Garbus S B, Weber M A, Priest R T, Brewer D D, Hubbell F A
J Clin Pharmacol. 1979 Aug-Sep;19(8-9 Pt 1):476-86. doi: 10.1002/j.1552-4604.1979.tb02510.x.
Although deleterious events following abrupt withdrawal of antihypertensive treatment are relatively uncommon, considerable attention has recently been focused on this problem. A withdrawal syndrome may occur after termination of almost all types of antihypertensive drugs, but most experience has been with the centrally acting agents and with beta-adrenoreceptor blockers. Abrupt discontinuation of high doses of centrally acting drugs such as alpha-methyldopa, clonidine, and guanabenz can produce a syndrome of sympathetic overactivity that includes agitation, headache, sweating, and nausea and less commonly can provoke rapid upswings in blood pressure. If beta blockers are suddenly stopped, a similar pattern can occur that may be related to excessive activity of thyroid hormones as well as sympathetic factors. Additionally, patients with ischemic heart disease may be susceptible to an acute exacerbation of their cardiac disease when beta-blocker treatment is stopped. It seems likely that discontinuation events can be particularly severe when combinations of different types of antihypertensive medications are sud-disease when betablocker treatment is denly stopped. This problem can be dealt with by educating patients to avoid sudden drug cessation and when elective discontinuation is planned, by gradual dose reduction.
尽管突然停用抗高血压治疗后出现有害事件相对不常见，但最近这个问题受到了相当多的关注。几乎所有类型的抗高血压药物停用后都可能出现戒断综合征，但大多数经验来自中枢作用药物和β-肾上腺素能受体阻滞剂。突然停用高剂量的中枢作用药物，如α-甲基多巴、可乐定和胍那苄，可产生交感神经过度活跃综合征，包括烦躁、头痛、出汗和恶心，较少见的是可引发血压迅速上升。如果突然停用β受体阻滞剂，可能会出现类似模式，这可能与甲状腺激素过度活跃以及交感神经因素有关。此外，缺血性心脏病患者在停用β受体阻滞剂治疗时可能易患心脏病急性加重。当不同类型的抗高血压药物组合突然停用，戒断事件似乎可能特别严重。通过教育患者避免突然停药，以及在计划选择性停药时逐渐减少剂量，可以解决这个问题。
