The Abrupt Discontinuation of Antihypertensive Treatment

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Abstract
Although deleterious events after abrupt withdrawal of antihypertensive treatment are relatively uncommon, considerable attention was recently focused on this problem. A withdrawal syndrome may occur after termination of almost all types of antihypertensive drugs, but most experience was with the centrally acting agents and with .beta.-adrenoreceptor blockers. Abrupt discontinuation of high doses of centrally acting drugs, i.e. .alpha.-methyldopa, clonidine and guanabenz, can produce a syndrome of sympathetic overactivity that includes agitation, headache, sweating and nausea and less commonly can provoke rapid upswings in blood pressure. If .beta.-blockers are suddenly stopped, a similar pattern can occur that may be related to excessive activity of thyroid hormones and sympathetic factors. Patients with ischemic heart disease may be susceptible to an acute exacerbation of their cardiac disease when .beta.-blocker treatment is stopped. Apparently discontinuation events can be particularly severe when combinations of different types of antihypertensive medications are suddenly stopped. This problem can be dealt with by educating patients to avoid sudden drug cessation and when elective discontinuation is planned, by gradual dose reduction.