Which drug may cause severe rebound hypertension when abruptly discontinued?

Which drug may cause severe rebound hypertension when abruptly discontinued?

• A. Captopril
• B. Hydralazine
• C. Minoxidil
• D. Clonidine

Answer: (D)

Rebound hypertension after abrupt stopping a medication happens when the body’s compensatory systems swing back with a vengeance after being chronically suppressed. Clonidine is a central alpha-2 agonist that lowers blood pressure by dampening sympathetic outflow from the brain. If you stop it suddenly, that brake is removed quickly, and norepinephrine surges. The result is sudden peripheral vasoconstriction and increased heart rate, which can produce a severe rise in blood pressure—a rebound hypertensive crisis. Other drugs on the list can affect blood pressure when discontinued, but the dramatic, severe rebound is most classically associated with clonidine. ACE inhibitors, when stopped, can allow BP to rise, but not with the characteristic abrupt, hypertensive surge. Direct vasodilators like hydralazine or minoxidil may cause BP changes and reflex tachycardia during use, and their withdrawal can lead to fluid retention or rebound effects, but the quintessential rebound hypertension scenario is clonidine.

Rebound hypertension after abrupt stopping a medication happens when the body’s compensatory systems swing back with a vengeance after being chronically suppressed. Clonidine is a central alpha-2 agonist that lowers blood pressure by dampening sympathetic outflow from the brain. If you stop it suddenly, that brake is removed quickly, and norepinephrine surges. The result is sudden peripheral vasoconstriction and increased heart rate, which can produce a severe rise in blood pressure—a rebound hypertensive crisis.

Other drugs on the list can affect blood pressure when discontinued, but the dramatic, severe rebound is most classically associated with clonidine. ACE inhibitors, when stopped, can allow BP to rise, but not with the characteristic abrupt, hypertensive surge. Direct vasodilators like hydralazine or minoxidil may cause BP changes and reflex tachycardia during use, and their withdrawal can lead to fluid retention or rebound effects, but the quintessential rebound hypertension scenario is clonidine.