Non-pharmacological treatment of hypertension in primary health care

OBJECTIVE: To assess whether lifestyle counselling is effective in non-pharmacological treatment of hypertension in primary health care. DESIGN: Open randomized controlled trial. SETTING: Ten municipal primary health care centres in eastern Finland. PATIENTS: Seven hundred and fifteen subjects aged 25-74 years with systolic blood pressure 140-179 mmHg and/or diastolic blood pressure 90-109 mmHg or antihypertensive drug treatment. INTERVENTIONS: Systematic health counselling given by local public health nurses for 2 years. MAIN OUTCOME MEASURES: Blood pressure, lipids and lifestyle data were collected annually. RESULTS: Among participants with no antihypertensive drug treatment, the net reductions after 1 year both in systolic blood pressure -2.6 mmHg; 95% confidence interval (CI), -4.7 to -0.5 mmHg and in diastolic blood pressure (-2.7 mmHg; 95% CI, -4.0 to -1.4 mmHg) were significant in favour of the intervention group. This difference in blood pressure change was maintained during the second year. In participants with antihypertensive drug treatment, no significant difference in blood pressure reduction was seen between the groups during the study. CONCLUSIONS: A relatively modest, but systematic counselling in primary health care can, at least among untreated hypertensive subjects, produce reductions in blood pressure levels that are modest for the individual, but very important from the public health point of view.