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Biomedical subjects

J F Potter

Publications and source records attributed to J F Potter.

At least 19 recordsLinked to original sources
PubMed1995

Screening tests for microalbuminuria in non-diabetic elderly subjects and their relation to blood pressure.

1. Microalbuminuria in non-diabetic elderly subjects is predictive of vascular disease and mortality, and related to levels of blood pressure. 2. This study was designed to examine whether more restricted periods of urine collection retained the relation to the prevailing level of blood pressure and successfully identified subjects with microalbuminuria. 3. Fifty elderly subjects (aged over 60 years) made two consecutive 24-h urine collections for measurement of urinary albumin excretion, divided between daytime and night-time periods. Thirty-three subjects also provided a random 'spot' urine sample. Clinic and 24-h ambulatory blood pressure were also recorded. 4. Median 24-h urinary albumin excretion was 15.75 mg; 17 subjects had microalbuminuria. The median 24-h albumin-creatinine ratio was 1.91 mg/mmol. A threshold albumin-creatinine ratio of > or = 3.0 mg/mmol in a random urine sample predicted microalbuminuria with 92% sensitivity and 90% specificity. Alternatively, threshold values of 2.5 mg/mmol for men and 4.5 mg/mmol for women in an overnight urine collection predicted microalbuminuria with 88% sensitivity and 100% specificity. 5. The closest relation between albumin-creatinine ratio and blood pressure was that between spot albumin-creatinine ratio and clinic systolic blood pressure (r = 0.64, P < 0.001). Albumin-creatinine ratio was generally related to clinic systolic blood pressure, diastolic blood pressure and ambulatory systolic blood pressure. Microalbuminuric subjects had significantly higher levels of clinic and ambulatory systolic blood pressure than non-microalbuminuric subjects. 6. Microalbuminuria in the elderly is most related to clinic systolic blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1995

Effect of hospitalization on conventional and 24-hour blood pressure.

Blood pressure (BP) levels, particularly in hypertensives, often fall on admission to hospital. Whether such a BP fall also occurs for BP measured automatically without the presence of medical and nursing staff and hence without the alerting reaction has not previously been studied. Twenty-two subjects, mean age 80 +/- 7 years (BP range 110-190/60-110 mmHg) underwent nurse-taken BP measurements and 24-hour non-invasive BP monitoring on admission to hospital and again after 5 days. Nurse-taken systolic BP (SBP) levels on admission fell significantly from 149 +/- 21 mmHg to 137 +/- 16 mmHg (p < 0.01) on day 2, to 131 +/- 16 mmHg on day 5 (p < 0.05). Mean diastolic BP (DBP) levels showed a less marked fall over 5 days from 87 +/- 12 mmHg to 84 +/- 11 mmHg (p < 0.05). Mean 24-hour BP levels showed no significant change from admission to day 5 (131 +/- 17/72 +/- 12 mmHg vs. 131 +/- 17/72 +/- 10 mmHg, respectively). In addition, nurse-taken SBP on day 5 was similar to mean 24-hour and daytime SBP taken on day 1 or day 5. Using shorter periods of BP monitoring gave similar mean BP levels to the full mean 24-hour BP level although BP reproducibility was poorer, even with more than 10 hours of BP monitoring. A period of automatic BP monitoring on admission to hospital will rapidly reveal a patient's sustained hospital BP level.

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PubMed1995

Reproducibility of the circadian systolic blood pressure variation in the elderly.

OBJECTIVES: To establish the reproducibility of the nocturnal systolic blood pressure (SBP) change in elderly subjects and to examine the use of cumulative sums (cusums) analysis in the assessment of circadian SBP variation. SUBJECTS: Forty-two untreated elderly subjects (35 hypertensive, 7 normotensive) of mean age 75.5 years from the hypertension clinic at a large teaching hospital participated in a reproducibility study. METHODS: Twenty-four-hour ambulatory blood pressure monitoring was performed and repeated at a median interval of 2 months (range 2 weeks to 9 months). OUTCOME MEASURES: Reproducibility of circadian SBP variation from fixed time analysis of day-night SBP difference and from cusums-based parameters. RESULTS: Twenty-four-hour SBP values were highly reproducible with a coefficient of variation of 5.8%. However, the day-night SBP difference for fixed time periods was poorly reproducible, with a coefficient of variation > 130%. A substantial proportion of subjects (36-43%) altered their 'dipping status' between visits. The use of cusums analysis improved the reproducibility of measures of circadian SBP change (cusums plot height and maximum circadian variation) with coefficients of variation falling to 40 and 38%, respectively. CONCLUSIONS: The use of fixed time definitions results in poor reproducibility of the circadian SBP change in the elderly, which will lead to regression dilution bias when studying the relationship of circadian SBP variation to outcome measures in hypertension. The notion of dipping and non-dipping circadian blood pressure patterns should be abandoned in favour of more reproducible cusums-based measures of circadian blood pressure variation.

