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Multicenter, randomized, parallel-group, and open trials were performed in patients with mild-to-moderate essential hypertension to assess the impact of nilvadipine and angiotensin-converting enzyme (ACE) inhibitors on patient quality of life (QOL). After a baseline observation period, 79 patients were enrolled. QOL was evaluated at baseline and at weeks 24, 36, and 52 of treatment. Fourteen patients had withdrawn from the trial by week 24. QOL was assessed in 34 patients treated with nilvadipine and 31 patients treated with ACE inhibitors. Patients receiving nilvadipine reported improvements in headaches and head heaviness, shoulder stiffness, fatigue during work, general well-being, and leisure time enjoyment. Patients receiving ACE inhibitors noted improvements in headaches and head heaviness, shoulder stiffness, irritability, social relationships, and sleep. Nilvadipine was considered better than ACE inhibitors in improving shoulder stiffness and self-control, whereas ACE inhibitors were better than nilvadipine in improving shortness of breath, nocturia, and social relationships. Both nilvadipine and the ACE inhibitors produced similar falls in blood pressure; neither changed heart rate significantly during the treatment period. In conclusion, the two regimens were equally effective in lowering blood pressure with equally favorable effects on QOL.