Document Detail

Clinical predictors of treatment reduction in hypertensive patients.
MedLine Citation:
PMID:  2341919     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To demonstrate that some hypertensive patients under good blood pressure (BP) control can reduce medications, and to identify predictors of successful reduction. DESIGN: Observational study with 11-month follow-up. SETTING: Outpatient hypertension clinic at the Seattle Veterans Administration Hospital. PATIENTS: 59 males (51% of those eligible) with diastolic BP less than 95 mm Hg for greater than or equal to 6 months; 57 patients (97%) completed the study. INTERVENTION: Gradual reduction of medications unless diastolic BP rose above 95 mm Hg. MEASUREMENTS AND MAIN RESULTS: Intensity of treatment with BP medications was assessed using a scale of their comparative "vigors." 35 patients (59%) reduced medications successfully. By the end of the study, systolic BP had risen by 8.2 +/- 12.3 mm Hg (mean +/- SD) in successful patients, while diastolic BP did not change significantly. Two predictors of treatment reduction were statistically significant in both univariate and multivariate analyses: successful patients had been treated more intensively (2.7 +/- 1.7 vs. 1.3 +/- 0.5 "vigor units," p = 0.0001), and they had been enrolled in the clinic longer (5.5 +/- 3.0 vs. 3.1 +/- 2.3 years, p = 0.003). Lower systolic BP, higher urinary sodium excretion, lower compliance, and younger age were significant predictors of treatment reduction on univariate analysis only. Age less than or equal to 65 years had the highest sensitivity (86%) for treatment reduction, while treatment with two or more "vigor units" had the highest specificity (79%) and likelihood ratio (3.3). CONCLUSIONS: Treatment reduction is feasible in many well-controlled hypertensives, though systolic BP rises. Patients with high intensity and long duration of treatment are most likely to reduce medications successfully.
J F Steiner; S D Fihn; T D Koepsell; B Blair; K Kelleher; D D'Alessandro; T S Inui
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Journal of general internal medicine     Volume:  5     ISSN:  0884-8734     ISO Abbreviation:  J Gen Intern Med     Publication Date:    1990 May-Jun
Date Detail:
Created Date:  1990-06-27     Completed Date:  1990-06-27     Revised Date:  2009-02-24    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  203-10     Citation Subset:  IM    
Department of Medicine, University of Colorado Health Sciences Center, Denver 80262.
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MeSH Terms
Antihypertensive Agents / administration & dosage*,  therapeutic use
Attitude to Health
Blood Pressure / physiology
Clinical Protocols
Drug Administration Schedule
Hypertension / prevention & control*,  psychology
Middle Aged
Multivariate Analysis
Patient Compliance
Time Factors
Reg. No./Substance:
0/Antihypertensive Agents

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