[Arterial hypertension - dosing recommendations at beginning and end of treatment]

In the treatment of arterial hypertension different dosing strategies like slow dose escalation at the beginning of antihypertensive therapy and gradual dose taper or abrupt withdrawal of drugs may be appropriate. In general treatment should be initiated with a long acting drug at a low dose and doses should only slowly be increased under close blood pressure control. The dose-response curve usually is very flat, whilst adverse effects may rise disproportionately with higher doses. Therefore dose increases to maximal doses are no longer desirable in modern antihypertensive therapy and combinations of two drugs as fixed combinations at low doses should be preferred. Modern antihypertensive drugs can be abruptly and safely withdrawn in most patients. However, a gradual dose taper can be necessary in patients with coronary heart disease treated with cardioselective beta-blockers. Withdrawal is easier and safer under telemetric blood pressure control than self measured blood pressure. The same treatment approach applies to reserve medications like alpha-blockers, centrally acting drugs as clonidine, methyldopa, moxonidine, the vasodilators hydralazine and minoxidil, and other antihypertensives like reserpine and guanethidine. Withdrawal phenomena have to be considered in individual cases and particularly with clonidine after long-term use.