A systematic review of predictors of maintenance of normotension after withdrawal of antihypertensive drugs

Background: The identification and treatment of hypertension in the general community has contributed to the reduction in strokes and coronary heart d isease observed during the past 30 years. However, concerns have arisen tha t some patients may be receiving unnecessary antihypertensive drug therapy leading to wasted resources and the potential for adverse drug effects. Onc e therapy has been started, treating physicians have difficulty in selectin g patients for withdrawal and have concerns regarding patient safety and th eir own legal liability. Procedures: This study reviews and consolidates information from published studies to identify known predictors of the successful maintenance of normo tension after antihypertensive drug withdrawal. The predictors were identif ied by determining the proportion of subjects with various baseline charact eristics who remained normotensive while off medication for at least 12 mon ths. From these data we have developed a clinical algorithm to help identif y patients in whom antihypertensive drug withdrawal might be considered. Th is may assist primary care physicians in achieving successful withdrawal of antihypertensive therapy among selected hypertensive patients. Results: The most consistent predictors identified were blood pressure (BP) (lower pretreatment, on treatment, and after withdrawal), nature of pharma cotherapy (fewer agents and lower dose), and preparedness to accept dietary intervention (weight and sodium reduction). Conclusions: On the basis of this information, a trial of withdrawal of ant ihypertensive medication might be recommended for patients who have mildly elevated, uncomplicated BP that is well controlled on a single agent, and w ho are motivated and likely to accept lifestyle changes. Am J Hypertens 200 1;14:98-105 (C) 2001 American Journal of Hypertension, Ltd.