Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Sep;35(9):1742-1749.
doi: 10.1097/HJH.0000000000001405.

Withdrawal of antihypertensive medication: a systematic review

Veronika van der Wardt  1 , Jennifer K Harrison, Tomas Welsh, Simon Conroy, John Gladman
Affiliations

Withdrawal of antihypertensive medication: a systematic review

Veronika van der Wardt et al. J Hypertens. 2017 Sep.

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.

PubMed Disclaimer

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.
See this image and copyright information in PMC

Comment in

References

    1. CAPSP. Critical Appraisal Skills Programme (CASP). CASP, UK; 2013. Available from: http://www.casp-uk.net/#!casp-tools-checklists/c18f8. [Accessed 9 June 2016].
    1. Fernandez PG, Galway AB, Kim BK. Prolonged normotension following cessation of therapy in uncomplicated essential hypertension. Clin Invest Med 1982; 5:31–37. - PubMed
    1. Nelson MR, Reid CM, Krum H, Ryan P, Wing LM, McNeil JJ. Management Committee, Second Australian National Blood Pressure Study. Short-term predictors of maintenance of normotension after withdrawal of antihypertensive drugs in the second Australian National Blood Pressure Study (ANBP2). Am J Hypertens 2003; 16:39–45. - PubMed
    1. Herlitz H, Hartford M, Ljungman S, Jonsson O, Wikstrand J, Berglund G. Different patterns of cellular sodium turnover in essential hypertension. J Hypertens Suppl 1988; 6:S213–S215. - PubMed
    1. Fernandez PG, Kim BK, Galway AB, Sharma JN. Separation of essential hypertensive patients based on blood pressure responses after the withdrawal of antihypertensive agents by step-wise discriminant analysis. Curr Med Res Opin 1983; 8:509–517. - PubMed

Publication types

MeSH terms

Substances