Reactions 430 - 5 Dec 1992

Antihypertensive therapywithdrawal has advantages

Numerous case reports as well as controlled studiessupport the idea that antihypertensive therapy can besuccessfully withdrawn or reduced for some time in atleast a certain subset of patients. This can be achievedwithout rebound hypertension or any increased risk ofischaemic heart disease or stroke, says Dr RE Schmiederfrom the University of Erlangen-Nurnberg, Germany,and colleagues.

Many of the commonly used antihypertensive agentsadversely affect the cardiovascular risk profile due totheir metabolic adverse effects which may limit or evenoffset the beneficial impact on BP control. Other criticalaspects of drug therapy are increasing costs anddecreasing patient compliance. Therefore, it has beensuggested that antihypertensive treatment should nolonger be regarded as life-long therapy, but rather beemployed intermittently in alternation with periods ofdrug withdrawal or dose reduction.

A gradual withdrawal of antihypertensive therapy issafe (provided that BP is frequently monitoredthereafter), may improve patient compliance and saveshealthcare costs. Furthermore, withdrawal of drugtherapy which negatively affects other cardiovascularrisk factors such as serum levels of lipids, glucose or uricacid, leads to a ‘normalisation’ of biochemical variableswhich may even decrease the risk of atherosclerosis.

The best results in discontinuation studies wereobtained for mildly hypertensive patients with lowpretreatment BP and minimal evidence of target organdamage. Nonpharmacological measures such as lowsodium diet, weight loss and reduction of alcoholconsumption proved to be helpful in maintaining anormotensive state after drug withdrawal.Schobel HP, et al. Risks versus benefits of withdrawing antihypertensive therapy.Drug Safety 7: 395-403, Nov-Dec 1992 800156218

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Reactions 5 Dec 1992 No. 4300114-9954/10/0430-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved