Use of ACE-inhibitors and quality of life in an older population

Background: Improved ability to treat chronic diseases have increased the interest in measuring health-related quality of life (HRQoL) in older adults. Hypertension and heart failure have been associated with decreased HRQoL. Hypothesis: The aim of this study was to assess the association between health-related quality of life and use of angiotensin converting enzyme inhibitors in unselected community-dwelling elderly. Methods: We analyzed data of all 387 subjects aged 75+ living in a rural Italian town, without exclusion criteria. HRQoL was assessed using the Health Utility Index Mark 3, which allows formal cost-effectiveness calculations. The association of the HRQoL score with use of ACE-I was analyzed by multivariable linear and logistic regression. Results: The median HUI3 score was 0.31, and 186 participants (48%) reported a score above the median value. Use of ACE-I was reported by 34 (9%) participants, and confirmed by general practitioners. Use of these agents was associated with significantly better HRQoL (B=.16, 95% CI=.02-.30; P=.025). Also, use of ACE-I was associated with increased probability of better HRQoL in logistic regression (OR=2.83; 95% CI=1.03-7.78; P=.044) after adjusting. No associations were found between the HRQoL score and use of calcium antagonists or beta-blockers. Conclusions: Use of ACE-I, but not of other antihypertensives, is associated with better HRQoL among community-dwelling older adults. ACE-inhibitors might therefore present with the best cost-effectiveness ratio for the treatment of older populations.