PREDICTIVE VALUE OF AMBULATORY BLOOD-PRESSURE SHORTLY AFTER WITHDRAWAL OF ANTIHYPERTENSIVE DRUGS IN PRIMARY-CARE PATIENTS

Objective-To determine whether ambulatory blood pressure eight weeks a fter withdrawal of antihypertensive medication is a more sensitive mea sure than seated blood pressure to predict blood pressure in the long term. Design-Patients with previously untreated diastolic hypertension were treated with antihypertensive drugs for one year; these were wit hdrawn in patients with well controlled blood pressure, who were then followed for one year. Setting-Primary care. Subjects-29 patients fulf illing the criteria for withdrawal of antihypertensive drugs. Main out come measures-Sensitivity, specificity, and positive and negative pred ictive value of seated and ambulatory blood pressure eight weeks after withdrawal of antihypertensive drugs. Results-Eight weeks after withd rawal of medication, mean diastolic blood pressure returned to the pre treatment level on ambulatory measurements but not on seated measureme nts. One;year after withdrawal of medication, mean diastolic blood pre ssure had returned to the pretreatment revel both for seated and ambul atory blood pressure. For ambulatory blood pressure, the sensitivity a nd the positive predictive value eight weeks after withdrawal of medic ation were superior to those for seated blood pressure; specificity an d negative predictive value were comparable for both types of measurem ent. Receiver operating characteristic curves showed that the results were not dependent on the cut off vales that were used. Conclusion-Amb ulatory blood pressure eight weeks after withdrawal of antihypertensiv e drugs predicts long term blood pressure better than measurements mad e when the patient is seated.