title: Revised guidelines for cardiovascular risk management - time to stop medication? A practice-based intervention study.
abstract: BACKGROUND
  According to the new Dutch guideline for cardiovascular risk management, patients with a low risk of cardiovascular mortality may have insufficient benefit to warrant medication. Therefore, numerous patients per general practice may be treated unnecessarily.
  
  
  OBJECTIVE
  To explore the feasibility and consequences of a re-evaluation programme for patients without target organ damage who were treated for hypertension and/or hypercholesterolaemia.
  
  
  METHODS
  Practice-based intervention study in six general practices.
  
  
  METHODS
  Patients treated for hypertension and/or hypercholesterolaemia without target organ damage (n = 833) were invited to re-evaluate their cardiovascular risk and were advised whether or not to stop medication. Patients who discontinued medication were followed for 6 months. To determine indicators for successful stopping, logistic regression analyses were performed, and differences between practices were analysed.
  
  
  RESULTS
  About two-thirds of the patients were re-evaluated and 61% of them had a low calculated risk, especially younger patients, females, and non-smokers. Of these, 42% were advised to stop medication, especially younger patients and non-smokers. Of those who discontinued medication, 40% had restarted within 6 months. After 6 months, 80 of the 833 patients (9.6%) had not restarted medication. There were no important side effects related to stopping medication.
  
  
  CONCLUSIONS
  Over 50% of patients without target organ damage treated for hypertension and/or hypercholesterolaemia may have insufficient benefit to warrant medication. Younger patients, females, and non-smokers in particular are more likely to have an insufficient indication for medication. GPs' and nurse practitioners' views seem to play a role in advising to stop or to restart medication.
authors.affiliation: Health Cooperative Katwijk langs de Rijn, Katwijk, The Netherlands. hj@vduijn.nl
authors.forename: Huug J
authors.initials: HJ
authors.lastname: van Duijn
authors.forename: Janneke N
authors.initials: JN
authors.lastname: Belo
authors.forename: Jeanet W
authors.initials: JW
authors.lastname: Blom
authors.forename: Irvine D
authors.initials: ID
authors.lastname: Velberg
authors.forename: Willem J J
authors.initials: WJ
authors.lastname: Assendelft
mesh_terms: D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003657:Decision Making; D005240:Feasibility Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy*; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010349:Patient Compliance; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D012308:Risk Management; D019564:Unnecessary Procedures
chemical_list: D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents