Once hypertensive, always hypertensive? A three year follow-up after stopping medication.

OBJECTIVE: To verify the existence of hypertension in a group of long-term pharmacologically treated hypertensives and to evaluate the possibility of discontinuing their medication.
DESIGN: The diagnosis of hypertension was established when after a wash-out period (one month) the blood pressure measured at three consecutive examinations, with at least one week interval between them, was always higher than WHO's reference levels for the diagnosis of hypertension. Those who did not fulfil these criteria would continue, with regular controls, without medication as long as clinically indicated. The final evaluation was done after a three year follow-up.
SETTING: The out-patient Hypertensive Unit of the Department of Geriatrics, Skellefteå Hospital, Sweden. PARTICIPANTS: 86 out-patients (33 males and 53 females) aged 68 to 82 years (mean 74) with long-term hypertension sent to our unit by general practitioners in our health district (population 80,000).
RESULTS: 34 of the initial 86 patients required medication by the end of the wash-out period. The remaining 52, 16 males and 36 females, continued without medication and after the three year follow up 14 of them were still without it. There was a striking difference between males and females since a significantly higher number of males than females were free of medication at the end of the period (p < 0.001). In those who restarted pharmacological therapy, the period without medication lasted no longer than five months.
CONCLUSIONS: Arterial hypertension can easily be over-represented as a diagnosis if not revised when clinically advisable or if established without accurate criteria. The possibility of stopping the antihypertensive medication in old patients is worth considering, particularly in male patients. The dangers of such strategy are practically minimal when regular controls are undertaken during the attempt.