Non-Drug Treatment of Hypertension

  • Henry R. Black
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 16)


In the past decade there has been considerable interest in treating hypertension (HBP) with non-pharmacologic methods, both old (sodium (Na+) restriction and weight reduction) and new (behavioral therapy and exercise). Yet, in its 1980 report the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure recommended some forms of non-drug therapy for HBP in some patients with little enthusiasm [1]. They felt that obese hypertensive patients should be encouraged to lose weight; that modest Na+ restriction (85 mEq/day) was a reasonably adjunctive therapy in all patients but that behavioral methods could not yet be considered a substitute for pharmacologic treatment. No recommendations were made about exercise. The rationale for non-pharmacologic treatment of HBP (Na+ restriction, weight reduction, stress reduction, and exercise) is based on experimental and epidemiologic evidence suggesting a role for excess Na+ intake, obesity, and stress in causing HBP in man.


Hypertensive Patient Essential Hypertension Relaxation Response Salt Restriction Behavioral Method 
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  1. 1.
    The 1980 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 140: 1280–1284, 1980.Google Scholar
  2. 2.
    Freis ED: Salt, volume and the prevention of hypertension. Circulation 53: 589–595, 1976.PubMedGoogle Scholar
  3. 3.
    Ambard L, Beujard E: Causes l’hypertension arterielle. Arch Gen Med 193: 520–533, 1904.Google Scholar
  4. 4.
    Allen FM, Sherrill JW: The treatment of arterial hypertension. J Metab Res 2: 429, 1922.Google Scholar
  5. 5.
    Kempner W: Treatment of hypertensive vascular disease with rice diet. Am J Med 4: 545–577, 1948.PubMedCrossRefGoogle Scholar
  6. 6.
    Dole VP, Dahl LK, Cotzias GC, Eder HA, Krebs ME: Dietary treatment of hypertension. Clinical and metabolic studies of patients on the rice-fruit diet. J Clin Invest 29: 1189–1206, 1950.PubMedCrossRefGoogle Scholar
  7. 7.
    Grollman A, Harrison TR, Mason MF, Baxter J, Crampton J, Reichsman F: Sodium restriction in the diet for hypertension. JAMA 129 (8): 533–537, 1945.Google Scholar
  8. 8.
    Dustan HR, Tarazi RC, Bravo EL: Diuretic and diet treatment of hypertension. Arch Intern Med 133: 1007–1013, 1974.PubMedCrossRefGoogle Scholar
  9. 9.
    Parijs J, Joossens JV, Van der Linden L, Verstreken G, Amery AKPC: Moderate sodium restriction and diuretics in the treatment of hypertension. Am Heart J 85: 22–34, 1973.PubMedCrossRefGoogle Scholar
  10. 10.
    Morgan T, Gillies A, Morgan G, Adam W, Wilson M, Carney S: Hypertension treated by salt restriction. Lancet 1: 227–230, 1978.PubMedCrossRefGoogle Scholar
  11. 11.
    Heyden S, Nelius SJ, Hames CG: Obesity, salt intake, and hypertension. J Cardiovasc Med 11: 987–994, 1980.Google Scholar
  12. 12.
    Hunt JC, Margie JD: The influence of diet on hypertension management. Hypertension Update 4: 37–47, 1979.Google Scholar
  13. 13.
    Haddy FJ: Mechanism, prevention and therapy of sodium-dependent hypertension. Am J Med 69: 746–758, 1980.PubMedCrossRefGoogle Scholar
  14. 14.
    Addison W: The uses of sodium chloride, potassium chloride, sodium bromide and potassium bromide in cases of arterial hypertension which are amenable to potassium chloride. Can Med Assoc J 18 (2): 281–285, 1928.PubMedGoogle Scholar
  15. 15.
    McQuarrie I, Thompson WH, Anderson JA: Effects of excessive ingestion of sodium and potassium salts on carbohydrate metabolism and blood pressure in diabetic children. J Nutr 11: 77–101, 1936.Google Scholar
  16. 16.
    Priddle WW: Observations on the management of hypertension. Can Med Assoc J 25: 5–8, 1931.PubMedGoogle Scholar
  17. 17.
    Meneely GR, Battarbee HD: High sodium-low potassium environment and hypertension. Am J Cardiol 38: 768–785, 1976.PubMedCrossRefGoogle Scholar
  18. 18.
