Beeftink Martine M A, van der Sande Nicolette G C, Bots Michiel L, Doevendans Pieter A, Blankestijn Peter J, Visseren Frank L J, Voskuil Michiel, Spiering Wilko
From the Department of Cardiology (M.M.A.B., P.A.D., M.V.), Department of Vascular Medicine (N.G.C.v.d.S., F.L.J.V., W.S.), Julius Center for Health Sciences and Primary Care (M.L.B.), Department of Nephrology and Hypertension (N.G.C.v.d.S., P.J.B.), University Medical Center Utrecht, The Netherlands.
Hypertension. 2017 May;69(5):927-932. doi: 10.1161/HYPERTENSIONAHA.116.08793. Epub 2017 Apr 3.
Successful control of blood pressure relies on identification of secondary causes and contributing factors of hypertension. As antihypertensive medication can interfere with diagnostic investigations, temporary discontinuation of medication is advised. However, there are concerns about the safety of temporary discontinuation of antihypertensive medication in patients with difficult-to-control hypertension. We assessed the occurrence of adverse cardiovascular and cerebrovascular events potentially attributable to temporary discontinuation of antihypertensive medication between February 2010 and March 2016 (n=604) in our Analysis of Complicated Hypertension screening program. A reference group (n=604) was extracted from the SMART study (Second Manifestations of Arterial Disease) cohort (comprising a similar cohort at our hospital in whom medication was not stopped) and individually matched for blood pressure, age, sex, and history of cardiovascular disease. Discontinuation of medication was well tolerated; 62% reported no complaints, 24% had mild discomfort that could be left untreated, and 14% experienced complaints that required prescription of antihypertensive escape medication. Three major adverse events were observed in the Analysis of Complicated Hypertension group between discontinuation of medication and 30 days after restart of medication (event rate=31.2 events per 1000 patient-year). In the reference cohort, 5 cardiovascular events were observed during a similar follow-up period (event rate=51.2 events per 1000 patient-year). In conclusion, discontinuation of antihypertensive medication for the diagnostic evaluation of hypertension does not increase the acute risk of cardiovascular events when performed in a well-controlled setting in specialized hospitals with appropriate protocols for monitoring safety.
血压的成功控制依赖于对高血压继发原因和促成因素的识别。由于抗高血压药物可能干扰诊断检查，建议暂时停用药物。然而，对于难以控制的高血压患者暂时停用抗高血压药物的安全性存在担忧。在我们的复杂高血压筛查项目分析中，我们评估了2010年2月至2016年3月期间（n = 604）因暂时停用抗高血压药物而可能导致的不良心血管和脑血管事件的发生情况。从SMART研究（动脉疾病的二次表现）队列中提取了一个对照组（n = 604）（包括我院一个未停药的类似队列），并根据血压、年龄、性别和心血管疾病史进行个体匹配。药物停用耐受性良好；62%的患者无不适主诉，24%有轻度不适可不予治疗，14%有需要开具抗高血压急救药物的不适症状。在复杂高血压分析组中，从停药到重新开始用药后30天内观察到3例主要不良事件（事件发生率 = 每1000患者年31.2例事件）。在对照组中，在类似的随访期间观察到5例心血管事件（事件发生率 = 每1000患者年51.2例事件）。总之，在配备适当安全监测方案的专科医院，在控制良好的情况下，为高血压诊断评估而停用抗高血压药物不会增加心血管事件的急性风险。
