Is it true , once a patient is labelled as a hypertensive he remains hypertensive life long ? Is it possible to withdraw antihypertensive drugs permanently ?
- Systemic hypertension is the most common clinical entity and it forms the bulk of the physician consultations world over.
- The anti hypertensive drugs are one of the most commonly prescribed medication by the medical professionals .
- It is estimated , the major chunk of revenue to pharma industry is contributed by antihypertensive drugs.
- SHT , is being maintained as a major , global cardiovascular risk factor , by periodically refixing the target blood pressure to lower levels by various committees.
- The terminology of pre hypertension for blood pressure between 120-140 was hugely controversial and some societies refused to accept this entity.
Is there a case for withdrawal of anti hypertensive agents among our patients ?
Yes , in fact there is a strong case for it.
While on the one hand there is a sustained effort ( By whom !) to increase the drug usage , very early in the course of hypertension , there is also a silent progress in our knowledge , regarding withdrawl of anti hypertensive agents in all those undeserving patients .
It is estimated 42% *of the so called hypertensives especially elderly can be successfully weaned of anti hypertensive drugs with out any adverse effect.( Mark R Nelson BMJ. 2002 October 12; 325(7368): 815.)
What are the situations where we can successfully with draw anti hypertensive drugs?
- The most common group of patients are the ones, where the anti hypertensive drugs are started prematurely , with out giving an option for non drug life style approach.These patients and their physicians continue to believe , anti HT drugs are sacred and essential !
- There is another major group of patients who have had a temporary elevation of BP due to a stressful environment.These patients get drugs permanently for a temporary problem . These patients need to be reassessed.
- Some of the elderly patients, with the onset of age related autonomic dysfunction ,these drugs are poorly tolerated and even have disastrous effects .In this population it is desirable , to wean off the anti HT drugs and switched over to life style medication whenever possible.
Final message
Essential or primary hypertension is not a permanent disease, in bulk of our population. It reflects the state of the blood pressure on a day to day basis and is a continuous variable. All patients who have been labelled as hypertensives( Either by us or others) should be constantly reviewed and considered for withdrawal of the drugs if possible.
* Note this rule does not apply in all secondary hypertensions, during emergencies, uncontrolled hyper tension with co existing CAD /diabetes /dyslipidemias etc .
Please refer to these forgotten Landmark articles
Does Withdrawl of Anti hypertensive Medication
Increase the Risk of Cardiovascular Events?
The TONE study
Source: The American Journal of Cardiology, Volume 82, Number 12, 15 December 1998 , pp. 1501-1508(8)
http://www.ncbi.nlm.nih.gov/pubmed/9874055
Conclusion of TONE study
The study shows that antihypertensive medication can be safely withdrawn in older persons without clinical evidence of cardiovascular disease who do not have diastolic pressure > or = 150/90 mm Hg at withdrawal, providing that good BP control can be maintained with nonpharmacologic therapy
Dr.S.Venkatesan MD 