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Antihypertensive therapy. To stop or not to stop?
R E Schmieder1, J K Rockstroh, F H Messerli
1Department of Medicine, University of Erlangen-Nürnberg, Federal Republic of Germany.
JAMA
|March 27, 1991
Summary
Discontinuing antihypertensive therapy may be possible for some patients with mild hypertension. Careful patient selection and regular blood pressure monitoring are key to this approach.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Continuous antihypertensive therapy is standard but faces challenges like poor compliance, cost, and side effects.
- Intermittent therapy or discontinuation are explored as alternatives to lifelong medication.
Purpose of the Study:
- To identify criteria for selecting patients suitable for stepping down or discontinuing antihypertensive therapy.
- To evaluate the feasibility and safety of stopping antihypertensive medication in mild essential hypertension.
Main Methods:
- Review of prospective studies on antihypertensive therapy discontinuation.
- Identification of patient characteristics associated with successful cessation of medication.
Main Results:
- Specific patient profiles (young, normal weight, low salt/alcohol intake, low baseline BP, single-drug therapy, minimal organ damage) are identified for potential discontinuation.
- A subset of patients with mild essential hypertension can stop medication for months to years without a significant blood pressure rise.
Conclusions:
- Stopping antihypertensive therapy is feasible for select mild hypertension patients, potentially improving compliance and reducing costs/side effects.
- Frequent blood pressure monitoring is crucial for safety. Long-term effects on morbidity and mortality require further investigation.