Predictors of normotension on withdrawal of antihypertensive drugs in elderly patients: prospective study in second Australian national blood pressure study cohort
Nelson et al present interesting data about the probability of
remaining normotensive after withdrawal of antihypertensive treatment in
their study population. However, their study population is highly
selected, which may limit the generalisability of their results. To be
eligible for entry into their study, patients had to have remained
normotensive for two weeks after withdrawal of medication, so anyone with
a rapid return to hypertension was automatically excluded from their
study.
Do the authors have any data on what proportion of patients who
withdrew from medication were still normotensive at two weeks and
therefore eligible for inclusion in their study? If this is large, their
conclusions are probably reasonable. However, if only a small number of
patients maintain normotension for two weeks, then their conclusion that
'the findings of this study emphasise the value of a trial of withdrawal
of antihypertensive treatment' may not be justified, as the proportion of
patients remaining normotensive at one year in their study may be a
substantial overestimate of the probability of remaining normotensive in
unselected patients.
Rapid Response:
Highly selected population
Nelson et al present interesting data about the probability of
remaining normotensive after withdrawal of antihypertensive treatment in
their study population. However, their study population is highly
selected, which may limit the generalisability of their results. To be
eligible for entry into their study, patients had to have remained
normotensive for two weeks after withdrawal of medication, so anyone with
a rapid return to hypertension was automatically excluded from their
study.
Do the authors have any data on what proportion of patients who
withdrew from medication were still normotensive at two weeks and
therefore eligible for inclusion in their study? If this is large, their
conclusions are probably reasonable. However, if only a small number of
patients maintain normotension for two weeks, then their conclusion that
'the findings of this study emphasise the value of a trial of withdrawal
of antihypertensive treatment' may not be justified, as the proportion of
patients remaining normotensive at one year in their study may be a
substantial overestimate of the probability of remaining normotensive in
unselected patients.
Competing interests: No competing interests