Withdrawing long-term diuretic therapy in the elderly: a study in general practice in The Netherlands

Abstract

Background: About 20% of all men and women age 65 or older are on maintenance therapy with diuretics. Multiple drug use and side effects increase with age whereas a clear indication for long-term diuretic therapy is not always present. The aim of the present study was to assess whether in some patients long-term diuretic therapy could be withdrawn in general practice.

Methods: This study is a pilot-study for a large multicentered randomized controlled trial in general practice. In one general practice in The Netherlands, 15 diuretic-using patients were selected from a total population of 52. All had been using diuretics for more than six months, were not hypertensive, and did not show overt symptoms of heart failure. In these 15 patients, diuretic medication was withdrawn under careful medical monitoring conditions.

Results: After six months, six patients were still without diuretic therapy. Diuretic therapy had to be resumed in nine cases, because of congestive heart failure (one), hypertension (three), bronchial asthma (one), increased ankle edema (two) and subjective complaints (two). The withdrawal of diuretic therapy caused an increase in mean systolic blood pressure, heart failure score, body weight and ankle edema.

Conclusions: Long-term maintenance diuretic therapy in patients age 65 or older in general practice may be successfully withdrawn in selected cases. Careful medical surveillance during and after withdrawal is warranted.