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      Discontinuation of Antihypertensive Therapy: Prevalence of Relapses and Predictors of Successful Withdrawal in a Hypertensive Community

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          Abstract

          Antihypertensive therapy has been thought to be a life-long treatment. Nevertheless, antihypertensive medication may be discontinued in a substantial proportion of hypertensive patients at least for some time. The current study focused on predictors for the development of elevated blood pressure levels after discontinuation of antihypertensive drug therapy. In an open, prospective study, 88 white male patients with newly discovered essential hypertension (age 42 ± 7 years) were tested at baseline. Blood pressure was measured in various situations (at work, at rest, before and during treatment, and at follow-up), and the hemodynamic profile at rest and cardiovascular response patterns during stress tests were evaluated. Left ventricular mass and other cardiovascular risk factors were also carefully determined. After 6 months of strict blood pressure control ( < 140/90 mm Hg), they were treated by their primary care physician (mean duration of antihypertensive therapy 1.3 ± 1.7 years). After 6 years, 37 patients were still on antihypertensive therapy, but 19 of the 37 had blood pressure values ≧ 160/95 mm Hg. In 51 patients, therapy was discontinued: 29 were hypertensive, 15 were borderline hypertensive and 7 were normotensive. Relapse of hypertensive blood pressure in these 51 patients off therapy was predicted by resting blood pressure values before therapy (138 ± 11/91 ± 5 vs. 131 ± 11/85 ± 7 mm Hg, p < 0.05/0.01), cardiac output at rest (7.5 ± 1.9 vs. 6.2 ± 2.1 1/min, p < 0.05), total peripheral resistance (20 ± 9 vs. 14 ± 4 U, p < 0.05), increased heart rate during ergometry (50 ± 8 vs. 44 ± 6 b.p.m., p < 0.05) and left ventricular mass determined by echocardiography(212 ± 60 vs. 189 ± 44g, p < 0.01). There was no difference in age, blood pressure levels before and during treatment, the number of consultations with the primary care physician or cardiovascular risk factor profiles. In conclusion, intermittent rather than life-long antihypertensive treatment may be possible in hypertensive patients with low resting blood pressure, high cardiac output, low total peripheral resistance and low left ventricular mass.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          0008-6312
          1421-9751
          1997
          1997
          19 November 2008
          : 88
          : 3
          : 277-284
          Affiliations
          aDepartment of Medicine IV, University of Erlangen-Nürnberg, and bDepartment of Medicine, University of Bonn, Germany
          Article
          177343 Cardiology 1997;88:277–284
          10.1159/000177343
          9129850
          © 1997 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 8
          Categories
          Clinical Pharmacology

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