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Can therapy be discontinued in well-controlled hypertension?

Author
Norman M Kaplan, MD
Section Editor
George L Bakris, MD
Deputy Editor
John P Forman, MD, MSc

INTRODUCTION

Some patients with stage 1 hypertension are well controlled, often on a single medication. After a period of years, the question arises as to whether antihypertensive therapy can be gradually diminished or even discontinued. The issue of discontinuation of therapy also arises in patients who develop symptoms related to low blood pressure.

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

SELECTING PATIENTS FOR ANTIHYPERTENSIVE DRUG WITHDRAWAL

Among patients with mild hypertension who are well controlled for at least one year, it may be possible to gradually diminish or discontinue antihypertensive therapy [1-3].

After discontinuation of treatment, between 5 and 55 percent of patients remain normotensive for at least one to two years [1]; a larger fraction of patients do well with a decrease in the number and/or dose of medications taken [3,4]. In a review of published series of planned withdrawal, for example, 42 percent of selected patients with mild hypertension (140-149/90-95 mmHg) were found to remain normotensive for 12 months or longer off medication [1]. In a more heterogeneous group of well-controlled hypertensives, only 18 percent remained normotensive after stopping therapy [4].

Patients who were more likely to tolerate cessation of antihypertensive therapy included those with milder hypertension, on fewer and lower doses of antihypertensive medications, and adherent to lifestyle modifications (eg, weight loss and sodium restriction). These findings suggest that full withdrawal may not be possible in patients on multiple drugs, but it may be possible to more gradually taper antihypertensive doses and agents [2].

      

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Literature review current through: Nov 2016. | This topic last updated: Mon Oct 19 00:00:00 GMT+00:00 2015.
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References
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