Predictors and Mediators of Successful Long-term Withdrawal From Antihypertensive Medications

摘要: BACKGROUND National guidelines recommend consideration of step down or withdrawal medication in patients with well-controlled hypertension, but knowledge factors that predict mediate success achieving this goal is limited. OBJECTIVE To identify patient characteristics associated controlling blood pressure (BP) after antihypertensive medication. DESIGN The Trial Nonpharmacologic Interventions the Elderly tested whether lifestyle interventions designed to promote weight loss a reduced intake sodium, alone combination, provided satisfactory BP control among elderly (aged 60-80 years) hypertension from drug therapy. Participants were observed for 15 36 months attempted withdrawal. MAIN OUTCOME MEASURES end points defined by (1) sustained 150/90 mm Hg higher, (2) clinical cardiovascular event, (3) decision participants their personal physicians resume RESULTS Proportional hazards regression analyses indicated hazard (+/- SE) experiencing an point persons assigned active was 75% +/- 9% (weight loss), 68% 7% (sodium reduction), and 55% (combined loss/sodium reduction) those usual care. Lower baseline systolic (P < .001), fewer years since diagnosis treatment no history disease = .01) important predictors maintaining successful nonpharmacological throughout follow-up, based on logistic analysis. Age, ethnicity, level physical activity weight, class, smoking status, alcohol not statistically significant predictors. During extent .001) urinary sodium excretion .04) reduction risk trial graded fashion. CONCLUSIONS Withdrawal most likely be who have been recently (within 5 diagnosed treated, adhere life-style involving reduction. More than 80% these may longer 1 year.