Withdrawal of antihypertensive therapy in the elderly. The issues

Studies of antihypertensive drug withdrawal suggest that at least 20% of selected older patients with hypertension can remain normotensive without drug treatment for periods of up to 5 years. Success of drug withdrawal is greater in those patients controlled on low dose monotherapy who have low on-treatment blood pressure (BP), are not overweight and who have no ECG evidence of left ventricular hypertrophy. Compliance with lifestyle advice may increase the chance of successful drug withdrawal. Unfortunately, many older hypertensive patients have poorly controlled BP despite treatment with antihypertensive drugs, and are overweight. These factors limit opportunities for drug withdrawal although they may not be so much of a problem in the very elderly. Patient who could be considered for a trial of antihypertensive drug withdrawal are those unhappy with such therapy who also: (a) have well controlled BP on monotherapy with no significant target organ damage, (b) have 'white-coat' hypertension, or (c) are very elderly (> 80 years). The withdrawal of antihypertensive drugs can improve drug-induced metabolic abnormalities and symptoms, and appears safe providing there is a gradual reduction in drug dosages and close follow-up to detect a return to hypertension.