement in total score was 1.4% with captopril and 2.3% with atenolol. The difference of 0.9% was not statistically significant (95% Cl - 1.2%, 3.0%). In the Symptom Rating Test subscales there was a tendency for atenolol to reduce anxiety more than captopril, — 0.6 units against — 0.1 units (difference 0.5 units, 95% Cl — 0.2, 1.2), for captopril to reduce depression more than atenolol, — 0.4 units against — 0.1 (difference 0.3, 95% Cl — 0.2, 1.2) and atenolol to reduce hostility more than captopril, - 0.7 against -0.2 (difference 0.5, 95% Cl - 0.3, 1.3). This trial on 125 patients followed for 2 months did not reveal any differences in quality of life between the two treatments. It is concluded that, overall, the quality-of-life measures during atenolol treatment were similar to those during captopril. However, important differences in measures of anxiety, depression and hostility could not be excluded with confidence.
Fletcher et al. (1990) studied this question.