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Safe Discontinuation of Antihypertensive Therapy
Saeed Ahmad, MD, FRCP, FCCP
Cardio-Diagnostic Clinique Fairmont, WVa
Arch Fam Med. 1995;4(9):755.
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The clinical review article by Kirk and Johnson1 in the March issue of the ARCHIVES is excellent, educational, and timely and emphasizes the dangers of antihypertensive withdrawal syndrome (AWS). I read it with great interest and concur strongly that such review teaches family practitioners how to prevent and manage AWS. Their article contained a table listing antihypertensive therapies that cause AWS. To this list should be added minoxidil,2 topical minoxidil,3 hydralazine,4 and guanethidine. In a report from Mexico, a patient was described who suffered a hypertensive crisis following withdrawal of topical minoxidil.3 Abrupt discontinuation of therapy with direct vasodilators, minoxidil, or the ganglionic blocker guanethidine also results in AWS.5 Antihypertensive withdrawal syndrome has been reported in a patient with renovascular hypertension treated with hydralazine.4 Finally, the angiotensin-converting enzyme inhibitor lisinopril has been implicated as the cause of AWS in the literature.6 Because the
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