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PubMed1995

The reliability and validity of the Geriatric Depression Rating Scale administered by telephone.

OBJECTIVE: To evaluate prospectively the reliability and validity of the Geriatric Depression Scale administered by telephone (T-GDS) in patients undergoing outpatient comprehensive geriatric assessment. SUBJECTS: A total of 101 geriatric patients were evaluated in a 1-year period at the outpatient Geriatric Assessment Center of the University of Nebraska Medical Center. METHODS: The 30-item GDS was completed by all patients on three occasions: by telephone several days before their assessment, face-to-face during their assessment visit, and several days later, again by phone. During their assessment, all patients were evaluated by one of three geriatric psychiatrists who were blind to all GDS results. The test-retest reliability of the T-GDS was measured by comparing the results of the two phone interviews. The construct validity of the T-GDS was estimated by comparing the results of the initial T-GDS to the GDS obtained during the comprehensive assessment. The criterion validity of the T-GDS was estimated by comparing the results of the T-GDS with the clinical diagnosis of depression assigned by the psychiatrists. RESULTS: The individual items of the initial T-GDS showed substantial concordance with the second T-GDS (kappa range 0.35-0.75, mean = 0.52), and with the assessment GDS (kappa range 0.29-0.75, mean = 0.52). One item showed evidence of bias when comparing the two T-GDSs, and two items when comparing the initial T-GDS to the GDS done during the assessment. The mean number of symptomatic responses was not significantly different for the T-GDS versus assessment administration but did decline slightly when comparing the two T-GDSs. ROC curve analyses showed good agreement between the clinical diagnosis and the T-GDS. CONCLUSION: The GDS appears to maintain its reliability and validity when administered via telephone and thus may be useful for a variety of epidemiological and clinical purposes.

Activities of Daily Living↗
PubMed1995

Pulse pressure and resistance artery structure in the elderly.

There has been recent interest in the possibility that resistance vessel structural adaptation in hypertension may be more closely related to pulse pressure than to other blood pressure parameters. We investigated the relation between blood pressure and resistance vessel structure in a group of subjects from an age group (older than 60 years) in which a widening of pulse pressure is a typical finding and characterized blood pressure parameters using 24-hour ambulatory blood pressure monitoring. We studied resistance vessels retrieved from biopsies of skin and subcutaneous fat taken from the gluteal region of 32 subjects under local anesthesia (age, 70 +/- 1 years [mean +/- SEM], 21 of whom were hypertensive and 11 normotensive. Media-lumen ratio was higher in the hypertensive than the normotensive subjects (18.6 +/- 1.6% versus 12.8 +/- 1.2%, P < .01) and correlated with age (r = .44, P < .05), clinic systolic pressure (r = .35, P < .05), 24-hour systolic pressure (r = .40, P < .05), and 24-hour pulse pressure (r = .56, P < .001). Stepwise multivariate regression analysis identified clinic and 24-hour pulse pressure as the only significant predictors of media-lumen ratio independent of age, other parameters of clinic blood pressure, and blood pressure variability (R2 = 41%, P < .05). These findings confirm those from animal models of hypertension in demonstrating the importance of pulse pressure in relation to cardiovascular structural adaptation and have important implications for the goals of treatment of hypertension in the elderly.

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PubMed1995

Postprandial and orthostatic cardiovascular changes after acute stroke.

