Medline ® Abstracts for References 1,4
of 'Can drug therapy be discontinued in well-controlled hypertension?'
Antihypertensive therapy. To stop or not to stop?
Schmieder RE, Rockstroh JK, Messerli FH
The benefits of continuous antihypertensive therapy have been extensively documented. However, lack of compliance with the prescribed regimen, excessive cost, and troublesome adverse effects of some antihypertensive agents led to the consideration of intermittent therapy or even complete discontinuation of therapy as an effective alternative to lifelong medication. Prospective studies dealing with this subject reported inconsistent results. Nevertheless, they allowed us to identify selection criteria of candidates for step-down or discontinuation of antihypertensive therapy. Such candidates include patients with mild essential hypertension who have one or more of the following characteristics: young age, normal body weight, low salt intake, no alcohol consumption, low pretreatment blood pressure, successful therapy with one drug only, and no or only minimal signs of target organ damage. Stopping antihypertensive therapy without subsequent rise in arterial pressure was shown to be possible in a subset of patients with mild essential hypertension for a period of months to years. This approach appears to be safe, provided that blood pressure is monitored frequently, and may improve compliance, save treatment costs, and reduce adverse effects of certain drugs, although its long-term consequences for morbidity and mortality remain to be determined.
Department of Medicine, University of Erlangen-Nürnberg, Federal Republic of Germany.
Withdrawal of antihypertensive medication: a systematic review.
van der Wardt V, Harrison JK, Welsh T, Conroy S, Gladman J
J Hypertens. 2017;35(9):1742.
: Although antihypertensive medication is usually continued indefinitely, observations during wash-out phases in hypertension trials have shown that withdrawal of antihypertensive medication might be well tolerated to do in a considerable proportion of people. A systematic review was completed to determine the proportion of people remaining normotensive for 6 months or longer after cessation of antihypertensive therapy and to investigate the safety of withdrawal. The mean proportion adjusted for sample size of people remaining below each study's threshold for hypertension treatment was 0.38 at 6 months [95% confidence interval (CI) 0.37-0.49; 912 participants], 0.40 at 1 year (95% CI 0.40-0.40; 2640 participants) and 0.26 at 2 years or longer (95% CI 0.26-0.27; 1262 participants). Monotherapy, lower blood pressure before withdrawal and body weight were reported as predictors for successful withdrawal. Adverse events were more common in those who withdrew but were minor and included headache, joint pain, palpitations, oedema and a general feeling of being unwell. Prescribers should consider offering patients with well controlled hypertension a trial of withdrawal of antihypertensive treatment with subsequent regular blood pressure monitoring.
aDivision of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham bCentre for Cognitive Ageing and Cognitive Epidemiology&The Alzheimer Scotland Dementia Research Centre, Royal Infirmary of Edinburgh, Edinburgh cRICE (Research Institute for the Care of Older People), Royal United Hospital, Bath dDepartment of Health Sciences, University of Leicester, Leicester, United Kingdom.