Withdrawal of antihypertensive medication: a systematic review

Veronika van der Wardt, Jennifer K Harrison, Tomas Welsh, Simon Conroy, John Gladman, Veronika van der Wardt, Jennifer K Harrison, Tomas Welsh, Simon Conroy, John Gladman

Abstract

: Although antihypertensive medication is usually continued indefinitely, observations during wash-out phases in hypertension trials have shown that withdrawal of antihypertensive medication might be well tolerated to do in a considerable proportion of people. A systematic review was completed to determine the proportion of people remaining normotensive for 6 months or longer after cessation of antihypertensive therapy and to investigate the safety of withdrawal. The mean proportion adjusted for sample size of people remaining below each study's threshold for hypertension treatment was 0.38 at 6 months [95% confidence interval (CI) 0.37-0.49; 912 participants], 0.40 at 1 year (95% CI 0.40-0.40; 2640 participants) and 0.26 at 2 years or longer (95% CI 0.26-0.27; 1262 participants). Monotherapy, lower blood pressure before withdrawal and body weight were reported as predictors for successful withdrawal. Adverse events were more common in those who withdrew but were minor and included headache, joint pain, palpitations, oedema and a general feeling of being unwell. Prescribers should consider offering patients with well controlled hypertension a trial of withdrawal of antihypertensive treatment with subsequent regular blood pressure monitoring.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram.
FIGURE 2
FIGURE 2
Proportion of people remaining normotensive at 6 months after antihypertensive treatment withdrawal. ∗For Candesartan group; ∗∗for Nifedipine group; †at 24 weeks.
FIGURE 3
FIGURE 3
Proportion of people remaining normotensive at 1 year after antihypertensive treatment withdrawal. ∗Using office blood pressure; ∗∗using ambulatory blood pressure monitoring; ∗∗∗the study is reported in two articles with differing analyses: only results with lower percentage reported used (at 60 weeks); †men, bendrofluazide group; ††men propranolol group; †††women bendrofluazide group; ††††women propranolol group; the Nelson et al., [3] study was not included as this reported a different analysis of the same study; TFor Candesartan group; TTfor Nifedipine group; ooverweight and mild HT; oooverweight and severe HT; ooonot overweight and mild HT; oooonot overweight and severe HT.
FIGURE 4
FIGURE 4
Proportion of people remaining normotensive at 2 years or longer after antihypertensive treatment withdrawal. xxBased on the results for 3-year follow-up measurements; ∗using office blood pressure based on diastolic BP only; ∗∗using ambulatory blood pressure monitoring based on diastolic BP only; †men, bendrofluazide group; ††men propranolol group; †††women bendrofluazide group; ††††women propranolol group.

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