[Hypertensive crisis after withdrawal of clonidine and nadolol. Case report and review of the literature].

The clonidine withdrawal syndrome occurs in at least 1.2% of patients following withdrawal of the drug. Its frequency is influenced by length of treatment, daily dosage and degree of hypertension. The combination of clonidine with beta blockers favours the development of hypertensive crisis following clonidine withdrawal. The case is presented of a 49-year-old female who had had chronic renal insufficiency and hypertension for several years and who developed a hypertensive crisis after cessation of therapy with clonidine and nadolol. An overshoot hypertension after clonidine withdrawal should be treated with vasodilatatory drugs such as nitroprusside; calcium antagonists and ACE inhibitors also offer a possible new approach. It is advisable to reduce the clonidine dose slowly, and combination with labetalol or calcium antagonists during clonidine withdrawal seems to have favourable results. Beta blockers should be discontinued well before the cessation of clonidine treatment.