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Titolo:
Predictors and mediators of successful long-term withdrawal from antihypertensive medications
Autore:
Espeland, MA; Whelton, PK; Kostis, JB; Bahnson, JL; Ettinger, WH; Cutler, JA; Appel, LJ; Kumanyika, S; Farmer, D; Elam, J; Wilson, AC; Applegate, WB;
Indirizzi:
Wake Forest Univ, Sch Med, Dept Publ Hlth Sci, Biostat Sect, Winston Salem, Wake Forest Univ Winston Salem NC USA 27157 Biostat Sect, Winston Salem, Wake Forest Univ, Sch Med, Dept Med, Winston Salem, NC 27157 USA Wake Forest Univ Winston Salem NC USA 27157 , Winston Salem, NC 27157 USA Tulane Univ, Sch Publ Hlth & Trop Med, New Orleans, LA USA Tulane Univ New Orleans LA USA Publ Hlth & Trop Med, New Orleans, LA USA Univswick, Dent New Jersey, Robert Wood Johnson Med Sch, Dept Med, New Brun Univ Med & Dent New Jersey New Brunswick NJ USA 08903 Dept Med, New Brun NHLBI, Bethesda, MD 20892 USA NHLBI Bethesda MD USA 20892NHLBI, Bethesda, MD 20892 USA Johns Hopkins Univ, Sch Hyg & Publ Hlth, Welch Ctr Prevent Epidemiol & Clin Johns Hopkins Univ Baltimore MD USA , Welch Ctr Prevent Epidemiol & Clin Johns Hopkins Univ, Sch Med, Baltimore, MD USA Johns Hopkins Univ Baltimore MD USA ins Univ, Sch Med, Baltimore, MD USA Univ Illinois, Dept Human Nutr & Dietet, Chicago, IL USA Univ Illinois Chicago IL USA , Dept Human Nutr & Dietet, Chicago, IL USA Univ Tennessee, Dept Med, Memphis, TN 38104 USA Univ Tennessee Memphis TNUSA 38104 ssee, Dept Med, Memphis, TN 38104 USA
Titolo Testata:
ARCHIVES OF FAMILY MEDICINE
fascicolo: 3, volume: 8, anno: 1999,
pagine: 228 - 236
SICI:
1063-3987(199905/06)8:3<228:PAMOSL>2.0.ZU;2-L
Fonte:
ISI
Lingua:
ENG
Soggetto:
RANDOMIZED CONTROLLED TRIAL; ELDERLY TONE; NONPHARMACOLOGIC INTERVENTIONS; MYOCARDIAL-INFARCTION; CROSS-VALIDATION; BLOOD-PRESSURE; UNITED-STATES; HYPERTENSION; THERAPY; REGRESSION;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
39
Recensione:
Indirizzi per estratti:
Indirizzo: Espeland, MA WakeWinston Univ, Sch Med, Dept Publ Hlth Sci, Biostat Sect, Med Ctr Blvd, Wake Forest Univ Med Ctr Blvd Winston Salem NC USA 27157 lvd,
Citazione:
M.A. Espeland et al., "Predictors and mediators of successful long-term withdrawal from antihypertensive medications", ARCH FAM M, 8(3), 1999, pp. 228-236

Abstract

Background: National guidelines recommend consideration of step down or withdrawal of medication in patients with well-controlled hypertension, but knowledge of factors that predict or mediate success in achieving this goal is limited. Objective: To identify patient characteristics associated with success, incontrolling blood pressure (BP) after withdrawal of antihypertensive medication. Design: The Trial of Nonpharmacologic Interventions in the Elderly tested whether lifestyle interventions designed to promote weight loss or a reduced intake of sodium, alone or in combination, provided satisfactory BP control among elderly patients (aged 60-80 years) with hypertension after withdrawal from antihypertensive drug therapy. Participants were observed for 15 to 36 months after attempted drug withdrawal. Main Outcome Measures: Trial end points were defined by (1) a sustained BPof 150/90 mm Hg or higher, (2) a clinical cardiovascular event, or (3),a decision by participants or their personal physicians to resume BP medication. Results: Proportional hazards regression analyses indicated that the hazard (+/-SE) of experiencing an end point among persons assigned to active interventions wa 75% +/- 9% (weight loss); 68% +/- 7% (sodium reduction), and 55% +/- 7% (combined weight loss/sodium reduction) that of the hazard for those assigned to usual care. Lower baseline systolic BP (P<.001), fewer years since diagnosis of hypertension (P<.001), fewer years of antihypertensive treatment (P<.001), and no history of cardiovascular disease(P=.01) were important predictors of maintaining successful nonpharmacological BP control throughout follow-up, based on logistic regression analysis. Age, ethnicity, baseline level of physical activity, baseline weight, medication class,smoking status, and alcohol intake were not statistically significant predictors. During follow-up, the extent of weight loss (P =.001) and urinary sodium excretion (P =.04) were associated with a reduction in the risk of trial end points in a graded fashion. Conclusions: Withdrawal from antihypertensive medication is most likely tobe successful in patients with well- controlled hypertension who have beenrecently (within 5 years) diagnosed or treated, and who adhere to lifestyle interventions involving weight loss and sodium reduction. More than 80% of these patients may have suer cess in medication withdrawal for longer than 1 year.

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Documento generato il 25/11/20 alle ore 17:25:13