Clinical predictors of treatment reduction in hypertensive patients

John F. Steiner, Stephan D. Fihn, Thomas D. Koepsell, Barbara Blair, Kathy Kelleher, Dianne D'Alessandro, Thomas S. Inui

Research output: Contribution to journalArticle

3 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)203-210
Number of pages8
JournalJournal of general internal medicine
Volume5
Issue number3
DOIs
StatePublished - May 1 1990
Externally publishedYes

Keywords

  • antihypertensive medications
  • blood pressure
  • clinical predictors
  • hypertension
  • patient compliance

ASJC Scopus subject areas

  • Internal Medicine

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    Steiner, J. F., Fihn, S. D., Koepsell, T. D., Blair, B., Kelleher, K., D'Alessandro, D., & Inui, T. S. (1990). Clinical predictors of treatment reduction in hypertensive patients. Journal of general internal medicine, 5(3), 203-210. https://doi.org/10.1007/BF02600534