22 DRUG REACTIONS

Antihypertensive therapy withdrawal has advantages

Numerous case reports as well as controlled studies support the idea that antihypertensive therapy can be successfully withdrawn or reduced for some time in at least a certain subset of patients. This can be achieved without rebound hypertension or any increased risk of ischaemic heart disease or stroke, says Dr RE Schmieder from the University of Erlangen-Nurnberg, Germany, and colleagues.

Many of the commonly used antihypertensive agents adversely affect the cardiovascular risk profile due to their metabolic adverse effects which may limit or even offset the beneficial impact on BP control. It has been suggested that antihypertensive treatment should no longer be regarded as life-long therapy, but rather be employed intermittently in alternation with periods of drug withdrawal or dose reduction.

A gradual withdrawal of antihypertensive therapy is safe (provided that BP is frequently monitored thereafter), may improve patient compliance and saves healthcare costs. Furthermore, withdrawal of drug therapy which negatively affects other cardiovascular risk factors such as serum levels of lipids, glucose or uric acid, leads to a 'normalisation' of biochemical variables which may even decrease the risk of atherosclerosis.

The best results in discontinuation studies were obtained for mildly hypertensive patients with low pretreatment BP and minimal evidence of target organ damage. Nonpharmacological measures such as low sodium diet, weight loss and reduction of alcohol consumption proved to be helpful in m~intaining a normotensive state after drug withdrawal. Schobel HP, Schmeider RE, Messerli AI. Risks versus benefits of withdrawing antihypertensive therapy. Drug Safety 7: 395-403, Nov-Dec 1992 8001"'218

5 Dec 1992INPHARMAiID ISSN 0156-2703/9211205-00221$1.00° Adlslnternatlonal Ltd