Nonpharmacological therapy of hypertension. Commentary on diet and blood pressure.

The use of dietary measures as sole therapy for hypertension has generated much enthusiasm and is supported by epidemiological and anecdotal data but is not substantiated by long-term controlled trials. Dietary measures should be effective in preventing the rise in blood pressure with age in civilized populations, but there are no firm data to substantiate this hypothesis. However, some data do suggest that weight loss and sodium restriction may benefit the drug-treated hypertensive patient. There are strong reasons to consider the use of nonpharmacological measures for the treatment of mild hypertension. Mild hypertension is ubiquitous. Some population subsets have a prevalence of mild hypertension approaching 40%, based on one blood pressure determination, for individuals older than 50 years. Even if the true prevalence is closer to 15%, this is a high proportion of the population in need of drug therapy. If a change in lifestyle could reduce the need for drug therapy by a respectable percentage, then an enormous number of individuals could be spared the necessity of taking antihypertensive medication.