Revised guidelines for cardiovascular risk management - time to stop medication? A practice-based intervention study

Br J Gen Pract. 2011 Jun;61(587):e347-52. doi: 10.3399/bjgp11X578025.

Abstract

Background: According to the new Dutch guideline for cardiovascular risk management, patients with a low risk of cardiovascular mortality may have insufficient benefit to warrant medication. Therefore, numerous patients per general practice may be treated unnecessarily.

Aim: To explore the feasibility and consequences of a re-evaluation programme for patients without target organ damage who were treated for hypertension and/or hypercholesterolaemia.

Design and setting: Practice-based intervention study in six general practices.

Method: Patients treated for hypertension and/or hypercholesterolaemia without target organ damage (n = 833) were invited to re-evaluate their cardiovascular risk and were advised whether or not to stop medication. Patients who discontinued medication were followed for 6 months. To determine indicators for successful stopping, logistic regression analyses were performed, and differences between practices were analysed.

Results: About two-thirds of the patients were re-evaluated and 61% of them had a low calculated risk, especially younger patients, females, and non-smokers. Of these, 42% were advised to stop medication, especially younger patients and non-smokers. Of those who discontinued medication, 40% had restarted within 6 months. After 6 months, 80 of the 833 patients (9.6%) had not restarted medication. There were no important side effects related to stopping medication.

Conclusion: Over 50% of patients without target organ damage treated for hypertension and/or hypercholesterolaemia may have insufficient benefit to warrant medication. Younger patients, females, and non-smokers in particular are more likely to have an insufficient indication for medication. GPs' and nurse practitioners' views seem to play a role in advising to stop or to restart medication.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anticholesteremic Agents / therapeutic use*
  • Antihypertensive Agents / therapeutic use*
  • Cardiovascular Diseases / prevention & control
  • Decision Making
  • Feasibility Studies
  • Female
  • Guideline Adherence
  • Humans
  • Hypercholesterolemia / drug therapy*
  • Hypertension / drug therapy*
  • Male
  • Middle Aged
  • Netherlands
  • Patient Compliance
  • Physician-Patient Relations
  • Practice Guidelines as Topic
  • Risk Management
  • Unnecessary Procedures

Substances

  • Anticholesteremic Agents
  • Antihypertensive Agents