Nelson Mark R, Reid Chris M, Krum Henry, Muir Tui, Ryan Philip, McNeil John J
Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Prahran 3181, Australia.
BMJ. 2002 Oct 12;325(7368):815. doi: 10.1136/bmj.325.7368.815.
To identify simple long term predictors of maintenance of normotension after withdrawal of antihypertensive drugs in elderly patients in general practice.
Prospective cohort study.
169 general practices in Victoria, Australia.
503 patients aged 65-84 with treated hypertension who were withdrawn from all antihypertensive drugs and remained drug free and normotensive for an initial two week period; all were followed for a further 12 months.
Relative likelihood of maintaining normotension 12 months after drug withdrawal; relative likelihood of early return to hypertension after drug withdrawal.
The likelihood of remaining normotensive at 12 months was greater among younger patients (65-74 years), patients with lower "on-treatment" systolic blood pressure, patients on single agent treatment, and patients with a greater waist:hip ratio. The likelihood of return to hypertension was greatest for patients with higher "on-treatment" systolic blood pressure.
Age, blood pressure control, and the number of antihypertensive drugs are important factors in the clinical decision to withdraw drug treatment. Because of consistent rates of return to antihypertensive treatment, all patients from whom such treatment is withdrawn should be monitored indefinitely to detect a recurrence of hypertension.
确定在全科医疗中，老年患者停用抗高血压药物后维持血压正常的简单长期预测因素。
前瞻性队列研究。
澳大利亚维多利亚州的169家全科诊所。
503例年龄在65 - 84岁之间接受过高血压治疗的患者，他们停用了所有抗高血压药物，在最初两周内保持无药且血压正常；所有患者均进一步随访12个月。
停药12个月后维持血压正常的相对可能性；停药后早期恢复高血压的相对可能性。
在较年轻患者（65 - 74岁）、“治疗中”收缩压较低的患者、接受单药治疗的患者以及腰臀比更大的患者中，12个月时维持血压正常的可能性更大。“治疗中”收缩压较高的患者恢复高血压的可能性最大。
年龄、血压控制情况以及抗高血压药物的数量是决定停药治疗的临床决策中的重要因素。由于恢复抗高血压治疗的比例一致，所有停用此类治疗的患者都应无限期监测，以检测高血压复发情况。