    Luft FC, Ranin LI, Weinberger MH: The role of potassium (K+) in the responses to extremes of sodium (Na+) intake in man. Clin Res 26 (5): 698A, 1978.Google Scholar
  19. 19.
    Oliver WJ, Cohen EL, Neel JV: Blood pressure, sodium intake and sodium relted hormones in the Yanomamo Indians, a ‘no-salt’ culture. Circulation 52 (1): 146–152, 1975.PubMedGoogle Scholar
  20. 20.
    Longworth DL, Drayer JIM, Weber MA, Laragh JH: Divergent blood pressure responses during short-term sodium restriction in hypertension. Clin Pharmacol Ther 27: 544–546, 1980.PubMedCrossRefGoogle Scholar
  21. 21.
    Society of Actuaries and Association of Life Insurance Medical Directors of America: Build Study 1979. Recording & Statistical Corp., USA, March 1980.Google Scholar
  22. 22.
    Society of Actuaries: Build and Blood Pressure Study, 1959, Vols 1 and 2, Chicago, 1959.Google Scholar
  23. 23.
    Stamler J: Research related to risk factors. Circulation 60: 1575–1586, 1979.PubMedGoogle Scholar
  24. 24.
    Rabkin SW, Mathewson FAL, Hse PH: Relation of body weight to development of ischemic heart disease in a cohort of young North American men after a 26 year observation period: the Manitoba Study. Am J Cardiol 39: 452–458, 1977.PubMedCrossRefGoogle Scholar
  25. 25.
    Messerli FH, Christie B, DeCarvalho JGR, Aristimuno GG, Suarez DH, Dreslinski GR, Frohlich ED: Obesity and essential hypertension: Hemodynamics, intravascular volume, sodium excretion, and plasma renin activity. Arch Intern Med 141: 81–85, 1981.PubMedCrossRefGoogle Scholar
  26. 26.
    Keys A, Aravanis G, Blackburn H, Van Buchen FSP, Buzino R, Djordjevic BS, Fidanza F, Karvonin JM, Menotti A, Pudda V, Taylor HL: Coronary heart disease: Overweight and obesity as risk factors. Ann Intern med 77: 15–27, 1972.PubMedGoogle Scholar
  27. 27.
    Weinsier RL, Fuchs RJ, Kay TD, Triebwasser JH, Lancaster MC: Body fat: its relationship to coronary heart disease, blood pressure, lipids and other risk factors measured in a large male population. Am J Med 61: 815–824, 1976.PubMedCrossRefGoogle Scholar
  28. 28.
    Kannel WB, Brand N, Skinner JJ, Dawber TR, McNamara P: The relation of adiposity to blood pressure and development of hypertension. The Framingham Study. Ann Intern Med 67: 48–59, 1967.PubMedGoogle Scholar
  29. 29.
    Voors AW, Foster TA, Frerichs RR, Webber LS, Berenson GS: Studies of blood pressures in children, ages 5–14 years, in a total biracial community: the Bogalusa Heart Study. Circulation 54: 319–327, 1976.PubMedGoogle Scholar
  30. 30.
    Rames LK, Clarke WR, Conner WE, Reiter MA, Lauer RM: Normal blood pressures and the evaluation of sustained blood pressure elevation in childhood: the Muscatine Study. Pediatrics 61: 245–251, 1978.PubMedGoogle Scholar
  31. 31.
    Harlan WR, Cornoni-Huntley J, Leaverton PE: Blood pressure in childhood. The national health examination survey. Hypertension 1: 559–565, 1979.PubMedGoogle Scholar
  32. 32.
    Munoz S, Munoz H, Zambrano LF: Blood pressure in a school-age population. Distribution, correlations, and prevalence of elevated values. Mayo Clin Proc 55: 623–632, 1980.PubMedGoogle Scholar
  33. 33.
    Chiang BN, Perlman LV, Epstein FH: Overweight and hypertension. A review. Circulation 39: 403–421, 1969.PubMedGoogle Scholar
  34. 34.
    Mann GV: The influence of obesity on health. N Engl J Med 291: 178–232, 1974.PubMedCrossRefGoogle Scholar
  35. 35.
