Might non-pharmacological treatment disadvantage patients with hypertension?
Weight reduction, moderate salt restriction and alcohol reduction are effective in lowering blood pressure (BP), and are feasible interventions 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 first step in the treatment of mild hypertension, resorting to drug therapy only if non-pharmacological measures fail, anti-hypertensive drugs can be avoided in about 40% of patients. However, BP control is again significantly inferior with this strategy compared with drug therapy without non-pharmacological advice. Those given advice on non-pharmacological measures may therefore have suboptimal protection against cardiovascular complications. This is particularly so when the threshold for drug treatment is set at a DBP of > or = 100 mmHg, 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 effective in preventing cardiovascular disease. The role of non-pharmacological therapy needs to be reconsidered.
Department of Medicine and Pharmacology, Royal Hallamshire Hospital, Sheffield, UK.
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Ramsay
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Haq
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Yeo
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Jackson
D000428:Alcohol Drinking; D004039:Diet, Sodium-Restricted; D005081:Exercise Therapy; D006801:Humans; D006973:Hypertension / Q000178:diet therapy / Q000188:drug therapy / Q000628:therapy*; D015431:Weight Loss