Clinical predictors of treatment reduction in hypertensive patients |
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Authors: | Dr John F Steiner MD MPH Stephan D Fihn MD MPH Thomas D Koepsell MD MPH Barbara Blair RN C MN Kathy Kelleher RN C MN Dianne D’Alessandro RN MSN Thomas S Inui ScM MD |
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Institution: | (1) Department of Medicine, University of Colorado Health Sciences Center, USA;(2) the Robert Wood Johnson Clinical Scholars Program, University of Washington, Seattle, Washington, USA;(3) the Health Services Research and Development Program, Seattle Veterans Administration Hospital, University of Washington, Seattle, Washington, USA;(4) the School of Public Health and Community Medicine (TDK), University of Washington, Seattle, Washington, USA |
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Abstract: | 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<95 mm Hg for ≥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≤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.
Presented in part at the annual meeting of the Society of General Internal Medicine, Arlington, Virginia, April 1988, and
the annual meeting of the Robert Wood Johnson Clinical Scholars Program, Miami, Florida, October 1988.
This study was conducted while Dr. Steiner was a Robert Wood Johnson Clinical Scholar at the University of Washington. Support
was provided by the Northwest Health Services Research and Development Program of the Veterans Administration.
The opinions, conclusions, and proposals in this paper are those of the authors, and do not necessarily represent the views
of the Robert Wood Johnson Foundation or the Veterans Administration. |
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Keywords: | hypertension blood pressure patient compliance clinical predictors antihypertensive medications |
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