Clinical Report: Discontinuation of Antihypertensive Therapy in Primary Care Patients
Overview
The STOP-Trial evaluated the feasibility of discontinuing antihypertensive therapy (AHT) in patients on monotherapy or low-dose dual therapy without additional cardiovascular risk factors. Approximately one-third (36%) of patients maintained normotension for one year after stopping AHT, with baseline home blood pressure measurement (HBPM) below 120 mmHg strongly predicting success.
Background
Hypertension is a major cardiovascular risk factor often requiring lifelong pharmacological treatment. However, many patients on monotherapy or low-dose dual therapy may have controlled blood pressure and no target organ damage, raising the question of whether AHT can be safely discontinued. Current guidelines emphasize diagnosis confirmation and monitoring via home blood pressure measurements (HBPM), but discontinuation strategies remain underexplored. The STOP-Trial was designed to assess the feasibility and predictors of maintaining normotension after AHT withdrawal in this selected population.
Data Highlights
Parameter
Value
Number screened
401
Number included
218 (54.4%)
Analyzed participants
203
Mean age
58.2 ± 10.1 years
Female participants
47.3%
Maintained normotension at 1 year
73 (36%)
Resumed AHT during follow-up
130 (64%)
Chance of normotension if baseline systolic HBPM <120 mmHg
60%
Chance of normotension if baseline systolic HBPM ≥120 mmHg
23%
Key Findings
36% of patients on monotherapy or low-dose dual AHT maintained blood pressure <135/85 mmHg for one year after discontinuation.
Baseline home systolic blood pressure <120 mmHg strongly predicted successful maintenance of normotension.
Patients with baseline systolic HBPM <120 mmHg had a 60% chance of maintaining normotension versus 23% for those with higher baseline values.
Office blood pressure measurements and white-coat hypertension status did not predict success in maintaining normotension.
One patient with baseline systolic HBPM >120 mmHg experienced an ischemic stroke after discontinuation.
Close blood pressure monitoring, especially during the first year after AHT withdrawal, is essential for patient safety.
Clinical Implications
Discontinuation of antihypertensive therapy may be considered in selected patients with well-controlled blood pressure on monotherapy or low-dose dual therapy, particularly those with baseline home systolic BP below 120 mmHg. Home blood pressure monitoring is critical to identify suitable candidates and to ensure safe follow-up. Clinicians should maintain vigilance during the first year after withdrawal to promptly detect blood pressure elevation or adverse events.
Conclusion
The STOP-Trial demonstrates that about one-third of selected hypertensive patients can maintain normotension for one year after stopping AHT, with baseline home BP measurements serving as a key predictor. Careful patient selection and close monitoring are essential to safely implement AHT discontinuation strategies.
References
STOP-Trial Investigators 2024 -- Evaluating the Discontinuation of Antihypertensive Therapy in Primary Care Hypertensive Patients