    Reisin E, Abel R, Modan M, Silverberg DS, Eliahou HE, Modan B: Effect of weight loss without salt restriction on the reduction of blood pressure in overweight hypertensive patients. N Engl J Med 298: 1–6, 1978.PubMedCrossRefGoogle Scholar
  36. 36.
    Dahl LK, Silver L, Christie RW: Role of salt in the fall of blood pressure accompanying reduction of obesity. N Engl J Med 258: 1186–1192, 1958.PubMedCrossRefGoogle Scholar
  37. 37.
    Stamler J, Farinaro E, Mojonnier LM, Hall Y, Moss D, Stamler R: Prevention and control of hypertension by nutritional-hygienic means. JAMA 243: 1819–1823, 1980.PubMedCrossRefGoogle Scholar
  38. 38.
    Stunkard A, McLaulin-Hume M: The results of the treatment for obesity. Arch Intern Med 103: 79–85, 1959.Google Scholar
  39. 39.
    Currey H, Malcolm R, Riddle E, Schachte M: Behavioral treatment of obesity. Limitations and results with the chronically obese. JAMA 237: 2829–2831, 1977.PubMedCrossRefGoogle Scholar
  40. 40.
    Dawber TR: Risk factors in young adults: The lessons from epidemiologic studies of cardiovascular disease: Framingham, Tecumseh, and Evans County. J Am Coll Health Assoc 22: 84–95, 1973.PubMedGoogle Scholar
  41. 41.
    Fox S, Skinner J: Physical activity and cardiovascular health. Am J Cardiol 14: 731–746, 1964.PubMedCrossRefGoogle Scholar
  42. 42.
    Morris Jn, Chave SPW, Adam C, Sirey C, Epstein L, Sheehan DJ: Vigorous exercise in leisure-time and the incidence of coronary heart disease. Lancet 1: 333–339, 1973.Google Scholar
  43. 43.
    Paffenbarger RS, Hale WE: Work activity and coronary heart mortality. N Engl J Med 292: 545–550, 1975.PubMedCrossRefGoogle Scholar
  44. 44.
    Montoye HJ, Metzner HL, Keller JB, Johnson BC, Epstein FH: Habitual physical activity and blood pressure. Med Sci Sports 4: 175–181, 1972.PubMedCrossRefGoogle Scholar
  45. 45.
    Cooper KH, Pollack ML, Martin RP, White SR, Linnerud AC, Jackson A: Physical fitness levels vs selected coronary risk factors. A cross-sectional study. JAMA 236: 166–169, 1976.PubMedCrossRefGoogle Scholar
  46. 46.
    Scheuer J, Tipton CM: Cardiovascular adaptations to physical training. Ann Rev Physiol 39: 221–251, 1977.CrossRefGoogle Scholar
  47. 47.
    Tipton CM, Matthes RD, Callahan A, Tcheng TK, Lais LT: The role of chronic exercise on resting blood pressures of normotensive and hypertensive rats. Med Sci Sports 9: 168–177, 1977.PubMedGoogle Scholar
  48. 48.
    Evenwel R, Struyker-Boudier H: Effect of physical training on the development of hyper-tension in the spontaneously hypertensive rat. Pfluegers Arch 381: 19–24, 1979.CrossRefGoogle Scholar
  49. 49.
    Weiss L: Adaptive cardiovascular changes to physical training in spontaneously hypertensive and normotensive rats. Cardiovasc Res 12: 329–333, 1978.PubMedCrossRefGoogle Scholar
  50. 50.
    Boyer JL, Kasch FW: Exercise therapy in hypertensive men. JAMA 211: 1668–1671, 1970.PubMedCrossRefGoogle Scholar
  51. 51.
    Choquette G, Ferguson RJ: Blood pressure reduction in ‘borderline’ hypertensives following physical training. Can Med assoc J 108: 699–703, 1973.PubMedGoogle Scholar
  52. 52.
    Wilmore JH, Royce J, Girandola RN, Katch FT, Katch VL: Physiological alterations resulting from a 10-week program of jogging. Med Sci Sports 2: 7–14, 1970.PubMedGoogle Scholar
  53. 53.
    Frick MH, Konttinen A, Sarajas HSS: Effects of physical training on circulation at rest and during exercise. Am J Cardiol 12: 142–147, 1963.PubMedCrossRefGoogle Scholar
  54. 54.
