By Will Boggs, MD

NEW YORK, Mar 06 (Reuters Health) - People with hypertension (high blood pressure) who have their blood pressure under control may be able to try stopping their medication--under the supervision of their doctor--without experiencing a return of their high blood pressure, researchers report.

However, this seems to be true only for those patients with mildly elevated pressure who are willing to make substantial lifestyle changes, including cutting back on salt and losing weight, according to Dr. Michael A. Weber, an editor of the American Journal of Hypertension from Downstate Medical College in New York.

"Those patients who conscientiously lowered their weight and reduced their salt intake while receiving treatment were most likely to keep their blood pressure normal when treatment was stopped. This suggests that normal blood pressure may be at least partly in your own hands," Weber told Reuters Health.

One in 10 adults take medication for hypertension, and once treatment is begun, doctors are reluctant to discontinue the therapy, according to Dr. Mark Nelson and colleagues from Monash Medical School, Alfred Hospital in Prahran, Australia. This is because high blood pressure is dangerous, increasing the risk of stroke and heart attack.

Recognizing that hypertension might be overdiagnosed and that unnecessary treatment is costly, the investigators reviewed a dozen studies to determine what factors might predict the safe and successful withdrawal of high blood pressure medications.

Three consistent predictors of success emerged from the analysis, according to the report published in the February issue of the American Journal of Hypertension. First, patients whose blood pressure was lower before, during, and after treatment were more likely to have normal blood pressure a year after discontinuing their medications.

Second, the researchers note, withdrawal of medications was most likely to succeed for those patients who had required the fewest medications at the lowest doses to control their blood pressure in the first place.

Third, those patients who followed recommendations for controlling their weight and lowering their salt intake were more likely to keep their blood pressure within normal levels after stopping their medications, the results indicate.

When withdrawal failed, high blood pressure was most likely to return during the first 6 months, the authors report, though the risk was still there after a year or more.

"On the basis of this information," Nelson and colleagues conclude, "a trial of withdrawal of antihypertensive medication might be recommended for patients who have mildly elevated, uncomplicated blood pressure that is well controlled on a single agent, and who are motivated and likely to accept lifestyle changes."

Weber also suggested that patients with newly diagnosed hypertension discuss the diagnosis with their physicians.

According to Weber, "20% to 25% of patients diagnosed with hypertension may not really have the condition. It's important that the diagnosis be based on several blood pressure readings during more than one doctor visit, especially for mild to moderate hypertension."

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