Remission of hypertension: Retrospective observations over a period of 20 years

Abstract

To clarify the background and outcome of hypertensive patients who have remission of their elevated blood pressure (BP) after a course of antihypertensive drug therapy, we designed a retrospective observational study. The clinical records of 106 hypertensive men and women (BP, 164.3/104.4 mmHg) given antihypertensive drug treatment and subsequently examined every 1 to 3 mo for more than 20 yr were reviewed. The patients were divided into two groups: those who had remission (R-group) and those who did not have remission (N-group). Patients were considered in remission if no significant elevation in BP was observed for more than 1 yr after withdrawing their medication. Remissions ranging in duration from 1.6 to 21.7 yr (average duration, 6.3 yr) occurred in 19 of 106 patients (17.9%). However, anti-hypertensive drug treatment was eventually restarted in 17 of the 19 patients. Before treatment, comparison of the R-group and N-group revealed no differences with respect to age, body weight, BP, or serum creatinine. In contrast, the proportion of patients who lacked high-voltage deflections in their electrocardiograms (ECG) as well as that of patients whose BP was well-controlled by a single medication was significantly greater in the R-group than in the N-group (12/19 vs. 22/87, p<0.05 and 10/19 vs. 13/87, p<0.001, respectively). In addition, body weight in the R-group decreased significantly by the time drug therapy was withdrawn (p<0.01). Finally, significantly more patients (14 of 19 patients) entered remission in the spring and summer (p<0.05) than at other times of the year. We conclude that remission occurs in a subset of well-controlled hypertensive patients and may persist for several years or more. However, in the majority of patients, antihypertensive drug treatment will usually need to be restarted at some point. Patients who lack ECG high-voltage deflections and who are successfully treated with a single therapeutic agent are most likely to experience remission. Moreover, it appears that withdrawing patients from drug therapy in the spring or summer is more likely to yield a favorable outcome than at other times of the year.