This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

To Stop or Not to Stop?

Roland E. Schmieder, MD; Jurgen K. Rockstroh, MD; Franz H. Messerli, MD

JAMA. 1991;265(12):1566-1571.

Abstract
The benefits of continuous antihypertensive therapy have been extensively documented. However, lack of compliance with the prescribed regimen, excessive cost, and troublesome adverse effects of some antihypertensive agents led to the consideration of intermittent therapy or even complete discontinuation of therapy as an effective alternative to lifelong medication. Prospective studies dealing with this subject reported inconsistent results. Nevertheless, they allowed us to identify selection criteria of candidates for step-down or discontinuation of antihypertensive therapy. Such candidates include patients with mild essential hypertension who have one or more of the following characteristics: young age, normal body weight, low salt intake, no alcohol consumption, low pretreatment blood pressure, successful therapy with one drug only, and no or only minimal signs of target organ damage. Stopping antihypertensive therapy without subsequent rise in arterial pressure was shown to be possible in a subset of patients with mild essential hypertension for a period of months to years. This approach appears to be safe, provided that blood pressure is monitored frequently, and may improve compliance, save treatment costs, and reduce adverse effects of certain drugs, although its long-term consequences for morbidity and mortality remain to be determined.

(JAMA. 1991;265:1566-1571)

Author Affiliations
From the Department of Medicine, University of Erlangen-Nürnberg, Federal Republic of Germany (Drs Schmieder and Rockstroh), and the Section on Hypertensive Diseases, Department of Internal Medicine, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, La (Dr Messerli).

Footnotes
Reprint requests to Department of Medicine, University of Erlangen-Nürnberg, Kontumazgarten 14-18, D8500 Nürnberg 80, Federal Republic of Germany (Dr Schmieder).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Withdrawing cardiovascular medications at a syncope clinic
Alsop and Mac Mahon
Postgrad. Med. J. 2001;77:403-405.
ABSTRACT | FULL TEXT  

Step-Down of Enalapril Treatment for Arterial Hypertension
Gonzalez-Juanatey et al.
Hypertension 1999;34:1287-1292.
ABSTRACT | FULL TEXT  

Salt, obesity, and alcohol fail to induce a lasting rise of blood pressure with age, and may be independent of renocortical vasculopathy
Tracy
QJM 1999;92:601-607.
ABSTRACT | FULL TEXT  

Doxazosin Withdrawal and Ambulatory Blood Pressure Monitoring in Normotensive Subjects
Takata et al.
ANGIOLOGY 1994;45:17-23.
ABSTRACT  

Treatment of Mild Hypertension: Decision Before Drugs
Zell and Lardinois
Arch Fam Med 1993;2:778-786.
ABSTRACT  

Prevention of Stroke in Older Persons With Isolated Systolic Hypertension
Simon
JAMA 1991;266:2829-2829.
ABSTRACT