Stopping Antihypertensive Treatment Among Hypertensive Patients in Primary Care: The Stop-Trial

Objective: Objective: Frequently antihypertensive therapy (AHT) is initiated without the confirmation of high blood pressure (BP) outside the office. Such AHT initiation based solely on office BP measurements may lead to overtreatment of otherwise non-hypertensive people who do not have a clinical indication for AHT. Therefore, identifying people in whom AHT can be safely discontinued is clinically important. The STOP-Trial aimed to identify factors associated with one-year normal BP maintenance after discontinuation of monotherapy or low-dose dual AHT among people with controlled BP and no cardiovascular target-organ damage. Design and method: Design and Method: We performed a multicenter non-randomized open-label trial screening people without target organ damage on AHT. AHT could be discontinued if BP was confirmed as controlled based on repeated home blood pressure measurements (HBPM) (i.e.,<135/85mmHg). The primary endpoint was one-year normal BP maintenance as assessed by HBPM. Results: Results: Among 401 screened individuals, 218(54.4%) were included after confirming they had controlled BP in HBPM and AHT was consequently discontinued. Among these 218 individuals, 73(33%) exhibited normal BP in HBPM at one year without any AHT (Figure). In univariable analysis, baseline office BP measurements were not significant predictors of the primary outcome whereas HBPM were. On multivariable analysis, higher average SBP and DBP on HBPM prior to AHD stop was associated with lower rates of one-year normal BP (OR for 5 mmHg of respectively, SBP=0.72, 0.56-0.94, p=0.014, and DBP=0.56, 0.41-0.77, p=0.0003). The best cut-offs of SBP and DBP on HBPM prior to AHD stop to predict the primary outcome was SBP=122.5mmHg and DBP=74.5mmHg. Patients with SBP<122.5 and DBP<74.5mmHg at HBPM prior to AHD stop had 65% chance of normal one-year BP without treatment. Regarding safety, one patient had a severe adverse event (ischemic stroke). Conclusions: Stopping AHT was feasible in patients without cardiovascular damage who had mono or low-dose dual AHT and maintained at one year in 33% of the population. HBPM measurements under treatment predicted well the success of AHD removal and HBPM consequently appears to be an efficient tool to select patients in whom AHD discontinuation may be safely considered.