Clinical Briefs-By Louis Kuritzky, MD
April 30, 2001 3 minutes read
Clinical Briefs-By Louis Kuritzky, MD
Review of Predictors of Maintenance of Normotension After Withdrawal of Antihypertensive Drugs
A substantial minority of pa-tients receiving antihypertensive medications remains normotensive upon cessation of treatment. Some of these individuals were treated prematurely, without adequately establishing a diagnosis of hypertension (HTN) with certainty. Others have eliminated the etiology for their elevated blood pressures (eg, obesity or alcohol) but continue on unnecessary medication. All the reasons for restoration of normotension in some hypertensive patients are unknown. Clinicians and their patients would benefit from knowing which predictors are associated with sustained normotension after medication withdrawal. To that end, the authors reviewed articles that examined withdrawal of antihypertensive medications in persons who subsequently remained normotensive for at least 12 months.
Approximately 42% of patients in whom medication was withdrawn remained normotensive for at least 12 months. Patients with lower pretreatment or on-treatment BP, those with good control on fewer agents or lower doses, and those who used weight reduction and salt restriction at the time of medication withdrawal predictably experienced greater likelihood of remaining normotensive upon cessation of antihypertensive therapy. Patients with mild-to-moderate hypertension, especially those with favorable predictors, should be periodically considered for a trial of treatment cessation.
Nelson M, et al. Am J Hypertension. 2001;14:98-105.
Routine PSA Testing: What Do Men Believe?
The controversy about the merit (or lack of merit) in PSA screening for asymptomatic men remains unabated, despite an apparent increase in use of the testing by both clinician and patient initiation. The current study examined men’s knowledge about PSA testing, specifically in regards to perceived benefits of, recommendations for, and controversy around PSA testing.
A survey was administered to 442 adult men (³ age 50) at 2 sites in the United States and 1 in Canada, asking such questions as, "How much can regular PSA testing reduce a man’s chance of dying from prostate cancer" and "How beneficial do you believe regular PSA testing would be for you?"
Most men believed that regular PSA testing could significantly reduce the risk of dying from prostate cancer, though this belief was substantially more widespread in American than Canadian men (80% vs 63%). Even among men who had discussed PSA testing with their physician, there was no consistent awareness of any attendant controversy.
It has been suggested by some that the choice for PSA testing should be offered to the patient, after informed consent. Apparently, men are currently ill-informed about PSA testing, having a much more confident view of the potential value of PSA testing than has ever been demonstrated in a prospective, randomized, double-blind trial. v
Zemencuk JK, et al. Am J Med. 2001; 110:309-313.
Aggressive vs. Conventional Lipid Lowering on Atherosclerosis Progression in Familial Hypercholesterolaemia (ASAP)
Cholesterol lowering by means of HGMCoA Reductase agents (statins) has proven favorable for reduction of cardiovascular end points. It is not clear whether the greatest reductions in cardiovascular end points are correlated with the greatest degree of lipid lowering. Rather, there may be some threshold effect, or pharmacologic aspects of different members of the statins class may have differential effects.
Using carotid intima media thickness (IMT) as a surrogate marker for vascular atherosclerosis, Smilde and associates compared (n = 325) atorvastatin 80 mg q.d. with simvastatin 40 mg q.d. administered over 2 years time.
Atorvastatin provided greater cholesterol reduction than simvastatin. Carotid IMT demonstrated reduction in the atorvastatin recipients, but progression in persons treated with simvastatin.
This trial demonstrates a more favorable impact of atorvastatin than simvastatin on degree of cholesterol lowering, triglyceride reduction, and carotid IMT. Whether these favorable effects associated with more aggressive cholesterol reduction will be reflected in comparable cardiovascular end point attenuation remains to be fully elucidated.
Smilde TJ, et al. Lancet. 2001;357: 577-581.
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