Nonpharmacological approaches to the control of high blood pressure. Final report of the Subcommittee on Nonpharmacological Therapy of the 1984 Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure.

Abstract

This report reviews a variety of nonpharmacological approaches used to control arterial blood pressure. Of all the modalities considered, only three had sufficient scientific support to warrant recommendation for inclusion in hypertension treatment programs. Each of these three modalities -weight control, alcohol restriction, and sodium restriction -was found to be capable not only of independently controlling blood pressure (particularly in patients with mild hypertension) but also of reducing the number and dosage of prescribed pharmacological agents, should their prescription be indicated. Weight reduction was found to reduce the risk from elevated arterial pressure as well as overall cardiovascular morbidity and mortality. However, because the rate of recidivism was exceedingly high in these studies, close and continuous patient follow-up is considered necessary. Excessive alcohol intake is associated in many studies with proportionally higher arterial pressures and an increased prevalence of hypertension. Therefore, the recommendation of moderation in alcohol consumption to less than 2 oz of ethanol daily for patients with hypertension is supported. Restriction of dietary sodium to less than 2 g/day was the only other nonpharmacological approach with sufficient scientific support to be recommended as a treatment for hypertension. Although long-term studies are sorely lacking, sodium restriction has been shown to be manageable and safe and probably will benefit those hypertensive patients who are sodium-sensitive. (Hypertension 8: 444-467, 1986) KEY WORDS • nonpharmacological therapy • obesity • nutritional factors • alcohol exercise • sodium • biofeedback and relaxation ObesityThe association of hypertension with obesity is well established, and a compelling body of evidence has related the two conditions. 2 " 4 Studies concerned with elucidation of the mechanisms involved, however, have recently intensified (see the section "Mechanisms at SWETS SUBS SERV-#38448440 on April 3, 2015 http://hyper.ahajournals.org/ Downloaded from at SWETS SUBS SERV-#38448440 on April 3, 2015 http://hyper.ahajournals.org/ Downloaded from Randomized, parallel trial of | Na + vs general health package (exercise, weight reduction, relaxation) Poor patient compliance. Large SE for BP and urinary sodium. Decrease in U Na V was 26 mmoL/day (mean change, 150-117 mmol/day) in intervention group. Both groups had significant fall in BP in 1 yr; no difference between groups. Elements of "general health package" may have lowered BP. Randomized, parallel trial of Na + vs control Both groups had significant fall in BP; no difference between groups. Diet group greatly reduced or stopped drug therapy; need for therapy only slighty decreased in control group. at SWETS SUBS SERV-#38448440 on April 3, 2015 http://hyper.ahajournals.org/ Downloaded from Edward D. Frohlich, M.D., Chairman, Vice President, Aca-