Clinical Scorecard: Reevaluating Antihypertensive Therapy: Discontinuing Treatment in Patients with Low Cardiovascular Risk
At a Glance
Category
Detail
Condition
Grade 1 hypertension without target organ damage and low cardiovascular risk
Key Mechanisms
Discontinuation of antihypertensive therapy in patients with confirmed low home blood pressure (<135/85 mmHg) and monitoring for normotension maintenance
Target Population
Patients with uncomplicated Grade 1 hypertension, low cardiovascular risk, treated with monotherapy or low-dose dual therapy
Care Setting
Primary care with general practitioners managing hypertension
Key Highlights
36% of patients maintained normotension at 1 year after antihypertensive treatment withdrawal.
Home systolic BP < 122.5 mmHg and diastolic BP < 74.5 mmHg predicted persistence of normotension.
Use of angiotensin-receptor blockers (ARBs) was positively associated with normotension maintenance.
Guideline-Based Recommendations
Diagnosis
Perform repeated blood pressure measurements to confirm hypertension diagnosis.
Use out-of-office blood pressure monitoring for accurate diagnosis except in Grade 3 hypertension or high cardiovascular risk cases.
Management
Consider discontinuation of antihypertensive therapy in selected low-risk patients with home BP < 120/80 mmHg.
Maintain lifestyle changes and non-pharmacological interventions during and after treatment withdrawal.
Monitoring & Follow-up
Schedule periodic blood pressure monitoring at 1, 3, 6, 9, and 12 months after treatment discontinuation.
Use home blood pressure monitoring to assess blood pressure control.
Risks
Risk of uncontrolled blood pressure requiring treatment restart in 64% of patients within 1 year.
Low incidence of adverse cardiovascular events observed during follow-up in selected patients.
Patient & Prescribing Data
Patients with Grade 1 hypertension, low cardiovascular risk, and no target organ damage
Monotherapy or low-dose dual therapy with ARBs may favor normotension maintenance after treatment withdrawal
Clinical Best Practices
Confirm hypertension diagnosis with repeated and out-of-office blood pressure measurements before initiating lifelong treatment.
Identify patients with home BP < 120/80 mmHg as candidates for safe antihypertensive treatment discontinuation.
Ensure regular follow-up and blood pressure monitoring after treatment withdrawal to detect uncontrolled hypertension early.
Encourage adherence to lifestyle modifications to support blood pressure control post-treatment.
