Should I stop taking antihypertensive medication if I have hypotension?

Should You Stop Blood Pressure Medication with BP 90/50?

Do not abruptly stop your antihypertensive medication, but you need urgent dose reduction or temporary discontinuation under medical supervision to prevent symptomatic hypotension and its complications.

Immediate Assessment Required

Your blood pressure of 90/50 mmHg represents symptomatic hypotension that requires prompt evaluation and medication adjustment. However, abrupt cessation of antihypertensive therapy can trigger rebound hypertension, enhanced sympathetic activity, and potentially serious cardiovascular events including myocardial infarction or stroke, particularly with certain drug classes 1.

Key Clinical Actions

First, identify the cause of hypotension:

• Review all medications that can lower blood pressure, including beta-blockers, calcium channel blockers, diuretics, and central-acting agents 2
• Check for volume depletion from excessive diuresis 2, 3
• Assess for orthostatic symptoms (dizziness, lightheadedness, weakness, syncope) 4, 5
• Measure blood pressure in both supine and standing positions 4

Second, adjust medications strategically:

• Symptomatic hypotension does not require intervention if asymptomatic, but at 90/50 mmHg with symptoms, immediate action is needed 6
• Reduce diuretic doses first if volume depletion is suspected 6, 2
• Consider halving doses of other antihypertensives rather than stopping completely 6
• If you must discontinue, taper medications gradually over 7-10 days to prevent rebound hypertension 1

Medication-Specific Considerations

High-risk medications for rebound if stopped abruptly:

• Beta-blockers and centrally-acting drugs (clonidine) carry the highest risk of withdrawal syndrome 1, 3
• These require the most careful tapering over 7-10 days 1

Medications that can be adjusted more safely:

• Diuretics can often be reduced or temporarily held without rebound 6
• ACE inhibitors and ARBs are generally safer to adjust 6
• Calcium channel blockers have lower withdrawal risk 5

Critical Pitfalls to Avoid

Never abruptly stop all antihypertensives simultaneously, especially if you have:

• Ischemic heart disease 1
• History of severe hypertension 1
• Multiple antihypertensive drugs at high doses 1

Do not dismiss asymptomatic blood pressure drops - even without symptoms, BP of 90/50 mmHg warrants medication review 4.

Ongoing Management Strategy

Once stabilized:

• The 2024 ESC Guidelines recommend maintaining BP-lowering treatment lifelong if well tolerated, but this assumes appropriate dosing 6
• Target systolic BP should be 120-129 mmHg in most adults, not below this range 6
• If treatment is poorly tolerated (as in your case), apply the "as low as reasonably achievable" (ALARA) principle rather than fixed targets 6

Re-evaluation approach:

• Reassess cardiovascular risk to determine if all current medications remain indicated 7
• Consider whether slower up-titration or lower dosing is more appropriate, particularly in elderly patients or those with frailty 6
• Monitor closely after any medication changes 6

Practical Next Steps

1. Contact your physician immediately - do not adjust medications on your own
2. Temporarily reduce or hold diuretics if volume depleted (under medical guidance) 6
3. Gradually taper other antihypertensives over 7-10 days if discontinuation is necessary 1
4. Monitor BP daily during medication adjustments 7
5. Watch for rebound hypertension in the weeks following any medication changes 1, 8

The goal is to achieve blood pressure control without causing hypotension - this requires careful dose adjustment rather than complete cessation of therapy 6.