On Resetting of "Barostats" in Hypertensive Patients

Thurm, Richard H.

doi:10.1001/jama.1967.03130050035010

Cited by 61 publications

(10 citation statements)

References 4 publications

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“…Whether the number of reversions is actually lower, or whether the time course of blood pressure increase is only slower in mild hypertensives, cannot be determined from this trial due to its 1-year length. A lower reversion rate for this study group was expected because of lower pretreatment pressures compared to the VA Cooperative Study Group, 1 the groups followed by Boyle et al, 2 Thurm and Smith, 6 and Perry and Schroeder. 4 Results of this study suggest that effective, longterm diuretic therapy can modify the course of hypertension in some patients.…”

Section: Reversion Vs Generalized Blood Pressure Increase In Placebosmentioning

confidence: 72%

“…Because of this gradual BP rise in placebo-treated nonreverters, we cannot assert that reverters and nonreverters are two separate groups. The BP response of our placebo group may be, as suggested by Thurm and Smith, 6 a continuum that is artificially separated by the point in time, and the duration of our analysis. Among compliant active treatment participants, there was no increase in DBP.…”

Section: Discussionmentioning

confidence: 99%

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

Maland¹,

Lutz²,

Castle³

1983

Hypertension

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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...

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Section: Reversion Vs Generalized Blood Pressure Increase In Placebosmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

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

Maland¹,

Lutz²,

Castle³

1983

Hypertension

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“…Clinically, in the treatment of patients with essential hypertension, it has been observed that, following prolonged reduction of blood pressure, the hypertension may regress to a much milder form or occasionally remit entirely for long periods (2,3). However, it has not been determined in man whether control of blood pressure prior to the appearance of the hypertension will alter the progression of the disease.…”

mentioning

confidence: 99%

Alteration of the Course of Hypertension in the Spontaneously Hypertensive Rat

Freis

Ragan

Pillsbury

et al. 1972

Circulation Research

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The blood pressure of spontaneously hypertensive rats was controlled at low normotensive levels, using antihypertensive drugs for a 6-month period beginning when the rats were 3 months of age. Treatment was then withdrawn and the rats observed for an additional 4 months, until they were 13 months of age. Treatment with antihypertensive drugs arrested the progression of the hypertension and the secondary pathology for the duration of the treatment period. Following withdrawal of drugs the blood pressure did not rise to the level of the controls of a similar age, but rather it returned to the level that existed before treatment began and then progressed at the same rate that the controls exhibited when they were 3-7 months of age. Pathological changes were found only in controls. These results indicate that, although the tendency toward hypertension is inherited, its rate of development depends on environmental factors. The hypei tension can be arrested by chemotherapeutic interventions and can be aggravated by excessive salt. The hypertension appears to be a progressive time-dependent process but is independent of biological processes associated with aging per se. Finally, control of blood pressure prevents end-organ damage. • The spontaneously hypertensive rat presents an experimental model which in many ways resembles essential hypertension in man (1). One of the great advantages of this model is that the entire life history of the disease is compressed within a period of less than 2 years. Clinically, in the treatment of patients with essential hypertension, it has been observed that, following prolonged reduction of blood

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“…FIGURE 3. Percent of high dose HCTZ patii remaining under diastolic BP control during 20 months after randomization.…”

Section: Resultsmentioning

confidence: 99%