Safety and blood pressure trajectory of short-term withdrawal of antihypertensive medications in older adults: experience from a clinical trial sample

Abstract

Background: The short-term safety of and blood pressure changes after withdrawing hypertension treatment in older adults in preparation for clinical trials have not been well established.

Methods: Participants were enrolled in a clinical trial and antihypertensive medications were tapered over 3 weeks (week 1: reduction by 25%-50%; week 2: 50%-75%, week 3: off). Blood pressure was measured at the initial visit and after stopping all antihypertensive therapy (personnel) and twice a day during the taper phase (provided monitor). Trend analyses and linear models were used to assess changes in blood pressure.

Results: All participants (n = 53, mean age = 71 years, total of 1158 readings) successfully tapered their medications with no symptoms. Only 2% of the readings exceeded 180/100 mm Hg, but none were consecutive. Blood pressure gradually increased with an overall increase of 12/6 mm Hg, 95% confidence interval (4/1, 21/11). The daily increase in blood pressure was 0.2 mm Hg (standard error = 0.1) in both the systolic and diastolic blood pressure. Increases in systolic and diastolic blood pressure were comparable for all antihypertensive classes (P > .05 for all).

Conclusion: Short-term (<3-4 weeks) withdrawal of antihypertensive therapy in older adults with hypertension is safe and is associated with mild increases in blood pressure.

Keywords: Antihypertensive withdrawal; older adults; trajectory.

Figure 1

Blood pressure dispersion during the taper phase, measured twice daily in those enrolled in the study who underwent the gradual taper of antihypertensive medications.

Figure 2

Trajectory of daily blood pressure over time in the study participants. Solid lines are the mean blood pressure at each day and dotted lines are the 95% confidence interval around the mean. Fitted linear regression showed overall increase in systolic blood pressure by 0.2 (SE, 0.1) mm Hg per day (P = .06) and 0.2 (SE, 0.1) mm Hg per day (P = .02) in diastolic blood pressure.

Figure 3

Demographic-based adjusted increase in blood pressure from initial visit (on antihypertensive medications) to pre-randomization visit (off antihypertensive medications). ACEI, Angiotensin converting enzyme inhibitors; ARB, Angiotensin receptor blockers; BB, beta blockers; CCB, calcium channel blockers; DIU, diuretics. Values are the least square means adjusted for age, gender, and race. P values are from comparing each class with the rest of the population of antihypertensive medications (DIU, SBP P value: .60/DBP P value: .30; ACE, 0.16/0.90; ARB, 0.19/0.74; CCB, 0.99/0.99; BB, 0.75/0.79).