    Barry AJ, Daly JW, Pruett EDR, Steinmetz JR, Page HF, Birkhead NC, Rodahl K: The effects of physical conditioning on older individuals — I. Work capacity, circulatory-respiratory function, and work electocardiogram. J Gerontol 21: 182–191, 1966.PubMedGoogle Scholar
  55. 55.
    Konig K: Changes in physical capacity, heart size and function in patients after myocardial infarction, who underwent a 4- to 6-week physical training program. Cardiology 62: 232–246, 1977.PubMedCrossRefGoogle Scholar
  56. 56.
    Haskell WL: Cardiovascular complications during exercise training of cardiac patients. Circulation 57: 920–924, 1978.PubMedGoogle Scholar
  57. 57.
    Gibbons LW, Cooper KH, Meyer BM, Ellison C: The acute cardiac risk of strenuous exercise. JAMA 244: 1799–1801, 1980.PubMedCrossRefGoogle Scholar
  58. 58.
    Reid EL, Morgan RW: Exercise prescription: A clinical trial. Am J Public Health 69: 591–595, 1979.PubMedCrossRefGoogle Scholar
  59. 59.
    Henry JP, Cassel JC: Psychosocial factors in essential hypertension. Recent epidemiologic and animal experimental evidence. Am J Epidemiol 90: 171–200, 1969.PubMedGoogle Scholar
  60. 60.
    Buell JC, Eliot RS: The role of emotional stress in the development of heart disease. JAMA 242: 365–368, 1979.PubMedCrossRefGoogle Scholar
  61. 61.
    Jenkins CD: Recent evidence supporting psychologic and social risk factors for coronary disease. N Engl J Med 294:987–994 1nd 1033–1038, 1976.Google Scholar
  62. 62.
    Shekelle RB: Psychosocial factors and high blood pressure. Cardiovasc Med 12: 1249 1253, 1979.Google Scholar
  63. 63.
    Jacobson E: Variation of blood pressure with skeletal muscle tension and relaxation. Ann Intern Med 12: 1194–1212, 1939.Google Scholar
  64. 64.
    Benson H: Systemic hypertension and the relaxation response. N Engl J Med 296: 1152–1156, 1977.CrossRefGoogle Scholar
  65. 65.
    Wallace RK, Benson H, Wilson AF: A wakeful hypometabolic physiologic state. Am J Physiol 221: 795–799, 1971.PubMedGoogle Scholar
  66. 66.
    Benson H, Rosner BA, Marzetta BR, Klemschuk HP: Decreased blood pressure in borderline hypertensive subjects who practiced meditation. J Chron Dis 27: 163–169, 1974.PubMedCrossRefGoogle Scholar
  67. 67.
    Banson H, Marzetta BR, Rosner BA, Klemschuk HM: Decreased blood pressure in pharmacologically treated hypertensive patients who regularly elicited the relaxation response. Lancet 1: 289–291, 1974.CrossRefGoogle Scholar
  68. 68.
    Blackwell B, Bloomfield S, Gartside P, Robinson A, Hanenson I, Magenheim H, Nidich S, Zigler R: Transcendental meditation in hypertension. Lancet 1: 223–226, 1976.PubMedCrossRefGoogle Scholar
  69. 69.
    Stone RA, DeLeo J: Psychotherapeutic control of hypertension. N Engl J Med 294: 80–84, 1976.PubMedCrossRefGoogle Scholar
  70. 70.
    Datey KK, Deshmukh SN, Dalvi CP, Vinekar SL: ‘Shavasan’: A yogic exercise in the management of hypertension. Angiology 20: 325–333, 1969.PubMedCrossRefGoogle Scholar
  71. 71.
    Taylor CB, Farquhar JW, Nelson E, Agras S: Relaxation therapy and high blood pressure, Arch Gen Psychiatry 34: 339–342, 1977.PubMedGoogle Scholar
  72. 72.
    Pollack AA, Case DB, Weber MA, Laragh JH: Limitations of transcendental meditation inthe treatment of essential hypertension. Lancet 1: 71–73, 1977.PubMedCrossRefGoogle Scholar
  73. 73.
    Deabler HL, Fidel E, Dillenkoffer RL, Elder ST: The use of relaxation and hypnosis in lowering high blood pressure. Am J Clin Hypn 16: 75–83, 1973.PubMedCrossRefGoogle Scholar
  74. 74.
