Nutritional and lifestyle approaches to the prevention and management of hypertension.

We have been encouraged by the growing interest in nutrition and lifestyle for the prevention and treatment of hypertension. While no proven means for preventing hypertension exist, epidemiologic data have identified risk factors for hypertension. We have attempted to outline a reasonable program based on knowledge of risk factors for hypertension on one hand vs. the lack of data that hypertension can be prevented on the other. Managing patients who have hypertension with nondrug strategies is a different matter. First, more evidence is available indicating effectiveness for reducing a high pressure than for preventing a normotensive person from becoming hypertensive. Secondly, hypertension is a risk factor for premature cardiovascular morbidity and mortality. Thus, the risk-to-benefit ratio from intervening is tipped toward probability of benefit. Many of the nondrug therapies have been presented. It is unreasonable to expect a patient to adhere to every one. Therefore, patients with uncomplicated, newly diagnosed borderline and mild hypertension are given the range of modalities available and assisted in choosing those best suited to their lifestyle. The nondrug efforts are tried for three to six months in patients with uncomplicated mild hypertension. We advocate evaluating responses to the nondrug approaches with blood pressures measured both in and outside the office. Blood pressures measured by the patient at work and rest have been very valuable in our practice. If no antihypertensive benefit is seen, then most of these patients receive standard antihypertensive drugs. For those who have complete or partial success, the nondrug efforts are continued or reinforced with follow-up every three to six months.(ABSTRACT TRUNCATED AT 250 WORDS)