Abrupt discontinuation of antihypertensive therapy

The abrupt cessation of antihypertensive medication is usually without immediate consequence but may be associated with symptoms and signs of enhanced sympathetic activity, severe hypertension, morbid ischemic cardiovascular events, or death. This syndrome is more common after discontinuation of high doses of centrally acting antiadrenergic and beta-adrenergic blocking drugs or combination antihypertensive therapy, but it also occurs with numerous antihypertensive agents. Predisposing factors include ischemic heart disease, severe hypertension, renovascular or high renin hypertension, and high doses of multiple antihypertensive drugs. Gradual tapering of antihypertensive medications over seven to ten days will prevent symptoms and marked elevation of blood pressure. Should a discontinuation syndrome develop, re-administration of the drug previously discontinued is the most appropriate treatment.