Non-pharmacologic therapy in the management of hypertension: an update

At the Canadian consensus conference on non-pharmacologic approaches to the management of high blood pressure in 1989 the evidence on the role of salt, body weight (obesity), alcohol, physical exercise, calcium and potassium supplementation, and stress management was reviewed, and recommendations were made. Most of the recommendations are still valid in 1994, although it is worth reviewing some of the data published since 1989. The evidence linking body weight or obesity to hypertension is strong, and weight reduction should be part of non-pharmacologic therapy for hypertension. The data on physical exercise are stronger now, such that further recommendations may be worth considering. There are new data on the management of patients who have borderline blood pressure elevation or are predisposed to develop hypertension. The roles of weight loss, salt restriction and mineral replacement are reviewed. The management of mild hypertension can involve a choice between non-pharmacologic and pharmacologic therapy; however, a combination of both is usually necessary. Public education may have a growing role in the prevention of hypertension in selected population groups.