Briefs: Review of Predictors of Maintenance of Normotension After Withdrawal of Antihypertensive Drugs; ERT and Ovarian Cancer
Therapeutics & Drug Briefs
Review of Predictors of Maintenance of Normotension After Withdrawal of Antihypertensive Drugs
Source: Nelson M, et al. Am J Hypertension. 2001;14:98-105.
A substantial minority of patients 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Approximately 42% of patients in whom medication was withdrawn remained normotensive for at least 12 months.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.
ERT and Ovarian Cancer
Source: Rodriguez C, et al. JAMA. 2001;285:1460-1465.
The preponderance of epidemiologic data associates both endometrial and breast cancer with postmenopausal estrogen replacement therapy (ERT). The relationship of ovarian cancer to ERT is less clear. Recent case-control studies have suggested an increased risk with ERT, especially of long duration. Rodriguez and colleagues investigated the association between ERT and ovarian cancer mortality in a large population of female participants in the Cancer Prevention Study II (n = 676,526). Data were accrued over 14 years of observation, and include almost 1000 ovarian cancer deaths.
Even users of ERT had a slightly increased rate of ovarian cancer mortality (rate ratio = 1.23). This positive association increased in strength with duration of ERT use, so that persons using ERT for more than 10 years had an approximately 2-fold increase in relative risk. When coupled with the earlier case-control studies, this current report strengthens the concerns that ERT, especially of long duration, increases the risk of ovarian cancer mortality. Nonetheless, since total lifetime risk of ovarian cancer mortality is relatively small (< 2%), other potential favorable effects of ERT in other tissue compartments must be taken into account in the risk-benefit analysis. Additionally, the effect of concomitant progestational treatment has not been comprehensively addressed.
The Therapeutics & Drug Briefs were written by Louis Kuritzky, MD, Clinical Professor, University of Florida, Gainesville, Fla.
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