Weight reduction, moderate
salt restriction and alcohol reduction are effective in lowering blood pressure (BP), and are feasible interventions for long-term management of
hypertension. When used in combination these non-pharmacological measures are significantly inferior to
drug therapy in
anti-hypertensive effect. When they are implemented as a first step in the treatment of mild
hypertension, resorting to
drug therapy only if non-pharmacological measures fail,
anti-hypertensive drugs can be avoided in about 40% of patients. However, BP control is again significantly inferior with this strategy compared with
drug therapy without non-pharmacological advice. Those given advice on non-pharmacological measures may therefore have suboptimal protection against cardiovascular complications. This is particularly so when the threshold for
drug treatment is set at a DBP of > or = 100 mmHg, as many patients will be left untreated with
DBPs between 90 and 99 mm Hg as a result of non-pharmacological measures. Non-pharmacological treatment may thus stand between patients and
anti-hypertensive drug therapy, which nowadays is simple, well-tolerated, safe and proven effective in preventing
cardiovascular disease. The role of non-pharmacological
therapy needs to be reconsidered.