Nelson M, Reid C, Krum H, McNeil J
Department of Epidemiology and Preventive Medicine, Monash Medical School, Alfred Hospital, Prahran, Australia.
Am J Hypertens. 2001 Feb;14(2):98-105. doi: 10.1016/s0895-7061(00)01246-2.
The identification and treatment of hypertension in the general community has contributed to the reduction in strokes and coronary heart disease observed during the past 30 years. However, concerns have arisen that some patients may be receiving unnecessary antihypertensive drug therapy leading to wasted resources and the potential for adverse drug effects. Once therapy has been started, treating physicians have difficulty in selecting patients for withdrawal and have concerns regarding patient safety and their own legal liability.
This study reviews and consolidates information from published studies to identify known predictors of the successful maintenance of normotension after antihypertensive drug withdrawal. The predictors were identified by determining the proportion of subjects with various baseline characteristics who remained normotensive while off medication for at least 12 months. From these data we have developed a clinical algorithm to help identify patients in whom antihypertensive drug withdrawal might be considered. This may assist primary care physicians in achieving successful withdrawal of antihypertensive therapy among selected hypertensive patients.
The most consistent predictors identified were blood pressure (BP) (lower pretreatment, on treatment, and after withdrawal), nature of pharmacotherapy (fewer agents and lower dose), and preparedness to accept dietary intervention (weight and sodium reduction).
On the basis of this information, a trial of withdrawal of antihypertensive medication might be recommended for patients who have mildly elevated, uncomplicated BP that is well controlled on a single agent, and who are motivated and likely to accept lifestyle changes.
在普通社区中对高血压的识别和治疗有助于减少过去30年中观察到的中风和冠心病病例。然而，人们担心一些患者可能正在接受不必要的抗高血压药物治疗，这会导致资源浪费以及药物不良反应的可能性。一旦开始治疗，治疗医生在选择停药患者时会遇到困难，并且会担心患者安全以及自身的法律责任。
本研究回顾并整合了已发表研究中的信息，以确定抗高血压药物停药后成功维持血压正常的已知预测因素。通过确定具有各种基线特征的受试者在停药至少12个月后仍保持血压正常的比例来确定预测因素。根据这些数据，我们开发了一种临床算法，以帮助识别可能考虑停用抗高血压药物的患者。这可能有助于初级保健医生在选定的高血压患者中成功停用抗高血压治疗。
确定的最一致的预测因素是血压（治疗前、治疗期间和停药后的较低血压）、药物治疗的性质（较少的药物和较低的剂量）以及接受饮食干预（减轻体重和减少钠摄入）的意愿。
基于这些信息，对于血压轻度升高、病情不复杂、仅用单一药物就能良好控制且有积极性并可能接受生活方式改变的患者，可能建议进行抗高血压药物停药试验。
