Transdermal Clonidine for Hypertension: An Underutilized Ally in the Modern Era

Despite advancements in pharmacological strategies, blood pressure (BP) control remains unsatisfactory in a significant proportion of hypertensive patients. This may be related to the multifactorial pathogenesis of hypertension, which makes treatment challenging and often requires the use of multiple BP-lowering pills that can reduce adherence. Transdermal clonidine, a central α₂-adrenergic agonist, offers a unique antihypertensive approach that may deserve renewed consideration. Although largely abandoned in the oral form due to side effects and withdrawal concerns, the transdermal patch provides a steadier drug release and improved tolerability. This review summarizes evidence from randomized and observational studies evaluating the efficacy, safety, and adherence profile of transdermal clonidine in the treatment of hypertension. Overall, the patch demonstrated blood pressure-lowering efficacy comparable to standard first-line agents, such as β-blockers, calcium channel blockers, and diuretics. It was particularly effective in improving treatment adherence and reducing the risk of rebound hypertension during discontinuation. Adverse effects, mainly dry mouth, sedation, and mild skin reactions, were generally well tolerated. These findings suggest that transdermal clonidine may serve as a useful adjunct or alternative therapy in patients with resistant hypertension, poor adherence to oral therapy, or intolerance to other drug classes, and that its role deserves to be reconsidered within contemporary, patient-centered antihypertensive strategies.