This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Maland, L. J. Articles by Castle, C. H. Search for Related Content PubMed PubMed Citation Articles by Maland, L. J. Articles by Castle, C. H.

Hypertension, Vol 5, 539-544, Copyright © 1983 by American Heart Association

ARTICLES

Effects of withdrawing diuretic therapy on blood pressure in mild hypertension

LJ Maland, LJ Lutz and CH Castle

A 1-year double-blind placebo-controlled study on the effects of diuretic withdrawal was conducted on a group of 62 previously well- controlled, mildly hypertensive patients. Data were collected on blood pressure (BP), biochemical laboratory values, and subjective reports of side-effects. Twenty-six percent of placebo subjects and 3% of the active treatment subjects reached preset criteria for the return of hypertension (reverters). The average systolic and diastolic pressures of all placebo-treated patients who did not revert showed statistically significant increases. BP control was quickly reestablished in reverters by restarting diuretic therapy. No substantial differences in side-effects were reported between the groups, and laboratory changes were those consistent with known metabolic effects of thiazide and thiazide-like diuretics. This study showed a much lower reversion rate after treatment withdrawal than previously reported by other investigators. It also showed significant increases in BP of placebo patients who did not revert. Long-term diuretic therapy retains its effectiveness in responsive mild hypertensive patients, potentially offering protection against the increased risks of mortality and morbidity associated with even slight elevations of BP. Withdrawal of diuretics cannot be recommended for patients with mild hypertension without use of other equally effective interventions to maintain optimum BP control.

This article has been cited by other articles:

				S. Julius, S. Nesbitt, B. Egan, N. Kaciroti, M. A. Schork, M. Grozinski, E. Michelson, and for the TROPHY study group Trial of Preventing Hypertension: Design and 2-Year Progress Report Hypertension, August 1, 2004; 44(2): 146 - 151. [Abstract] [Full Text] [PDF]

				J. S. Trilling and J. Froom The Urgent Need to Improve Hypertension Care Arch Fam Med, September 1, 2000; 9(9): 794 - 801. [Abstract] [Full Text] [PDF]

				M. A. Espeland, P. K. Whelton, J. B. Kostis, J. L. Bahnson, W. H. Ettinger, J. A. Cutler, L. J. Appel, S. Kumanyika, D. Farmer, J. Elam, et al. Predictors and Mediators of Successful Long-term Withdrawal From Antihypertensive Medications Arch Fam Med, May 1, 1999; 8(3): 228 - 236. [Abstract] [Full Text] [PDF]

				S. C. Zell and C. K. Lardinois Treatment of Mild Hypertension: Decision Before Drugs Arch Fam Med, July 1, 1993; 2(7): 778 - 786. [Abstract] [PDF]

				R. E. Schmieder, J. K. Rockstroh, and F. H. Messerli Antihypertensive Therapy: To Stop or Not to Stop? JAMA, March 27, 1991; 265(12): 1566 - 1571. [Abstract] [PDF]

				M. S. Kochar, K. M. Landry, and S. M. Ristow Effects of Reduction in Dose and Discontinuation of Hydrochlorothiazide in Patients With Controlled Essential Hypertension Arch Intern Med, May 1, 1990; 150(5): 1009 - 1011. [Abstract] [PDF]

				Hypertension Detection and Follow-up Program Coope, N. Shulman, E. Tuttle Jr, G. Entwisle, A. Apostolides, A. Oberman, H. W. Schnaper, E. H. Kass, J. O. Taylor, B. F. Polk, et al. Persistence of Reduction in Blood Pressure and Mortality of Participants in the Hypertension Detection and Follow-up Program JAMA, April 8, 1988; 259(14): 2113 - 2122. [Abstract] [PDF]

				A. L. Dannenberg and W. B. Kannel Remission of Hypertension: The 'Natural' History of Blood Pressure Treatment in the Framingham Study JAMA, March 20, 1987; 257(11): 1477 - 1483. [Abstract] [PDF]

				M. H. Alderman, T. K. Davis, L. M. Gerber, and M. Robb Antihypertensive Drug Therapy Withdrawal in a General Population Arch Intern Med, July 1, 1986; 146(7): 1309 - 1311. [Abstract] [PDF]

				H. G. Langford, M. D. Blaufox, A. Oberman, C. M. Hawkins, J. D. Curb, G. R. Cutter, S. Wassertheil-Smoller, S. Pressel, C. Babcock, J. D. Abernethy, et al. Dietary Therapy Slows the Return of Hypertension After Stopping Prolonged Medication JAMA, February 1, 1985; 253(5): 657 - 664. [Abstract] [PDF]