title: Safety and blood pressure trajectory of short-term withdrawal of antihypertensive medications in older adults: experience from a clinical trial sample.
abstract: BACKGROUND
  The short-term safety of and blood pressure changes after withdrawing hypertension treatment in older adults in preparation for clinical trials have not been well established.
  
  
  METHODS
  Participants were enrolled in a clinical trial and antihypertensive medications were tapered over 3 weeks (week 1: reduction by 25%-50%; week 2: 50%-75%, week 3: off). Blood pressure was measured at the initial visit and after stopping all antihypertensive therapy (personnel) and twice a day during the taper phase (provided monitor). Trend analyses and linear models were used to assess changes in blood pressure.
  
  
  RESULTS
  All participants (n = 53, mean age = 71 years, total of 1158 readings) successfully tapered their medications with no symptoms. Only 2% of the readings exceeded 180/100 mm Hg, but none were consecutive. Blood pressure gradually increased with an overall increase of 12/6 mm Hg, 95% confidence interval (4/1, 21/11). The daily increase in blood pressure was 0.2 mm Hg (standard error = 0.1) in both the systolic and diastolic blood pressure. Increases in systolic and diastolic blood pressure were comparable for all antihypertensive classes (P > .05 for all).
  
  
  CONCLUSIONS
  Short-term (<3-4 weeks) withdrawal of antihypertensive therapy in older adults with hypertension is safe and is associated with mild increases in blood pressure.
authors.affiliation: Division of Geriatric, Hospital and General Internal Medicine, Department of Medicine, University of Southern California, Los Angeles, CA, USA. ihajjar@usc.edu
authors.forename: Ihab
authors.initials: I
authors.lastname: Hajjar
authors.forename: Meaghan
authors.initials: M
authors.lastname: Hart
authors.forename: Siu-Hin
authors.initials: SH
authors.lastname: Wan
authors.forename: Vera
authors.initials: V
authors.lastname: Novak
mesh_terms: D000368:Aged; D000375:Aging; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis*
chemical_list: D000959:Antihypertensive Agents
keywords: Antihypertensive withdrawal; older adults; trajectory