Doc, are pills prescribed for BP and cholesterol, habit forming? Is it true 

that once started they cannot be stopped?

Well, the answer is that they are not habit forming (in the sense some drugs acting on the mind are), although if they benefit you in the long term helping you to prevent heart attacks and brain strokes, they are a good “habit” to form!

If BP and cholesterol levels are not at desirable levels as per your risk profile, and if your cardiologist feels you that in addition to the lifestyle changes you have instituted, pills are also required to control their levels to reduce the risk of heart attack or brain strokes, then it may be advisable to take them as long as your cardiologist feels you should take them, which in many cases could be lifelong. But that will drastically cut your risk of heart attack or brain strokes in future, if taken as advised.

About stopping them once started? Well it depends on your risk of having heart attacks in future (which depends on your lifestyle and risk factors like family history, presence of hypertension, diabetes, cholesterol etc.), and your response to changes in lifestyle and drugs.

For example, if your BP comes down with lifestyle measures such as weight reduction, salt and alcohol restriction, doing regular exercise, sleeping well and increasing fruits and vegetables in diet, your pills can be tapered gradually over weeks and months keeping a watch over your BP, lest it should go up again.

If it remains normal on repeated checking despite tapering and stopping pills, one can do away with the BP pills. If after tapering and stopping pills, BP rises again, then the pills will have to be reinstituted.

In case of cholesterol pills, commonest of which are called statins, research has found tremendous benefits with their use in people at high risk, for example people who are known to have coronary artery disease or people with multiple risk factors alluded above.

But again, in people with low or intermediate risk, if cholesterol levels plummet with intensive lifestyle changes, these pills can be stopped, and lipid levels checked again at regular intervals to see if they remain low. If they rise again, one may have to reinstitute the drugs at the advice of one’s cardiologist after a risk-benefit discussion.

One caveat to all the above is that there are certain drugs which are dangerous to stop suddenly. For example, a class of drugs called betablockers or a drug like clonidine, if stopped suddenly can cause rebound hypertension (to levels higher than those before drug was started) and rarely even cause heart attacks. Hence if they are to be stopped, it should only be done gradually under the guidance of your cardiologist.

As far as cholesterol lowering drugs (like statins) are concerned, stopping them suddenly in a person having underlying coronary disease may increase his/her risk of worsening his/her condition. Hence again, if one wants to stop or alter them, it should be done under a cardiologist’s guidance.

Thus, BP drugs and Cholesterol drugs are a good “habit” to form if they are required to control your BP and cholesterol levels which will benefit you in the long term to prevent heart attacks and brain strokes. If you are at low or intermediate risk and if BP and cholesterol are well controlled with healthy lifestyle and habits, then stopping or altering drugs is possible but not without medical guidance.