REMISSION OF HYPERTENSION - RETROSPECTIVE OBSERVATIONS OVER A PERIOD OF 20 YEARS

To clarify the background and outcome of hypertensive patients who hav e remission of their elevated blood pressure (BP) after a course of an tihypertensive drug therapy, we designed a retrospective observational study. The clinical records of 106 hypertensive men and women (BP, 16 4.3/104.4 mmHg) given antihypertensive drug treatment and subsequently examined every 1 to 3 mo for more than 20 yr were reviewed. The patie nts were divided into two groups: those who had remission (R-group) an d those who did not have remission (N-group). Patients were considered in remission if no significant elevation in BP was observed for more than 1 yr after withdrawing their medication. Remissions ranging in du ration from 1.6 to 21.7 yr (average duration, 6.3 yr) occurred in 19 o f 106 patients (17.9%). However, antihypertensive drug treatment was e ventually restarted in 17 of the 19 patients. Before treatment, compar ison of the R-group and N-group revealed no differences with respect t o age, body weight, BP, or serum creatinine. In contrast, the proporti on of patients who lacked high-voltage deflections in their electrocar diograms (ECG) as well as that of patients whose BP was well-controlle d by a single medication was significantly greater in the R-group than in the N-group (12/19 vs. 22/87, p < 0.05 and 10/19 us. 13/87, p < 0. 001, respectively). In addition, body weight in the R-group decreased significantly by the time drug therapy was withdrawn (p < 0.01). Final ly, significantly more patients (14 of 19 patients) entered remission in the spring and summer (p < 0.05) than at other times of the year. W e conclude that remission occurs in a subset of well-controlled hypert ensive patients and may persist for several years or more. However, in the majority of patients, antihypertensive drug treatment will usuall y need to be restarted at some point. Patients who lack ECG high-volta ge deflections and who are successfully treated with a single therapeu tic agent are most likely to experience remission. Moreover, it appear s that withdrawing patients from drug therapy in the spring or summer is more likely to yield a favorable outcome than at other times of the year.