BACKGROUND AND PURPOSE: Large falls in blood pressure after meals have been demonstrated in fit and frail elderly subjects; these changes may be associated with an increased incidence of stroke. Postprandial falls in BP may be particularly deleterious after acute stroke, when normal baroreflex mechanisms and cerebral autoregulation are already impaired, resulting in stroke progression. Therefore, the postprandial hemodynamic responses to orthostasis were examined in nine acute stroke subjects and eight age-, sex-, and blood pressure-matched control subjects after an oral energy load. METHODS: All subjects were studied on two occasions in a randomized, double-blind, crossover trial after administration of either oral glucose (1 g/kg body wt) or equivalent isovolumic, isosmotic xylose (0.83 g/kg). Measurements of blood pressure, pulse rate, and forearm blood flow were recorded for 30 minutes preprandially and 90 minutes postprandially. Hemodynamic responses to 60 degrees tilt, along with plasma glucose and insulin changes, were measured at baseline and at 30-minute intervals postprandially. RESULTS: Supine mean arterial and diastolic blood pressures fell significantly after glucose but not xylose ingestion in control subjects (P < .03) but not stroke subjects, whereas supine pulse rate increased in stroke subjects (P < .04) only. No significant changes in forearm vascular resistance were recorded in either control or stroke subjects. After tilt, stroke subjects showed a fall in mean arterial pressure compared with control subjects preprandially (P = .03) and at 30 (P < .005) and 90 (P < .03) minutes postprandially, although no differences were observed between the xylose and glucose phases. Orthostatic tolerance was maintained in control subjects throughout both phases of the study. Pulse rate increased significantly to tilt at all time intervals in both groups, although there were no significant changes in forearm vascular resistance. CONCLUSIONS: Acute stroke subjects are not at significantly greater risk of blood pressure falls in response to an oral energy load than age-, sex-, and blood pressure-matched control subjects. Unlike control subjects, the stroke group had an increased pulse-rate postprandially, which could result in a compensatory rise in cardiac output as a result of increased sympathetic nervous system activity in the poststroke period. Although orthostatic blood pressure control is impaired after acute stroke, these changes are unaffected by meals.

Acute Disease↗
PubMed1995

Malignant hypertension in the elderly.

To investigate age-related differences in malignant hypertension (MHT), we studied 38 elderly patients (18 males, 20 females; mean age 70.6 years, SD 4.6 years, range 65 to 84) and 277 younger patients (193 males, 84 females; mean age 46.4 years, SD 10.5, range 15 to 64) with MHT presenting 1965-93. Mean duration of known hypertension before presentation was greater in the elderly group (43.8 months vs. 23.1 months). The elderly group included 18 (47.4%) newly diagnosed hypertensives, compared to 160 (55.8%) in the younger group. At presentation, 19 (50.0%) elderly patients were receiving no antihypertensive drug therapy, whilst 18 (47.4%) were taking one or more drugs for hypertension. Presenting clinical features in elderly MHT patients included visual disturbance (9), headaches (2), headaches with visual disturbance (2), stroke (3), and heart failure (2). Six patients were asymptomatic. The commonest clinical complications were ischaemic heart disease (angina and myocardial infarction) (5), heart failure (4) and stroke (4). The majority (58%) of patients, however, had no vascular complications at presentation. Comparing elderly and younger MHT groups, there was no significant difference in presenting systolic blood pressures, although mean diastolic blood pressure was significantly greater in the younger group (mean 143.7 mmHg +/- 19.3 vs. 130.0 mmHg +/- 15.2; p < 0.0001). After a mean follow-up of 30.9 months (SD 37.1; range 1 to 123 months), 17 (44.7%) of the elderly patients were still alive, 15 were dead (39.5%) and six were lost to follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1994

Can topical zinc accentuate tuberculin reactivity in the elderly?

We examined the effect of topical zinc on Heaf tests in 58 elderly hospitalized patients in a double-blind study. Plasma zinc levels were measured. Thirty-eight subjects (66%) had negative reactions with placebo ointment. Fourteen of these negative responders (37%) had positive reactions with topical zinc ointment; 12 (32%) had weakly positive reactions and 12 remained negative. There was no significant difference in the plasma zinc levels between the different grades of topical zinc effect in the negative responders. Zinc deficiency is therefore unlikely to account for the observed booster effect of topical zinc on tuberculin reactivity.

Administration, Topical↗
PubMed1994

The outcome of a medical examination for applicants to Leicestershire homes for older people.

