Return of elevated blood pressure after withdrawal of antihypertensive drugs

Area of Science:

• Cardiology
• Clinical Pharmacology

Background:

• Long-term antihypertensive therapy with hydrochlorothiazide, reserpine, and hydralazine is common for managing hypertension.
• Assessing the impact of treatment withdrawal on blood pressure control is crucial for patient management.

Purpose of the Study:

• To investigate the rate of arterial pressure increase after discontinuing active antihypertensive treatment.
• To identify factors influencing blood pressure rebound after medication cessation.

Main Methods:

• A double-blind, placebo-controlled study involving 86 hypertensive patients previously treated for at least two years.
• Patients were randomized to receive either placebo or continued active medication.
• Blood pressure, serum uric acid, serum potassium, glucose tolerance, and serum creatinine were monitored over 18 months.

Main Results:

• 42 out of 60 placebo patients (70%) required re-initiation of treatment due to elevated blood pressure within 18 months.
• The rate of blood pressure rise in the placebo group correlated with pre-treatment pressure and inversely with patient age.
• Discontinuation led to decreased serum uric acid and increased serum potassium levels.

Conclusions:

• Abrupt cessation of antihypertensive medications can result in significant and rapid arterial pressure increases.
• Patient age and baseline blood pressure influence the rate of pressure rebound.
• Monitoring biochemical parameters like uric acid and potassium is important during treatment withdrawal.