Key result
Withdrawal of antihypertensive therapy in elderly patients resulted in a 20% probability of remaining treatment-free for 5 years, with lower mortality risk than the matched general population.
Why the study?
Does the withdrawal of antihypertensive treatment increase the risk of cardiovascular events and total mortality in elderly hypertensive patients?
Observational (n=333)
Yes
Does the withdrawal of antihypertensive treatment increase the risk of cardiovascular events and total mortality in elderly hypertensive patients?
Withdrawal of antihypertensive therapy in elderly patients, particularly those on low-dose monotherapy, may be feasible with frequent monitoring without increasing the risk of cardiovascular events.
Supports hypothesis of safe monitored withdrawal in select elderly hypertensives; leaves open confirmation by randomized trials.
OBJECTIVES: To observe blood pressure, cardiovascular events, and total mortality after withdrawing antihypertensive treatment for elderly patients. DESIGN: Multicentre observational study. SETTING: Sweden. A 5-year follow-up of 333 elderly hypertensive patients, aged 70-84 years (mean age 75.2 +/- SD 3.8 years, 68% females). In all, 74 out of the 333 patients (22%) died during the study period. METHOD: After withdrawal of the antihypertensive therapy, all patients started in the untreated state and during the 5-year follow-up they could then either remain in the untreated state, or be reverted to blood-pressure-lowering drug treatment because of hypertension or other diseases, e.g. angina pectoris, oedema, congestive heart failure, etc. RESULTS: The probability of remaining without treatment for 5 years was estimated to be 20%. During the state of no treatment the patients had a lower total mortality risk than that of the general Swedish population, matched for age and sex. They also had a lower risk of cardiovascular events than those in the treated states. Markers indicating a successful withdrawal were monotherapy in low doses and relatively low blood pressure before withdrawal. CONCLUSION: These results suggest that with frequent check-ups, withdrawal of antihypertensive therapy in the elderly can be tried without increased risk of cardiovascular events.
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Ekbom et al. (1994) conducted an observational in hypertension (n=333). Withdrawal of antihypertensive treatment vs. General Swedish population / treated states was evaluated on Blood pressure, cardiovascular events, and total mortality. Withdrawal of antihypertensive therapy in elderly patients resulted in a 20% probability of remaining treatment-free for 5 years, with lower mortality risk than the matched general population.
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