Arterial Pressure Responses to Discontinuing Antihypertensive Drugs

Abstract

A wide spectrum of arterial pressure responses to discontinuing long-term antihypertensive drug treatment was found in 65 patients. In five, spontaneous pressure variations prevented judging effects of drug discontinuance. Of the remaining 60, pressure returned to pretreatment levels in 21, and rose toward control levels in 37; while in two, diastolic hypertension did not reappear in more than 8 years. Rate of rise of arterial pressure seemed related to type of hypertension and to height of diastolic pressure and severity of vascular disease before treatment. In six of nine patients who had had malignant hypertension and six of nine with renal arterial disease, pressure rose promptly and treatment was restarted within a month. Among essential hypertensive patients, those who remained off treatment for 2 to 6 months had significantly lower pretreatment pressure than those whose hypertension returned in less than 2 months. The two whose diastolic hypertension seemed "cured" had no distinguishing features. These results suggest that most hypertensive patients require continuous treatment for good pressure control; downward resetting of pressure by treatment is rare.