A substantial proportion (probably 30-40%) of elderly persons are being treated with BP medications. The efficacy of BP drug therapy in older patient with diastolic or combined diastolic/systolic hypertension is well proven but there is little doubt that such therapy can adversely effect quality of life and the biochemical profile. There is a compelling rationale to (1) identify what proportion of medicates, well- controlled elderly hypertensives can be maintained. (long-term; greater than 30 months) in the normotensive state following withdrawal of BP medications, and (2) determine whether non-pharmacologic therapy can significantly increase the proportion with a successful outcome. Nine-hundred subjects (225 in each of four centers) 65-80 yrs. with a SBP less than 160 and DBP less than 90 mmhg while receiving one BP medication will be enrolled in a trial to test the efficacy of weight loss and sodium restriction (alone and combined) in maintaining the normotensive state following withdrawal of antihypertensive medications. Six-hundred overweight participants will be randomly assigned to weight loss, sodium restriction, combined weight loss and sodium restriction, or attention control. Three-hundred non-overweight participants will be randomly assigned to a sodium restriction or attention control group. The attention groups will be engaged in a series of non-BP related health encounters designed to control for non-specific effects of group contacts. Withdrawal of antihypertensive medications will be attempted following 6 weeks of intervention. The primary trial endpoint will be needed for recurrent antihypertensive drug therapy. The significance of the proposed study is that our findings may identify a non-pharmacologic approach which provides a safe and well-tolerated method by which to discontinue antihypertensive drug therapy in the approximately 15 million persons greater than or equal to 65 years who are currently being treated with BP medications. In addition, our study will identify the proportion of elderly hypertensives who can be maintained in the normotensive state without and intervention following withdrawal of their BP medications.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
1R01AG009799-01A1
Application #
3121727
Study Section
Biological and Clinical Aging Review Committee (BCA)
Project Start
1992-05-15
Project End
1996-04-30
Budget Start
1992-05-15
Budget End
1993-04-30
Support Year
1
Fiscal Year
1992
Total Cost
Indirect Cost
Name
Wake Forest University Health Sciences
Department
Type
Schools of Medicine
DUNS #
041418799
City
Winston-Salem
State
NC
Country
United States
Zip Code
27106
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Espeland, M A; Whelton, P K; Kostis, J B et al. (1999) Predictors and mediators of successful long-term withdrawal from antihypertensive medications. TONE Cooperative Research Group. Trial of Nonpharmacologic Interventions in the Elderly. Arch Fam Med 8:228-36
Whelton, P K; Appel, L J; Espeland, M A et al. (1998) Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group. JAMA 279:839-46

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