Clinical Scorecard: Evaluating the Discontinuation of Antihypertensive Therapy in Primary Care Hypertensive Patients: Insights from the STOP-Trial
At a Glance
Category
Detail
Condition
Hypertension managed with antihypertensive therapy (AHT)
Key Mechanisms
Discontinuation of AHT in selected patients with controlled blood pressure and no cardiovascular risk factors or target organ damage
Target Population
Patients on monotherapy or low-dose dual AHT without additional cardiovascular risk factors or target organ damage
Care Setting
Primary care with home blood pressure monitoring (HBPM)
Key Highlights
Approximately one-third (36%) of patients maintained normotension (<135/85 mmHg) for one year after stopping AHT.
Baseline home systolic BP <120 mmHg predicted a 60% chance of maintaining normotension without treatment.
Close BP monitoring, especially within the first year after discontinuation, is essential to identify patients needing resumption of therapy.
Guideline-Based Recommendations
Diagnosis
Confirm hypertension diagnosis with repeated office BP measurements and home blood pressure measurements (HBPM) to exclude white-coat hypertension.
Use HBPM rather than office BP alone for better prediction of blood pressure control.
Management
Consider discontinuing AHT in selected patients on monotherapy or low-dose dual therapy with controlled BP and no cardiovascular risk factors or target organ damage.
Discontinuation may be considered if baseline home systolic BP is below 120 mmHg.
Resume AHT promptly if BP rises above target during follow-up.
Monitoring & Follow-up
Perform regular home blood pressure monitoring at 1, 3, 6, 9, and 12 months after discontinuation.
Close monitoring is critical during the first year to detect BP elevation early.
Risks
Patients with baseline home systolic BP ≥120 mmHg have a lower chance of maintaining normotension and higher risk of adverse events such as ischemic stroke.
Discontinuation should be avoided or done cautiously in patients with higher baseline HBPM.
Patient & Prescribing Data
Adults with grade 1 hypertension on monotherapy or low-dose dual therapy without other cardiovascular risk factors
54.4% of screened patients were eligible for discontinuation; 36% maintained normotension after one year off therapy; baseline HBPM is a key predictor of success.
Clinical Best Practices
Use HBPM to confirm controlled BP before considering AHT discontinuation.
Select patients without cardiovascular or neurovascular disease and no target organ damage for trial of discontinuation.
Ensure close and regular follow-up with HBPM after stopping therapy.
Educate patients on the importance of adherence to monitoring schedules and prompt reporting of symptoms.
Be prepared to reinstitute AHT if BP control is lost.
