Prevalence of tinnitus in patients withhypertension and the impact of different anti hypertensive drugs on the incidence of tinnitus: A prospective, single-blind, observational study.
BACKGROUND
Tinnitus is a common symptom in audiology and neurologypatients. Controversial data have been reported in the literature about the prevalence of tinnitus in hypertensive patients, whereas its relationship with the extent of blood pressure (BP) control has not been substantially explored.


OBJECTIVE
The aim of this study was to determine the prevalence of tinnitus in hypertensive patients, and the impact of different antihypertensive drugs on the incidence of tinnitus in these patients.


METHODS
This prospective, single-blind, observational study was conducted at the Hypertension Clinic, St. Orsola-Malpighi Hospital, Bologna, Italy. Patients aged 18 to 75 years with uncontrolled hypertension and receiving antihypertensive therapy were enrolled. Patients were asked to complete a standardized questionnaire to assess the presence, frequency, and duration of tinnitus and the apparent effect of their antihypertensive treatment on it. Patients considered by the investigator to have tinnitus, regardless of their audiologic condition, underwent a complete clinical cardiovascular examination, including supine systolic BP (SBP) and diastolic BP measurement and standard 12-lead electrocardiography. Twelve-hour ambulatory BP monitoring was also performed, and patients were asked to record, using patient diaries, times of the onset and resolution of tinnitus that occurred during those 12 hours. From these data, correlations between the onset of tinnitus and BP were calculated.


RESULTS
A total of 476 patients participated in the study (283 men, 193 women). Of these, 84 (17.6%) patients reported occasional or prolonged spontaneous tinnitus, whereas 392 (82.4%) reported no tinnitus. The incidence of tinnitus was significantly higher in patients receiving diuretics (72/265 [27.2%]) compared with those receiving angiotensin lI receptor blockers (5/37 [13.5%]), α-blockers (12/55 [21.8%]), or 3-hydroxy-3-methylglutaryl coenzyme A reduc tase inhibitors (9/73 [12.3%]) (all, P < 0.05). Mean (SD) SBP was significantly higher in patients without tinnitus compared with those with it (143.2 [11.1 ] vs 140.6 [10.3] mm Hg; P < 0.005). In 10 (11.9%) patients with tinnitus, the onset was correlated with a sudden decrease in SBP (<140 mm Hg).


CONCLUSIONS
In this study of tinnitus in patients receiving antihypertensivetherapy, tinnitus was found in 17.6% of patients. Tinnitus was associated with the use of diuretics and with low SBP. Further studies are needed.
Department of Internal Medicine, University of Bologna, Bologna, Italy.
Claudio
C
Borghi
Department of Surgical and Anaesthesiological Sciences, University of Bologna, Bologna, Italy.
Cristina
C
Brandolini
Department of Internal Medicine, University of Bologna, Bologna, Italy.
Maria Grazia
MG
Prandin
Department of Internal Medicine, University of Bologna, Bologna, Italy.
Ada
A
Dormi
Department of Surgical and Anaesthesiological Sciences, University of Bologna, Bologna, Italy.
Giovanni Carlo
GC
Modugno
Department of Surgical and Anaesthesiological Sciences, University of Bologna, Bologna, Italy.
Antonio
A
Pirodda
3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors; angiotensin II receptor blockers; diuretics; hypertension; tinnitus; α-blockers