Can You Safely Stop ACE Inhibitors After 5 Years of Stable Blood Pressure? A Thoughtful Guide for Adults 62–76

If you’re over 60 and have been taking an ACE inhibitor for high blood pressure—and your readings have stayed comfortably in the healthy range (e.g., consistently below 135/85 mm Hg) for five years—you may wonder whether it’s time to consider stopping ACE inhibitors safely over 60. This is a very reasonable and increasingly common question. As we age, our bodies change—not just in how they respond to medication, but also in how they manage blood pressure naturally. Many people assume that stable BP means the medicine is “no longer needed,” or that stopping ACE inhibitors safely over 60 is simple if numbers look good. But neither is quite true. The reality is more nuanced—and reassuringly manageable—with thoughtful planning and shared decision-making.

Let’s gently unpack what science and real-world experience tell us—without alarm, and with plenty of practical support.

Why Stopping ACE Inhibitors Safely Over 60 Requires Careful Planning

ACE inhibitors work by relaxing blood vessels and reducing strain on the heart and kidneys. Over time—especially after years of use—the body adapts. One key adaptation involves the renin-angiotensin-aldosterone system (RAAS), which helps regulate blood pressure and fluid balance. With long-term ACE inhibition, the body often increases plasma renin activity (PRA) as a compensatory response. If the drug is stopped abruptly, this heightened RAAS activity can rebound, causing blood pressure to rise—sometimes significantly—within days to weeks. Studies suggest up to 30% of adults aged 60+ experience some degree of rebound hypertension after discontinuation, particularly if PRA was elevated before stopping.

Another important factor is renal autoregulation—the kidneys’ ability to maintain stable blood flow despite changes in arterial pressure. With age, this capacity gradually declines. ACE inhibitors help protect kidney function in many older adults, especially those with mild chronic kidney disease (eGFR 60–89 mL/min/1.73m²). Stopping them without reassessment could unintentionally reduce this protective effect.

Who Should Pay Extra Attention Before Considering Deprescribing?

Not everyone responds the same way—and certain factors increase the need for caution. Adults aged 62–76 with any of the following should approach stopping ACE inhibitors safely over 60 with extra care:

• A history of heart failure, diabetes, or proteinuria (even mild)
• Estimated glomerular filtration rate (eGFR) below 75 mL/min/1.73m²
• Baseline plasma renin activity above 1.5 ng/mL/hr (a sign of higher RAAS dependence)
• Previous episodes of unexplained BP spikes or orthostatic dizziness

Importantly, stable BP alone isn’t enough to confirm readiness. It’s essential to assess both cardiovascular and kidney resilience—not just today’s number, but how your body manages pressure shifts over time.

Practical Steps: Partnering With Your Doctor for Safer Decisions

If deprescribing is being considered, here’s what often helps:
✅ Gradual tapering, not abrupt stoppage—typically over 4–8 weeks, with close BP monitoring
✅ Baseline biomarker testing before tapering: plasma renin activity, aldosterone, creatinine, and urine albumin-to-creatinine ratio
✅ Home BP monitoring twice daily (morning and evening), for at least two weeks before and six weeks after starting the taper

Lifestyle habits remain foundational: aim for 30 minutes of gentle movement most days (like walking or tai chi), limit sodium to under 1,500 mg daily, prioritize whole foods and hydration, and keep alcohol moderate (≤1 drink/day for women, ≤2 for men). Sleep quality matters too—poor sleep can elevate nighttime BP and blunt natural dips.

Tracking your blood pressure trends can help you and your doctor make better decisions. Consider keeping a daily log or using a monitoring tool to stay informed.

🚩 Call your doctor right away if you notice:

• Systolic BP consistently above 140 mm Hg or diastolic above 90 mm Hg for three days in a row
• New dizziness when standing, shortness of breath, or swelling in ankles/feet
• Unusual fatigue or changes in urination patterns

These signs don’t mean something is wrong—they mean your body is giving helpful feedback, and adjustments can be made thoughtfully.

A Reassuring Perspective

Deciding whether to continue or adjust long-term blood pressure medication isn’t about “fixing” something broken—it’s about honoring how your body has changed and supporting it wisely. For many adults 62–76, continuing an ACE inhibitor remains the safest choice. For others, carefully guided deprescribing may be appropriate. What matters most is doing it together, with time, data, and compassion. If you're unsure, talking to your doctor is always a good idea.

FAQ

#### Is it safe to stop ACE inhibitors after 5 years if my blood pressure is normal?

Yes—potentially—but only with medical guidance and careful monitoring. Normal BP doesn’t guarantee your body no longer relies on the medication. Stopping ACE inhibitors safely over 60 requires assessing kidney function, RAAS activity, and cardiovascular history—not just current numbers.

#### What are the risks of stopping ACE inhibitors safely over 60?

The main concern is rebound hypertension—BP rising above pre-treatment levels—often within 1–3 weeks. Other possible effects include subtle declines in kidney filtration or increased albuminuria. These are usually reversible if caught early, which is why gradual tapering and follow-up are essential.

#### Can lifestyle changes alone replace ACE inhibitors after years of use?

For some, yes—but it’s uncommon in adults over 60 without additional risk factors (e.g., diabetes, heart disease). Most benefit from combining healthy habits with medication, rather than viewing them as alternatives. Think of lifestyle as the foundation, and medication as targeted support.

#### How often should I check my blood pressure when tapering off an ACE inhibitor?

Check twice daily (morning and evening) for at least six weeks after starting the taper. Record each reading—including date, time, posture, and any symptoms—to spot patterns your doctor can interpret.

#### Does stopping ACE inhibitors affect kidney health in older adults?

It can, especially if there’s underlying kidney vulnerability. ACE inhibitors help preserve renal blood flow in aging kidneys. That’s why eGFR and urine albumin tests are part of the evaluation before considering stopping ACE inhibitors safely over 60.