Defining the patient group for cost-effective withdrawal of antihypertensive therapy

Many people receiving drug treatment for hypertension have had good control of their blood pressure for several years. It is feasible, and might be desirable, to discontinue drug treatment in selected groups of these patients if their long term outcome was not adversely affected. A few small series and 2 larger trials indicate that withdrawal of antihypertensive medication can be followed by 1 to 4 years of normal blood pressure, especially for those with mild hypertension (pretreatment diastolic blood pressure < 100mm Hg) and who have no evidence of target organ damage. In the 2 randomised trials of withdrawing medication emerging from the High Blood Pressure Detection and Follow-up Program, the addition of nutritional interventions (bodyweight reduction and/or dietary salt restriction) was shown to enhance the likelihood that antihypertensive drugs could be deferred for long intervals. Sustained bodyweight reduction for overweight patients with mild hypertension was the most successful approach. Short term nonpharmacological programmes have been evaluated for their economic effects on this process through cost-effectiveness and cost-benefit analyses. The available studies imply that reduced costs and decreased adverse effects associated with withdrawal of antihypertensive medication are offset by cost of the nonpharmacological interventions needed to maximise continued blood pressure control. Other influences, such as willingness to pay for nonpharmacological management or change in sense of well-being when on or off medication, need consideration for comprehensive cost-effectiveness analyses.(ABSTRACT TRUNCATED AT 250 WORDS)