Clinical Effectiveness of Non-Drug Treatment for Hypertension: a Meta-Analysis

Abstract We conducted a meta-analysis of the clinical effectiveness of treatments for essential hypertension using 166 studies that evaluated the effects of diuretics, beta-blockers, and calcium-channel blockers, weight reduction, sodium and alcohol restriction, physical exercise, calcium and potassium supplements, single-component and multi-component relaxation therapy, and individualized cognitive-behavioral therapies. The findings were consistent with previous reviews that weight reduction, physical exercise, reduced sodium and alcohol intake, potassium supplements, and standardized relaxation treatments led to pressure reductions which mostly fell below effect size magnitudes observed with drug therapies. Of the non-drug approaches, weight reduction/physical exercise, and individualized cognitive-behavioral psychological therapy were particularly effective and did not differ from drug treatments in observed raw effect sizes for systolic blood pressure reductions. Calcium supplements were the least effective intervention. Drug therapies were initiated at higher initial levels of blood pressure than non-drug therapies with average pressures of 154.1 mmHg vs. 145.4 mmHg systolic and 101.5 mmHg vs. 94.3 mmHg diastolic pressure for drug/non-drug treatments respectively. After adjustment for differences in initial pressure levels, the effects for non-drug therapies increased, and the effect size of individualized psychological therapy matched the effect sizes of drug treatments for systolic and diastolic pressure reduction. These findings suggest that some non-drug therapies are more effective than commonly believed especially when differences in pre-treatment blood pressure levels are accounted for.