This study asks whether prolonged antihypertensive therapy will "cure" a substantial percent of rigorously treated hypertensive patients and whether nutritional change will add an antihypertensive effect and reduce the relapse rate. Of 584 eligible patients normotensive while receiving therapy, 496 were randomized into control and discontinued-medication groups with and without dietary intervention. At 56 weeks, 50% of those who were no longer receiving medication remained normotensive by study criteria. Randomization either to weight-loss group (mean loss of 4.5 kg [10 lb]) or to sodium-restriction group (mean reduction of 40 mEq/day) increased the likelihood of remaining without drug therapy, with an adjusted odds ratio of 2.17 for the sodium group and 3.43 for the weight group. Highest success rates were in the nonoverweight mild hypertensives with sodium restriction (78%) and the overweight mild hypertensives who were reducing their weight (72%). These data demonstrate that weight loss or sodium restriction, in hypertensives controlled for five years, more than doubles success in withdrawal of drug therapy.

Since the use of NH₄CI – the standard agent for short duration acid loading – may be hazardous in patients with hepatic disease, the acute renal response to another acidifying agent, orally administered CaCl₂ (2 mEq/kg body weight), was compared to that obtained with NH₄CI (1.9 mEq/kg body weight) in normal subjects during a 5- to 6-hour test. Urine pH decreased in all subjects to less than 5.20, and there were no significant differences in the maximal renal responses to either agent. Both in terms of acidification of the blood and as a stimulus to lowering of urine pH and excretion of acid, CaCl₂ can adequately replace NH₄CI as an acidifying agent in a short duration test and can be used in clinical settings in which NH₄CI is contraindicated.

In the Hypertension Detection and Follow-up Program, 7825 (71.5 per cent) of the 10,940 participants had diastolic blood pressures averaging between 90 and 104 mm Hg on entry into the study and were designated Stratum 1. Half were referred to their usual source of care in the community (the referred-care group), and half were treated intensively in special clinics (the stepped-care group). Five-year mortality in the Stratum 1 patients given stepped care was 20.3 per cent lower than in those given referred care (P less than 0.01). Particularly noteworthy was the beneficial effect of stepped-care treatment on persons with diastolic pressures of 90 to 104 mm Hg who had no evidence of end-organ damage and were not receiving antihypertensive medication when they entered the study. This subgroup had 28.6 per cent fewer deaths at five years among those treated with stepped care than among those treated with referred care (P less than 0.01). These findings support a recommendation that in patients with mild hypertension, treatment should be considered early, before damage to end organs occurs.

and 'Hypertension Detection and Follow-Up Program, Bronx, New York. U.S.A. Summary 1.Among 160 patients who were withdrawn from antihypertensive therapy after long-term treatment, 42% had to be restarted on medication within 8 months of the withdrawal. Average time to return to medication was 16 weeks. 2.A significantly higher proportion of more severe hypertensive patients had to be restarted on drugs than of mild hypertensive patients (25% versus 75%).3. For mild hypertensive patients, there were no differences in rate of return to drugs by age, race, sex, or obesity status. For the more severe hypertensive patients failure rate was considerably higher among the obese than the non-obese in each sex-race group.

No abstract