Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Can drug therapy be discontinued in well-controlled hypertension?

William J Elliott, MD, PhD
Section Editor
George L Bakris, MD
Deputy Editors
Daniel J Sullivan, MD, MPH
John P Forman, MD, MSc


The large majority of patients with hypertension will require lifelong antihypertensive drug therapy to control their blood pressure. However, some patients with hypertension have well-controlled blood pressures, occasionally needing just a single medication. After a year below the target blood pressure, many wonder whether antihypertensive drug therapy can be gradually diminished or even discontinued. The issue of discontinuation of drug therapy also arises in patients who develop symptoms related to low blood pressure.

Discontinuation of antihypertensive drug therapy in patients with controlled blood pressure is discussed in this topic. Withdrawal syndromes that may develop as a result of drug discontinuation are presented elsewhere. (See "Withdrawal syndromes with antihypertensive therapy".)


Identifying candidates for drug withdrawal — Diminishing or discontinuing antihypertensive medication may be possible among patients with hypertension that is well controlled for at least one year [1-4].

Among such patients in one study, approximately 40 percent remained free from antihypertensive drugs at one year after discontinuation [1,4], and approximately 25 percent remained off therapy at two years [4]. A larger fraction can successfully decrease the number and/or dose of medications taken [1,3,5].

Higher success rates for cessation of antihypertensive therapy are seen in individuals with the following characteristics:

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Dec 06, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Schmieder RE, Rockstroh JK, Messerli FH. Antihypertensive therapy. To stop or not to stop? JAMA 1991; 265:1566.
  2. Course of blood pressure in mild hypertensives after withdrawal of long term antihypertensive treatment. Medical Research Council Working Party on Mild Hypertension. Br Med J (Clin Res Ed) 1986; 293:988.
  3. Freis ED, Thomas JR, Fisher SG, et al. Effects of reduction in drugs or dosage after long-term control of systemic hypertension. Am J Cardiol 1989; 63:702.
  4. van der Wardt V, Harrison JK, Welsh T, et al. Withdrawal of antihypertensive medication: a systematic review. J Hypertens 2017; 35:1742.
  5. Nelson MR, Reid CM, Krum H, et al. Short-term predictors of maintenance of normotension after withdrawal of antihypertensive drugs in the second Australian National Blood Pressure Study (ANBP2). Am J Hypertens 2003; 16:39.
  6. Qiu C, Winblad B, Fratiglioni L. The age-dependent relation of blood pressure to cognitive function and dementia. Lancet Neurol 2005; 4:487.
  7. Kennelly SP, Lawlor BA, Kenny RA. Blood pressure and the risk for dementia: a double edged sword. Ageing Res Rev 2009; 8:61.
  8. Moonen JE, Foster-Dingley JC, de Ruijter W, et al. Effect of Discontinuation of Antihypertensive Treatment in Elderly People on Cognitive Functioning--the DANTE Study Leiden: A Randomized Clinical Trial. JAMA Intern Med 2015; 175:1622.
  9. Hirakawa Y, Arima H, Webster R, et al. Risks associated with permanent discontinuation of blood pressure-lowering medications in patients with type 2 diabetes. J Hypertens 2016; 34:781.
  10. Sussman JB, Kerr EA, Saini SD, et al. Rates of Deintensification of Blood Pressure and Glycemic Medication Treatment Based on Levels of Control and Life Expectancy in Older Patients With Diabetes Mellitus. JAMA Intern Med 2015; 175:1942.
  11. Christensen KL, Mulvany MJ. Vasodilatation, not hypotension, improves resistance vessel design during treatment of essential hypertension: a literature survey. J Hypertens 2001; 19:1001.
  12. Langford HG, Blaufox MD, Oberman A, et al. Dietary therapy slows the return of hypertension after stopping prolonged medication. JAMA 1985; 253:657.
  13. Stamler R, Stamler J, Grimm R, et al. Nutritional therapy for high blood pressure. Final report of a four-year randomized controlled trial--the Hypertension Control Program. JAMA 1987; 257:1484.
  14. Nelson M, Reid C, Krum H, McNeil J. A systematic review of predictors of maintenance of normotension after withdrawal of antihypertensive drugs. Am J Hypertens 2001; 14:98.
  15. Appel LJ, Espeland MA, Easter L, et al. Effects of reduced sodium intake on hypertension control in older individuals: results from the Trial of Nonpharmacologic Interventions in the Elderly (TONE). Arch Intern Med 2001; 161:685.
  16. Whelton PK, Appel LJ, Espeland MA, et al. 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 1998; 279:839.
  17. Finnerty FA Jr. Stepped-down therapy versus intermittent therapy in systemic hypertension. Am J Cardiol 1990; 66:1373.
  18. Carlsen JE, Køber L, Torp-Pedersen C, Johansen P. Relation between dose of bendrofluazide, antihypertensive effect, and adverse biochemical effects. BMJ 1990; 300:975.
  19. Johnston GD, Wilson R, McDermott BJ, et al. Low-dose cyclopenthiazide in the treatment of hypertension: a one-year community-based study. Q J Med 1991; 78:135.
  20. Houston MC. Abrupt cessation of treatment in hypertension: consideration of clinical features, mechanisms, prevention and management of the discontinuation syndrome. Am Heart J 1981; 102:415.