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Stopping antihypertensive Treatment amOng hypertensive patients in Primary care: the STOP-Trial
J-M Boivin1, J P Ferreira1,2,3, M Lopez-Sublet4,5
1Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
Insights
Discontinuing antihypertensive therapy (AHT) is feasible in about one-third of patients on low-dose treatment who achieve normal blood pressure. Home blood pressure monitoring below 120 mmHg is key for successful AHT withdrawal.
Area of Science:
- Cardiology
- Hypertension Management
- Clinical Trials
Background:
- Antihypertensive therapy (AHT) is typically lifelong, with limited research on discontinuing treatment.
- Assessing the feasibility of AHT cessation in select patients is crucial for personalized medicine.
Purpose of the Study:
- To evaluate the possibility of discontinuing AHT in patients on monotherapy or low-dose dual therapy.
- To identify predictors of maintaining normal blood pressure (BP) for one year post-AHT cessation.
Main Methods:
- Prospective, multicenter, open-label study involving 203 participants who stopped AHT.
- Primary endpoint: maintaining normotension (<135/85 mmHg) for one year using home BP measurements (HBPM).
- Exploration of factors associated with successful and unsuccessful BP control after AHT withdrawal.
Main Results:
- 36% of participants maintained normotension (<135/85 mmHg) for one year without AHT.
- Baseline systolic HBPM <120 mmHg predicted a 60% success rate for normotension, versus 23% for ≥120 mmHg.
- Office BP and white coat hypertension did not predict long-term BP control.
Conclusions:
- Approximately one-third of patients on monotherapy or low-dose dual AHT can successfully discontinue treatment while maintaining controlled BP.
- AHT withdrawal may be considered for individuals with baseline systolic HBPM <120 mmHg, with close monitoring.
- Close BP monitoring is essential during the first year after AHT discontinuation.
Aims:
Antihypertensive therapy (AHT) is usually lifelong. The feasibility of discontinuing AHT in selected individuals is insufficiently studied. The aims are to assess the feasibility of discontinuing AHT in patients on monotherapy or low-dose dual therapy, and identify factors associated with maintaining normotension without treatment for one year.
Methods And Results:
This prospective, multicentre, non-randomized, open-label study assessed stopping AHT in individuals without self-reported cardiovascular risk factors (other than hypertension) or target organ damage, on monotherapy or low-dose dual AHT. The primary endpoint was maintaining normotension (<135/85 mmHg) for one year (with measurements at 1, 3, 6, 9, and 12 months) based on home blood pressure measurements (HBPM). Factors associated with success and failure of maintaining normotension were explored. Among 401 screened individuals, 218 (54.4%) were included after confirmation of controlled blood pressure (BP) by HBPM at baseline and their AHT was discontinued within 3 days. Two hundred three participants had available BP measurements throughout the follow-up and were analysed. Their mean age was 58.2 (±10.1) years, and 47.3% were women. Of these 203, 73 (36%) maintained BP < 135/85 mmHg for one year without AHT while 130 patients (64%) required resumption of their AHT during the follow-up. Baseline HBPM predicted BP values at one year, while office BP or white-coat hypertension did not. Patients with systolic HBPM < 120 mmHg prior to AHT discontinuation had a 60% chance of maintaining normal BP, compared to 23% with systolic HBPM ≥ 120 mmHg. One patient with systolic HBPM > 120 mmHg at baseline experienced an ischaemic stroke.
Conclusion:
About one-third of individuals on monotherapy or low-dose dual AHT who discontinued treatment maintained controlled BP after one year. Discontinuing AHT may be considered in selected individuals with HBPM below 120 mmHg, provided close BP monitoring is performed, particularly within the first year of AHT withdrawal.
Registration:
Clinicaltrial.gov registration number: NCT02268071.
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