Medical screening of applicants to residential homes for older people has been shown to redirect inappropriate applications, although other outcomes have not been reported. This study assessed 117 applicants, of whom 63% were medically examined and offered medically directed interventions if indicated. All applicants were then reassessed at 6 and 12 weeks. No significant differences in survival, or changes in cognitive score, disability, incontinence or self-reported health were found between intervention and control groups. Intervention did redirect some applicants to more appropriate care and resulted in significantly greater improvements in morale. These results raised the question of whether it is appropriate for medical assessment to be used primarily to enforce admission criteria in the absence of other significant health benefits. However, the greater improvements in morale of the intervention group did indicate some benefit from the medical examination.

Activities of Daily Living↗
PubMed1994

Eligibility of acute stroke patients for pharmacological therapy.

The aims of this study were to analyse the characteristics of patients with acute stroke and to ascertain the number of patients meeting eligibility criteria commonly applied in clinical trials of pharmacological agents for ischaemic stroke. Details of all consecutive admissions with a diagnosis of acute stroke (n = 410, 55% female, mean age 77, range 22-99 years) admitted over a 12-month period to a district general hospital were recorded. Major exclusion criteria used in acute stroke trials were applied to data collected from the study patients. Exclusion criteria were met by 386 (94%) stroke patients, 188 (46%) had admission delay > 12 hours, 85 (21%) had pre-existing major disability, 80 (20%) minor stroke, 66 (15%) had coexisting severe illness, 51 (12%) were unconscious, and 30 (7%) had major electrolyte or ECG abnormalities. One hundred and five (26%) had two or more exclusion criteria. The majority of acute stroke patients admitted to a district general hospital would be likely to be excluded from most current pharmacological treatment studies.

Adult↗
PubMed1994

Predictors of mortality in outpatient geriatric evaluation and management clinic patients.

BACKGROUND: This study describes characteristics and predictors of survival in an outpatient Geriatric Evaluation and Management (GEM) population. METHODS: Prospective evaluation and longitudinal follow-up of consecutive patients (N = 636) seen in a GEM Clinic between January 1986 and September 1991. RESULTS: The typical patient was 78.4 years of age, White, female (73%), unmarried (66%), and living with a spouse or relative (47%). Although two-thirds were demented, most were independent in Activities of Daily Living (ADL) and partially dependent in Instrumental Activities of Daily Living (IADL). Subjects were followed for an average of 25 months. In bivariate analysis, IADL was the strongest predictor of survival (O.R. = 4.4). Higher ADL, better cognitive status, lower comorbid illness, and lack of recent hospitalization were also predictive of survival. In stepwise logistic regression, only IADL (O.R. = 4.2) and comorbid illness (O.R. = 1.5) predicted survival. In Kaplan-Meier Lifetable Analysis, survival at two years was 91% in the least dependent IADL group while survival was 75% in the most dependent group. Comorbid illness was the only factor that improved prediction of survival above that seen with IADL alone. When subjects are stratified by both function and illness, mortality was 36% in the ill and disabled group and 8% in those of high function and limited illness. CONCLUSIONS: IADL and comorbid illness scores offer a means of stratifying subjects for risk of death and may be useful in evaluating and comparing mortality experience in outpatient GEM and control populations. Stratification may increase the likelihood that studies aimed at improving survival will detect a difference resulting from the intervention.

Activities of Daily Living↗
PubMed1994

Hypertension and the elderly.

Cardiovascular disease remains the major cause of death in elderly people, with hypertension the main treatable risk factor. Despite this there has been little consensus with regard to assessment or treatment of the elderly hypertensive patient. Several recent large intervention trials have shown blood pressure (BP) reduction in elderly patients with combined and isolated systolic hypertension using thiazide diuretics or beta-blockers significantly reduces cardiovascular morbidity and mortality. However, only the STOP-Hypertension Trial has shown a reduction in total mortality with active treatment. Patients under 80 years with an SBP > or = 160 mmHg and DBP > or = 90 mmHg or SBP > or = 160 mmHg and DBP < 90 mmHg should be considered for anti-hypertensive therapy, initially using non-pharmacological methods. Thiazide diuretics and beta-blockers remain first-line pharmacological therapy, the long-term benefits of other types of anti-hypertensive agent have yet to be assessed. In general the negative attitudes to treating hypertension in the elderly can no longer be upheld, although in certain sub-groups the benefits of treatment are as yet unproven.

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PubMed1994

The changes in blood pressure after acute stroke: abolishing the 'white coat effect' with 24-h ambulatory monitoring.

