Lifestyle interventions or drugs for patients with essential hypertension

OBJECTIVE: To compare the effectiveness of lifestyle and drug interventions for treating patients with essential hypertension. METHODS: Systematic review of randomized controlled trials (RCTs), with 8 or more weeks follow-up, enrolling patients with blood pressure of at least 140/85 mmHg, which directly compared lifestyle and drug interventions. Planned outcome measures were cardiovascular morbidity and mortality and blood pressure. RESULTS: We found five RCTs meeting our inclusion criteria and additionally included one quasi-randomized trial. These trials enrolled between 27 and 64 participants, mean age 55 years, with follow-up of less than 1 year; none reported cardiovascular outcomes. The lifestyle and drug interventions and patient populations were heterogeneous. Overall, the trials were of poor quality and had inconsistent results. Although dietary interventions did not always lower blood pressure as much as antihypertensive drugs, secondary analysis suggested that they might be better at lowering cholesterol levels. CONCLUSIONS: In the short term, lifestyle treatment may be effective at reducing blood pressure for some individuals. A healthier diet, by lowering blood pressure and cardiovascular risk, may reduce, delay or remove the need for long-term drug therapy in some patients. However, further comparisons of lifestyle and drug interventions for hypertension are required, with larger clinical trials of longer duration and better quality. Future trials should aim to identify the characteristics of patients most likely to benefit from lifestyle changes.