Nonpharmacologic therapy for hypertension.

Nonpharmacologic treatment for hypertension, including behavioral therapy, weight and/or salt reduction and exercise has been proposed as an alternative or as an adjunct to accepted drug therapy. Behavioral technics, especially the relaxation response, a modification of transcendental meditation, have successfully lowered blood pressure ($\text{10}\text{5}$ mm Hg) in small numbers of highly motivated patients, but the general applicability and success of these technics have been questioned. Biofeedback uses complex instrumentation to inform the patient of his or her moment-to-moment blood pressure and can assist the patient in voluntarily learning to lower it. In studies carried out with biofeedback, small reductions in blood pressure have been achieved. Substantial weight and salt reduction will lower blood pressure, and recent studies suggest that even modest reductions in weight (averaging 9.5 kg on a 800 to 1,200 calorie diet) or salt intake (157 meq/day) may be adequate antihypertensive therapy for many patients. Regular exercise has also been advocated, but data are too fragmentary to draw any firm conclusions as to its efficacy for the general hypertensive population. Long term follow-up of all of these nonpharmacologic methods of treatment has not yet been reported, and only preliminary information is available on simultaneous use of several methods to see if synergy occurs. Patient adherence to these life-style modifications is uncertain, and no data demonstrating the reduction of cardiovascular mortality and morbidity have been obtained as yet Since nonpharmacologic treatment for hypertension is inexpensive and probably safe, the time is right for extensive research to determine the efficacy, applicability, patient compliance and safety of this approach.