Remission of hypertension. The 'natural' history of blood pressure treatment in the Framingham Study

Abstract

Recent studies suggesting that adequate blood pressure control may be maintained without medication in some persons with mild hypertension have been limited by short follow-up and/or small sample size. The Framingham Heart Study provides an opportunity for long-term observation of antihypertensive medication use by a group of hypertensive subjects. While 801 (70%) of the 1138 cohort members taking such medication at two consecutive biennial examinations continued to receive medication until death or the end of observation, 242 subjects (21%) had blood pressure of at least 140/90 mm Hg and 95 subjects (8%) were normotensive at the first examination while not receiving medication. The 95 normotensive subjects had lower pretreatment blood pressure and a greater proportion with controlled blood pressure at 4, 8, and 12 years after first medication use than those in the first two groups. Eleven of these 95 subjects maintained good blood pressure control while not receiving medication for at least four years, including one subject who continued not to receive medication for 12 years. While virtually all hypertensive subjects eventually relapse, a small group may experience a period of emission of hypertension while not receiving medication. As further studies permit more specific identification of individuals who will do well not receiving medication, guidelines for medical care of hypertensive persons will need to be updated.