OBJECTIVES: To assess the changes in 24-h and casual blood pressure (BP) levels following hospitalization for acute stroke. DESIGN: Prospective study of patients admitted with acute hemispheric stroke and hospitalized controls using casual and 24-h BP monitoring. SETTING: Medical wards in a large teaching hospital. SUBJECTS: Thirty-three patients (median age 77 years, 17 male) and 21 control subjects admitted non-acutely. INTERVENTIONS: All subjects underwent 24-h BP monitoring within 24 h of stroke onset (patients) or admission (controls) and again at 1 week. Casual BPs were recorded over the same period. MAIN OUTCOME MEASURES: The change in BP over the first week in each group. Eleven stroke subjects had 24-h BP monitoring repeated at 6 months. RESULTS: In the stroke group, 24-h systolic BP (SBP) fell by 7 mmHg (95% CI, 0 to 14 mmHg; P < 0.05) and diastolic BP (DBP) by 3 mmHg (95% CI, 0 to 6 mmHg; P < 0.02) over the first week. Mean 24-h BP levels in the control group did not change during this period. However, casual BP recordings fell in both stroke (18/12 mmHg) and control (19/9 mmHg) groups. Stroke subjects followed to 6 months showed no further change in 24-h BP (day 7: 137 +/- 17/79 +/- 13 mmHg; month 6: 138 +/- 16/78 +/- 11 mmHg). CONCLUSIONS: Although there was a large fall in causal BPs seen in both groups there was only a small, but a significant fall in mean 24-h BP over the first week following hemispheric stroke that was not seen in control subjects. Although the 'white coat effect' and admission to hospital play an important part in the high casual BP observed in the days following acute stroke they are unlikely to be the sole factors.

Acute Disease↗
PubMed1994

Orthostatic hypotension and anti-hypertensive therapy in the elderly.

The effect of withdrawing or continuing anti-hypertensive therapy on orthostatic blood pressure change in elderly hypertensive subjects was examined. Subjects meeting criteria for therapy withdrawal had supine and standing blood pressure measurements taken on treatment, and at 1, 3, 6, 9 and 12 months off treatment whilst receiving standard non-pharmacological advice to lower blood pressure. Subjects not meeting blood pressure criteria for treatment withdrawal or were unwilling to stop treatment had blood pressure measurements taken after 6 and 12 months whilst also receiving non-pharmacological advice. Orthostatic hypotension was defined as a mean systolic blood pressure fall > or = 20 mmHg on standing from a supine position. Forty-seven subjects (median age 76 years, range 65-84 years) had treatment withdrawn. Thirteen subjects (median age 73 years, range 68-82 years) continued on their treatment. Twelve months after treatment withdrawal there was a significant reduction in the number demonstrating orthostatic hypotension from 11 (23%) to four (11%) (P < 0.05), whilst the group continuing on treatment showed no change. In the withdrawal group those with orthostatic hypotension on treatment (n = 11) were older (79 versus 74 years, P = 0.05), had higher prewithdrawal systolic blood pressure (164 +/- 21 versus 147 +/- 17 mmHg, P = 0.02) compared to those without, although there was no difference in body mass index, gender, number or type of anti-hypertensive drugs taken. In elderly hypertensive subjects withdrawal of anti-hypertensive therapy and institution of non-pharmacological treatment can over several months reduce the prevalence of orthostatic hypotension.

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PubMed1994

Factors affecting changes in blood pressure after acute stroke.

