Withdrawal of long-term diuretic medication in elderly patients: a double blind randomised trial.
OBJECTIVE
About 20% of elderly people use long-term diuretic medication, but there is doubt whether prolonged diuretic medication on such a large scale is necessary. We performed a study to assess what proportion may successfully be withdrawn from diuretic therapy.


METHODS
Double blind randomised controlled trial with six month follow up.


METHODS
General practice.


METHODS
202 patients taking long-term diuretics without manifest heart failure or hypertension.


METHODS
Patients were allocated to either placebo (withdrawal group, n = 102) or continuation of diuretic treatment (control group, n = 100).


METHODS
Occurrence of clinical conditions requiring diuretic therapy based on fixed criteria.


RESULTS
During follow up diuretic therapy was required in 50 patients in the withdrawal group and 13 in the control group (risk difference 36%; 95% confidence interval 22% to 50%). Heart failure was the most frequent cause of prescribing diuretic therapy (n = 25). Cessation of diuretic therapy caused a mean increase in systolic blood pressure of 13.5 (9.2 to 17.8) mm Hg and in diastolic pressure of 4.6 (1.9 to 7.3) mm Hg.


CONCLUSIONS
Withdrawal of long-term diuretic treatment in elderly patients leads to symptoms of heart failure or increase in blood pressure to hypertensive values in most cases. Any attempt to withdraw diuretic therapy requires careful monitoring conditions, notably during the initial four weeks.
Walma
E P
EP
Department of General Practice, Erasmus University Medical School, Rotterdam, Netherlands. walma@hag.fgg.eur.nl
Hoes
A W
AW
van Dooren
C
C
Prins
A
A
van der Does
E
E
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D002303:Cardiac Output, Low / Q000188:drug therapy; D004232:Diuretics / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D010349:Patient Compliance; D013375:Substance Withdrawal Syndrome / Q000209:etiology
D004232:Diuretics