RT Journal Article
SR Electronic
T1 Withdrawal of Antihypertensive Medications
JF The Journal of the American Board of Family
                Practice
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 249
OP 258
DO 10.3122/jabfm.10.4.249
VO 10
IS 4
A1 Froom, Jack
A1 Trilling, Jeffrey S.
A1 Yeh, Shing-shing
A1 Gomolin, Irving H.
A1 Filkin, Anne-Marie
A1 Grimson, Roger C.
YR 1997
UL http://www.jabfm.org/content/10/4/249.abstract
AB Background: Pharmacologic treatment of hypertension reduces risks of stroke, congestive heart failure, renal failure, and mortality, but whether medications, once begun, need to be continued for life is uncertain. Methods: Several search strategies on MEDLINE using key words “medication,” “withdrawal,” “discontinuance,” and “therapy” in several combinations, nested within “hypertension,” were not productive. Accordingly, articles known to the authors and citations within them were reviewed. A survey of a random sample of members of the New York Academy of Family Practice was conducted to ascertain current practice of practicing physicians. Results: Eighteen studies of antihypertensive medication withdrawal were located and all were reviewed. In 12 trials average success rates of 40.3 percent after 1 year of follow-up and 27.7 percent after 2 years were achieved. In six studies limited to elderly patients, an average success rate of 26.2 percent was obtained for periods of 2 or more years. The trials, however, were heterogeneous in design, patient selection criteria, and follow-up. The survey of family physicians indicated that 79.1 percent attempt withdrawal of antihypertensive medications in hypertensive patients whose blood pressure is controlled and who are without symptoms from medication. Conclusions: We conclude that successful withdrawal of antihypertensive medications can have substantial benefits with few or no adverse consequences and might be successful in about one third of patients. Additional research is required to substantiate rates of successful medication withdrawal, to define the best method of withdrawing medications, and to delineate characteristics of patients in whom withdrawal is most likely to succeed.