No abstract

No abstract

No abstract

SUMMARY A 1-year double-blind placebo-controlled study on the effects of diuretic withdrawal was conducted on a group of 62 previously well-controlled, mildly hypertensive patients. Data were collected on blood pressure (BP), biochemical laboratory values, and subjective reports of side-effects. Twenty-six percent of placebo subjects and 3% of the active treatment subjects reached preset criteria for the return of hypertension (reverters). The average systolic and diastolic pressures of all placebotreated patients who did not revert showed statistically significant increases. BP control was quickly reestablished in reverters by restarting diuretic therapy. No substantial differences in side-effects were reported between the groups, and laboratory changes were those consistent with known metabolic effects of thiazide and thiazide-like diuretics. This study showed a much lower reversion rate after treatment withdrawal than previously reported by other investigators. It also showed significant increases in BP of placebo patients who did not revert. Long-term diuretic therapy retains its effectiveness in responsive mild hypertensive patients, potentially offering protection against the increased risks of mortality and morbidity associated with even slight elevations of BP. Withdrawal of diuretics cannot be recommended for patients with mild hypertension without use of other equally effective interventions to maintain optimum BP control. 6 reported changes in blood pressure (BP) and considered the possibility that BP might remain in the normal range when antihypertensive treatment is discontinued after a prolonged period of control. The results reported have been inconsistent, and they have been difficult to interpret due to differences in patient selection, levels of BP, drugs used, and study designs.The VA Cooperative Study Group 1 on hypertension reviewed earlier reports and presented its own findings from withdrawal of effective therapy in a double-blind placebo-controlled trial. Patients had to maintain an average diastolic pressure less than 90 mm Hg for six visits during the first six months, and thereafter pressures had to remain consistently less than 95 mm Hg. Seventy percent of these individuals with previously controlled BP reverted, requiring reuse of antihyperFrom the Department of Family and Community Medicine, University of Utah, Salt Lake City, Utah.Supported in part by a grant from the Montana State Heart Association.Address for reprints: Dr. Lawrence J. Lutz, M.D., MSCM, Department of Family and Community Medicine, University of Utah, Salt Lake City, Utah 84132.Received August 3, 1982; revision accepted January 7, 1983. tensive medication during the 18-month observation period. Boyle et al. 2 reported the results of withdrawing treatment from 20 patients controlled on thiazides only. Eighteen (90%) were returned to treatment after 1 to 132 weeks (mean, 31 weeks). Others 78 have shown that some patients with hypertension previously controlled with diuretics alone have remained normotensive for pr...

No abstract