BACKGROUND AND PURPOSE: We sought to establish the pattern of blood pressure (BP) change after hospitalization for acute hemispheric stroke. METHODS: In 292 patients from the Leicester teaching hospitals with acute hemispheric stroke within the previous 24 hours (139 men; median age, 75 years [range, 42 to 98 years]), we prospectively studied BP changes between admission, 24 hours, 1 week, and 4 to 6 weeks. Changes were assessed in relation to the main stroke risk factors, stroke type and severity, and antihypertensive drug treatment. All subjects were followed up for 1 week, with 117 subjects followed up for 4 to 6 weeks. Changes were assessed by repeated-measures ANOVA, and Student's t tests were used to compare group pairs. RESULTS: Systolic and diastolic BP fell by 12 mm Hg (95% confidence interval [CI], 8 to 15 mm Hg) and 7 mm Hg (95% CI, 5 to 9 mm Hg), respectively, in the first 24 hours and 22 mm Hg (95% CI, 18 to 25 mm Hg) and 12 mm Hg (95% CI, 10 to 14 mm Hg), respectively, during the first week (all changes significant at P < .01) but no further thereafter. In those patients receiving no antihypertensive medication before or after stroke, the pattern of change was similar to that of the whole group. Previously diagnosed hypertensive subjects (n = 106) had higher initial BP values than did normotensive subjects, although by 1 week the levels were not significantly different. Patients with cerebral hemorrhage confirmed by computed tomography (n = 20) had higher systolic BP, but not diastolic BP, throughout the first week than those with cerebral infarction (n = 89). The severity of stroke, age, and previous stroke history did not appear to alter the BP pattern. Stroke patients who were moderate to heavy alcohol consumers had lower convalescent systolic BP levels than lighter drinkers or abstainers. CONCLUSIONS: We have demonstrated a marked fall in systolic and diastolic BP levels during the first 7 days after acute hemispheric stroke, with little change thereafter. Higher initial systolic BP values were found in patients with cerebral hemorrhage compared with those with cerebral infarct. Moderate to heavy alcohol consumption before stroke was associated with a greater systolic BP decline in the first week after the event compared with stroke patients who were light drinkers or abstainers.

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PubMed1994

Clinic and 24h blood pressure in elderly treated hypertensives with postural hypotension.

The objectives of this study were to determine the prevalence of, and factors associated with, postural hypotension (PH) in elderly treated hypertensive subjects, to examine the 24h BP profile in those subjects with and without PH and to determine the effects of antihypertensive treatment withdrawal on the prevalence and symptoms of PH. Eighty-six subjects (mean age +/- standard deviation 76 +/- 6 years) on antihypertensive drug therapy for > 6 months had three clinic BP measurements taken in supine and standing positions followed by 24h ambulatory BP monitoring. Forty-seven subjects underwent repeat BP measurement five weeks after withdrawal of antihypertensive medication and institution of standard nonpharmacological methods. Twenty-six (30%) of the 86 subjects exhibited PH (defined as SBP fall on standing > or = 20 mmHg) within three minutes of standing. Supine clinic and 24h SBP and DBP, age and presence of previous cardiovascular events were similar in the groups with and without PH. There was a significant correlation between the orthostatic BP fall for all subjects and day-night SBP difference (r = -0.30, P = 0.01) and urinary sodium:creatinine ratio (r = -0.33, P = 0.04). Multiple regression analysis revealed only the day-night SBP difference was a significant predictor of orthostatic BP change. In the PH group, 19 subjects had treatment withdrawn resulting in a reduction of 58% (P > 0.001) in those continuing to demonstrate PH. If indicated a trial of antihypertensive drug treatment withdrawal could reduce the risk of PH; the additional benefit of instituting nonpharmacological therapy in reducing BP and orthostatic hypotension warrants further assessment.

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PubMed1994

Possibilities for antihypertensive drug therapy withdrawal in the elderly.

The aims of this study were to determine: (1) the proportion of elderly hypertensive subjects currently attending a hospital hypertension clinic suitable for a trial of antihypertensive drug withdrawal, (2) the proportion of suitable patients who can be successfully withdrawn from drug therapy while receiving nonpharmacological advice, and (3) the factors associated with successful withdrawal. One hundred and five consecutive hypertensive subjects, 53% female, mean age 76 years (range 65-84 years) on pharmacological antihypertensive therapy for > 1 year were studied, of whom 78 (74%) had a clinic SBP < 175 mmHg and DBP < 100 mmHg. Subjects with recent myocardial infarction or stroke or with symptoms of ischaemic heart disease were excluded. Antihypertensive drug therapy was withdrawn in this group and nonpharmacological advice to lower BP was instituted. Clinic BP and weight were subsequently recorded monthly for 12 months in all subjects and at every three months in those who had a possible follow-up period of 24 months. The 24h ambulatory BP was measured at baseline and repeated one month off therapy; 24h urine electrolytes were also assessed at baseline and at 12 months or before restarting drug therapy. Seventy-four (70%) subjects had a potential follow-up of 12 months (four were withdrawn from the study) and 64 were available for two years of follow-up. Antihypertensive treatment was restarted if SBP > or = 160 mmHg and/or DBP > or = 90 mmHg on two consecutive visits. After 12 months, 20 (25%) of those withdrawn remained normotensive, the majority restarting therapy did so in the first three months.(ABSTRACT TRUNCATED AT 250 WORDS)

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