Nonpharmacologic approaches to therapy for hypertension

To provide an overview of nondrug therapeutic modalities for management of hypertension.

We review four strategies that involve lifestyle changes--weight reduction, moderation of sodium intake, physical activity, and moderation of alcohol consumption--that can potentially have a blood pressure-lowering effect.

Several clinical trials have shown that a weight loss of 10 to 20% will significantly decrease blood pressure. An average of 1 to 2 mm Hg reduction in blood pressure may occur per kilogram of weight lost. Although sodium restriction has less effect on blood pressure than does weight reduction, a decrease in sodium intake to <100 mmol/day can yield a mean blood pressure reduction of 3 to 5 mm Hg systolic and 2 to 3 mm Hg diastolic. Exercise regimens have demonstrated convincing antihypertensive effects. In recent randomized studies, the average reduction in blood pressure ranged from 5 to 15 mm Hg for systolic measurements and 5 to 10 mm Hg for diastolic readings. Alcohol consumption has been shown to have one of the strongest associations with blood pressure among the potentially modifiable risk factors for hypertension. An average of 1 mm Hg decrease in blood pressure has been noted per one drink/day reduction in consumption.

Lifestyle changes that can decrease blood pressure are important because they may not only eliminate the need for drug treatment but also decrease other cardiovascular risk factors.