DISCONTINUATION OF ANTIHYPERTENSIVE THERAPY - PREVALENCE OF RELAPSES AND PREDICTORS OF SUCCESSFUL WITHDRAWAL IN A HYPERTENSIVE COMMUNITY

Antihypertensive therapy has been-thought to be a life-long treatment. Nevertheless, antihypertensive medication may be discontinued in a su bstantial proportion of hypertensive patients at least for some time. The current study focused on predictors for the development of elevate d blood pressure levels after discontinuation of antihypertensive drug therapy. In an open, prospective study, 88 white male patients with n ewly discovered essential hypertension (age 42 +/- 7 years) were teste d at baseline. Blood pressure was measured in various situations (at w ork, at rest, before and during treatment, and at follow-up), and the hemodynamic profile at rest and cardiovascular response patterns durin g stress tests were evaluated. Left ventricular mass and other cardiov ascular risk factors were also carefully determined. After 6 months of strict blood pressure control (<140/90 mm Hg), they were treated by t heir primary care physician (mean duration of antihypertensive therapy 1.3 +/- 1.7 years). After 6 years, 37 patients were still on antihype rtensive therapy, but 19 of the 37 had blood pressure values greater t han or equal to 160/95 mm Hg. In 51 patients, therapy was discontinued : 29 were hypertensive, 15 were borderline hypertensive and 7 were nor motensive. Relapse of hypertensive blood pressure in these 51 patients off therapy was predicted by resting blood pressure values before the rapy (138 +/- 11/91 +/- 5 vs. 131 +/- 11/85 +/- 7 mm Hg, p < 0.05/0.01 ), cardiac output at rest (7.5 +/- 1.9 vs. 6.2 +/- 2.1 1/min, p < 0.05 ), total peripheral resistance (20 +/- 9 vs. 14 +/- 4 U, p < 0.05), in creased heart rate during ergometry (50 +/- 8 vs. 44 +/- 6 b.p.m., p < 0.05) and left ventricular mass determined by echocardiography (212 /- 60 vs. 189 +/- 44 g, p < 0.01). There was no difference in age, blo od pressure levels before and during treatment, the number of consulta tions with the primary care physician or cardiovascular risk factor pr ofiles. In conclusion, intermittent rather than life-long antihyperten sive treatment may be possible in hypertensive patients with low resti ng blood pressure, high cardiac output, low total peripheral resistanc e and low left ventricular mass.