Effects of withdrawing diuretic therapy on blood pressure in mild hypertension.

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...

Prehypertension: A possible target for antihypertensive medication

“…Later, discontinuation of treatment was reinvestigated in patients who completed the randomized trials of mild hypertension. On the basis of reports of the Medical Research Council trial [19] and the Hypertension Detection and Follow-up Program (HDFP) trial [20] and a few smaller trials [21,22], the following conclusions can be drawn: patients with milder hypertension at entry are more likely to stay normotensive; a substantial proportion of patients remain normotensive or near normotensive for 1 year or more; and in patients whose blood pressure will rebound, the return of hypertension is brisk and likely to be seen in the first 4 months after discontinuation of treatment. The percentage of patients who remain normotensive depends on the definition of normal blood pressure, but it ranges from 50% to 75% at 1 year and from 45% to 52% after 2 years.…”

“…All patients in the trial will receive literature on diet and exercise throughout the study. Patients will be evaluated at 3,6,9,12,15,18,21, and 24 months for the 2-year double-blind treatment period. To ensure compliance and allow patients to monitor blood pressure between visits, patients will be provided with the OMRON 705-CP device (OMRON Healthcare, Inc. Vernon Hills, IL) for home blood pressure measurements.…”

Effect of Casein Hydrolysate, Prepared with Protease Derived from Aspergillus oryzae, on Subjects with High-Normal Blood Pressure or Mild Hypertension

“…Although the mechanism of the sustained antihypertensive effect observed over several weeks following the cessation of intake is unclear, previous studies have shown similar results. [31][32][33] In several ACE inhibitory substances, the slow absorption and the inhibition of the tissue renin-angiotensin system were reported in human or animal studies. 29,34,35 Peptide composition of A. oryzae casein hydrolysate was reported to mainly comprise small peptides, X-Pro-Pro and X-Pro.…”

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

“…Most study groups have observed that a subset of formerly treated hyperten sive patients remained normotensive after drug with drawal [14][15][16][17][18][19][20], In those studies, the proportion of pa tients showing remission of hypertension ranged from 10 to 75%; however, follow-up was limited to 4 years or less. Overall, the percentage of patients remaining normoten sive after drug withdrawal decreases over time.…”