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 .
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 . Th ese 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.
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 .
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
Some of the references for successful withdrawl of antihypertenive drugs
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