Nonpharmacological interventions as an adjunct to the pharmacological treatment of hypertension: a statement by WHL. The World Hypertension League

Abstract

Nonpharmacological approaches lower medication requirements in patients with hypertension. A decreased salt intake to a sodium value of about 80 mmol/day lowers BP in the presence of diuretics, beta-blockers, converting enzyme antagonists and sympatholytics but apparently not in patients treated solely with calcium antagonists. A reduced medication requirement is seen in about half of the patients suggesting that the phenomenon of 'salt-sensitivity' still applies. Weight loss is an effective adjunctive therapy and simultaneously improves other cardiovascular risk factors. A high alcohol consumption is a confounding factor in the drug treatment of hypertension. Reducing the alcohol intake of hypertensive heavy drinkers significantly lowers their BPs and drug requirements. Aerobic exercise is an effective nonpharmacological treatment which simultaneously fosters weight loss and improves risk factors. Potassium supplementation does not decrease medication requirements in drug-treated patients who are ingesting a low salt diet but may do so in those eating large amounts of salt. Nonpharmacological approaches should be included in the management of all hypertensive patients irrespective of their drug therapy. These should include weight reduction through decreased food and alcohol consumption as well as regular, programmed exercise. Patients should be instructed in a low calorie diet rich in fresh rather than processed products and high in fruits and vegetables. Such a diet will contain relatively little salt, reduced fat, and ample amounts of potassium and calcium. However, physicians should not lose sight of the fact that cigarette smoking remains the most important risk factor to be addressed in their hypertensive patients.