Drug and dietary intervention in hypertension

Antihypertensive drug treatment has been shown to be efficacious in reducing mortality, morbidity, and end-organ damage from hypertension. However, the health care consequences of providing continued antihypertensive therapy for approximately one-fourth of the adult population has led to inquiry into the potential of nutritional change as an alternative therapy. The relapse rate for the return of hypertension after withdrawal of antihypertensive drugs is greater in the obese than in the nonobese patient. The relapse rate is also much greater if the hypertension was severe before antihypertensive drugs were started. A programmed course of dietary instruction enabled participants to drop sodium excretion by 50%, and to lose approximately 5% of body weight in 32 weeks. Adequate large-scale trials to determine the therapeutic success rate of dietary modification in mild hypertension have yet to be done. Studies have been initiated in the United States and Finland to determine the feasibility of dietary modifications as a means of preventing the occurrence of hypertension. This endeavor deserves the highest priority, for the magnitude of the problem threatens to overwhelm conventional means of provision of medical care.