Cutting out the unnecessary: deprescribing antihypertensive treatments in patients at low cardiovascular risk

This editorial refers to ‘Stopping antihypertensive Treatment amOng hypertensive patients in Primary care: the STOP-Trial’, by J.-M. Boivin et al., https://doi.org/10.1093/eurjpc/zwaf511. The most recent guidelines1,2 recommend the early diagnosis of hypertension and, based on an accurate risk stratification, the prescription of non-pharmacological and pharmacological antihypertensive treatment. However, in the real world, the diagnosis of hypertension is made and the decision to treat may be taken hastily by physicians. As a consequence, the diagnosis is rarely reconsidered, and treatment often continues indefinitely without reassessment. The STOP (Stopping antihypertensive Treatment amOng hypertensive patients in Primary care)3 trial is a multicentre, non-randomized, open-label, pragmatic study that aimed to assess the clinical phenotype of patients with a diagnosis of uncomplicated hypertension who maintain normal blood pressure (BP) upon discontinuation of antihypertensive therapy (AHT). The authors postulated that a large number of patients are labelled as hypertensive by their general practitioner (GP) without any out-of-office BP assessment or repeated measurements over time. Thus, the trial explores whether these patients, who may be non-hypertensive or may have white-coat hypertension, show normal home BP after AHT withdrawal. The study population screened 401 individuals selected by GPs or recruited by public advertisement and enrolled 218 (54.4%) patients. After home BP monitoring (HBPM) confirmed the presence of values lower than