Withdrawal of antihypertensive drug treatment: time-course for redevelopment of hypertension and effects upon left ventricular mass.
OBJECTIVE
To examine: (1) in how many treated hypertensive patients it was possible to discontinue drug treatment; (2) the time-course for redevelopment of hypertension after discontinuation of therapy; and (3) whether drug withdrawal was associated with an increase in left ventricular mass (LVM).


METHODS
Fifty-four men with primary hypertension treated for a mean period of 6 years (primarily beta 1-selective beta-blockade) were evaluated for withdrawal of treatment. Exclusion criteria were signs of organ damage, severe hypertension, other serious disease and unwillingness. Treatment was reinstituted if blood pressure increased above a safety level or if symptoms occurred. Echocardiographic estimations of LVM were obtained before withdrawal and 1, 4 and 8 weeks after withdrawal or before return to treatment.


METHODS
Outpatient clinic in a city hospital.


METHODS
A random sample of 56-year-old hypertensive men.


METHODS
Gradual discontinuation of treatment with close follow-up of blood pressure.


METHODS
Number of patients who could withdraw from treatment and who had to return to pharmacological therapy; time-courses for development of hypertension; absolute changes in LVM.


RESULTS
Thirty-two patients withdrew from treatment for 1-1000 days. Therapy was reinstituted in all owing to hypertension or symptoms. Serial echocardiograms were obtained in 22 patients. During the drug-free period, relative wall thickness increased, but LVM did not. Patients with rapid redevelopment of hypertension had larger prewithdrawal LVM than patients whose blood pressure increased more slowly.


CONCLUSIONS
It was possible to withdraw treatment and obtain readable echocardiograms in a minority of the patients. After drug-withdrawal, relative wall thickness increased, but not LVM. We suggest that previously treated patients should be avoided in studies examining reversal of left ventricular hypertrophy.
Fagerberg
B
B
Department of Medicine I, Gothenburg University, Sahlgren's Hospital, Sweden.
Wikstrand
J
J
Berglund
G
G
Hartford
M
M
Ljungman
S
S
Wendelhag
I
I
D000959:Antihypertensive Agents / Q000009:adverse effects*; D001794:Blood Pressure; D006332:Cardiomegaly / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D004452:Echocardiography; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology / Q000503:physiopathology*; D013997:Time Factors
D000959:Antihypertensive Agents