Hypertension nonpharmacologic treatment

Nonpharmacologic treatment (particularly weight loss in obese children) is the cornerstone of therapy of primary hypertension. 

Antihypertensives are used to treat hypertension in a stepped-care treatment after nonpharmacological treatment (lose weight, reduce sodium, limit alcohol consumption, stop smoking, exercise) has not achieved the desired results. The stepped-care treatment follows these steps. Treatment progresses to the next step if blood pressure remains elevated. 

Therapeutic lifestyle modifications consisting of nonpharmacologic approaches to blood pressure reduction should be an active part of all treatment plans for patients with hypertension. The most widely studied interventions demonstrating effectiveness include ... 

Whelton PK, Appel LJ, Espeland MA, Applegate WB, Ettinger WH Jr., Kostis JB et al. Sodium reduction and weight loss in the treatment of hypertension in older persons a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group. JAMA 1998 279(ll) 839-46. 

The initial step in treating hypertension may be nonpharmacologic. As discussed previously, sodium restriction may be effective treatment for many patients with mild hypertension. The average American diet contains about 200 mEq of sodium per day. A reasonable dietary goal in treating hypertension is 70-100 mEq of sodium per day, which can be achieved by not salting food... 

The complexity of the heart failure syndrome necessitates a comprehensive approach to management that includes accurate diagnosis, identification and treatment of risk factors (e.g., diabetes, hypertension, and coronary artery disease), elimination or minimization of precipitating factors such as NSAlDs, and appropriate pharmacologic and nonpharmacologic therapy. 

Diuretics are used clinically to treat hypertension (see Chapter 32) and to reduce edema associated with cardiac, renal, and hepatic disorders. Three fundamental strategies exist for mobilizing edema fluid correct the underlying disease, restrict Na intake, or administer diuretics. The most desirable course of action would be to correct the primary disease however, this often is impossible. Restriction of Na+ intake is the favored nonpharmacologic approach to the treatment of edema and hypertension and should be attempted however, compliance is a major obstacle. Diuretics therefore remain the cornerstone for the treatment of edema or volume overload, particularly that owing to congestive heart failure, ascites, chronic renal failure, or nephrotic syndrome. 

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