MIGHT NONPHARMACOLOGICAL TREATMENT DISADVANTAGE PATIENTS WITH HYPERTENSION

Weight reduction, moderate salt restriction and alcohol reduction are effective in lowering blood pressure (BP), and are feasible interventi ons for long-term management of hypertension. When used in combination these non-pharmacological measures are significantly inferior to drug therapy in anti-hypertensive effect. When they are implemented as a f irst step in the treatment of mild hypertension, resorting to drug the rapy only if non-pharmacological measures fail, anti-hypertensive drug s can be avoided in about 40% of patients. However, BP control is agai n significantly inferior with this strategy compared with drug therapy without nonpharmacological advice. Those given advice on nonpharmacol ogical measures may therefore have suboptimal protection against cardi ovascular complications. This is particularly so when the threshold fo r drug treatment is set at a DBP of greater than or equal to 100 mm Hg , as many patients will be left untreated with DBPs between 90 and 99 mm Hg as a result of non-pharmacological measures. Non-pharmacological treatment may thus stand between patients and anti-hypertensive drug therapy, which nowadays is simple, well-tolerated, safe and proven eff ective in preventing cardiovascular disease. The role of non-pharmacol ogical therapy needs to be reconsidered.