Fagerberg B, Wikstrand J, Berglund G, Hartford M, Ljungman S, Wendelhag I
Department of Medicine I, Gothenburg University, Sahlgren's Hospital, Sweden.
J Hypertens. 1992 Jun;10(6):587-93. doi: 10.1097/00004872-199206000-00012.
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).
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.
Outpatient clinic in a city hospital.
A random sample of 56-year-old hypertensive men.
Gradual discontinuation of treatment with close follow-up of blood pressure.
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.
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.
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.
研究：（1）在多少接受治疗的高血压患者中可以停用药物治疗；（2）治疗中断后高血压复发的时间进程；（3）停药是否与左心室质量（LVM）增加有关。
对54名患有原发性高血压且平均治疗6年（主要采用β1选择性β受体阻滞剂）的男性进行停药评估。排除标准为器官损害迹象、重度高血压、其他严重疾病以及不愿意停药者。如果血压升高超过安全水平或出现症状，则重新开始治疗。在停药前以及停药后1周、4周和8周或恢复治疗前，通过超声心动图评估LVM。
城市医院的门诊诊所。
随机抽取的56岁高血压男性样本。
逐步停药并密切监测血压。
能够停药以及必须恢复药物治疗的患者数量；高血压发展的时间进程；LVM的绝对变化。
32名患者停药1至1000天。由于高血压或症状，所有患者均重新开始治疗。22名患者进行了系列超声心动图检查。在无药期间，相对室壁厚度增加，但LVM未增加。高血压复发迅速的患者停药前的LVM比血压升高较慢的患者更大。
少数患者能够停药并获得可读的超声心动图。停药后，相对室壁厚度增加，但LVM未增加。我们建议在研究左心室肥厚逆转时应避免纳入既往接受过治疗的患者。
