Stopping antihypertensive Treatment amOng hypertensive patients in Primary care: The STOP-Trial

Abstract Background Antihypertensive therapy (AHT) is usually lifelong. The feasibility of discontinuing AHT in selected individuals is insufficiently studied. Aims To assess the feasibility of discontinuing AHT in patients on monotherapy or low-dose dual therapy, and identify factors associated with maintaining normotension without treatment for one year. Methods This prospective, multicenter, non-randomized, open-label study assessed stopping AHT in individuals without self-reported cardiovascular risk factors (other than hypertension) or target organ damage, on monotherapy or low-dose dual AHT. The primary endpoint was maintaining normotension (135/85 mmHg) for one year (with measurements at 1, 3, 6, 9, and 12 months) based on home blood pressure measurements (HBPM). Factors associated with success and failure of maintaining normotension were explored. Results Among 401 screened individuals, 218 (54.4%) were included after confirmation of controlled blood pressure (BP) by HBPM at baseline and their AHT was discontinued within 3 days. 203 participants had available BP measurements throughout the follow-up and were analyzed. Their mean age was 58.2 (±10.1) years, and 47.3% were women. Of these 203, 73 (36%) maintained BP 135/85 mmHg for one year without AHT while 130 patients (64%) required resumption of their AHT during the follow-up. Baseline HBPM predicted BP values at one year, while office BP or white coat hypertension did not. Patients with systolic HBPM 120 mmHg prior to AHT discontinuation had a 60% chance of maintaining normal BP, compared to 23% with systolic HBPM ≥120 mmHg. One patient with systolic HBPM 120 mmHg at baseline experienced an ischemic stroke. Conclusions About one-third of individuals on monotherapy or low-dose dual AHT who discontinued treatment maintained controlled BP after one year. Discontinuing AHT may be considered in selected individuals with HBPM below 120 mmHg, provided close BP monitoring is performed, particularly within the first year of AHT withdrawal. Clinicaltrial.gov registration number: NCT02268071