Background: According to the new Dutch guideline for cardiovascular riskmanagement, patients with a low risk of cardiovascularmortalitymay have insufficient benefit to warrantmedication. Therefore, numerous patients per general practicemay 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 stopmedication. Patients who discontinuedmedication were followed for 6months. 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 reevaluated and 61% of themhad a low calculated risk, especially younger patients, females, and non-smokers. Of these, 42% were advised to stopmedication, especially younger patients and non-smokers. Of those who discontinuedmedication, 40% had restarted within 6months. After 6months, 80 of the 833 patients (9.6%) had not restartedmedication. There were no important side effects related to stoppingmedication. Conclusion: Over 50% of patients without target organ damage treated for hypertension and/or hypercholesterolaemiamay have insufficient benefit to warrantmedication. Younger patients, females, and non-smokers in particular are more likely to have an insufficient indication for medication. GPs' and nurse practitioners' views seemto play a role in advising to stop or to restart medication.

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British Journal of General Practice
Erasmus MC: University Medical Center Rotterdam

van Duijn, H., Belo, J., Blom, J., Velberg, I., & Assendelft, W. (2011). Revised guidelines for cardiovascular risk management - Time to stopmedication? A practice-based intervention study. British Journal of General Practice, 61(587). doi:10.3399/bjgp11X578025