    Patel C, North WRS: Randomised controlled trial of yoga and biofeedback in management of hypertension. Lancet 1: 93–95, 1975.CrossRefGoogle Scholar
  75. 75.
    Patel C: Yoga and biofeedback in the management of ‘stress’ in hypertensive patients. Clin Sci Mol Med 48: 171s–174s, 1975.Google Scholar
  76. 76.
    Shoemaker JE, Tasto DL: The effects of muscle relaxation on blood pressure of essential hypertensives. Behav Res Ther 13: 29–43, 1975.PubMedCrossRefGoogle Scholar
  77. 77.
    Frankel BL, Patel DJ, Horwitz D, Friedewald WT, Gaarder KR: Treatment of hypertension with biofeedback and relaxation techniques. Psychosom Med 40: 276–293, 1978.PubMedGoogle Scholar
  78. 78.
    Luthe W: Autogenic Therapy. New York: Grune & Stratton, 1969.Google Scholar
  79. 79.
    Roberts BW, Forester WE: Group relaxation-acute and chronic effects on essential hypertension. Cardiovasc Med 5: 575–580, 1979.Google Scholar
  80. 80.
    Moutsos SE, Sapira JD, Scheib ET, Shapiro AP: An analysis of the placebo effect in hospitalized hypertensive patients. Clin Pharmacol Ther 8: 676–683, 1967.PubMedGoogle Scholar
  81. 81.
    Ayman D: An evaluation of therapeutic results in essential hypertension — I. The interpretation of symptomatic relief. JAMA 95: 246–249, 1930.Google Scholar
  82. 82.
    Goldring W, Chasis H, Schreiner GE, Smith HW: Reassurance in the management of benign hypertensive disease. Circulation 14: 260–264, 1956.PubMedGoogle Scholar
  83. 83.
    Schwartz GE, Shapiro AP, Redmond DP, Ferguson DCE, Ragland DR, Weiss SM: Behavioral medicine approaches to hypertension: An integrative analysis of theory and research. J Behav Med 2: 311–363, 1979.PubMedCrossRefGoogle Scholar
  84. 84.
    Shapiro D, Tursky B, Gershon E, Stern M: Effects of feedback and reinforcement on the control of human systolic blood pressure. Science 163: 588–590, 1969.PubMedCrossRefGoogle Scholar
  85. 85.
    Benson H, Shapiro D, Tursky B, Schwartz GE: Decreased systolic blood pressure through operant conditioning techniques in patients with essential hypertension. Science 173: 740–742, 1971.PubMedCrossRefGoogle Scholar
  86. 86.
    Kristt DA, Engel BT: Learned control of blood pressure in patients with high blood pressure. Circulation 15: 370–378, 1975.Google Scholar
  87. 87.
    Blanchard EB, Young LD, Haynes MR: Technique innovations. A simple feedback system for the treatment of elevated blood pressure. Behavior Ther 6: 241–245, 1975.CrossRefGoogle Scholar
  88. 88.
    Elder ST, Ruiz RZ, Deabler HL, Dillenkoffer RL: Instrumental conditioning of diastolic blood pressure in essential hypertensive patients. J Appl Behav Anal 6: 377–382, 1973.PubMedCrossRefGoogle Scholar
  89. 89.
    Goldman H, Kleinman KM, Snow MY, Bidus DR, Korol B: Relationship between essential hypertension and cognitive functioning: Effects of biofeedback. Psychophysiology 12: 569–573, 1975.PubMedCrossRefGoogle Scholar
  90. 90.
    Frankel BL, Patel D, Horwitz D, Friedwald WT, Gaarder KR: Clinical ineffectiveness of a combination of psychophysiologic therapies. Psychosom Med 39: 51–52, 1977.Google Scholar
  91. 91.
    Weiss T: Biofeedback training for cardiovascular dysfunctions. Med Clin North Am 61: 913–928, 1977.PubMedGoogle Scholar
  92. 92.
    Orne MT: The efficacy of biofeedback therapy. Ann Rev Med 30: 489–503, 1979.PubMedCrossRefGoogle Scholar
  93. 93.
    Schwartz GE: Voluntary control of human cardiovascular integration and differentiation through feedback and reward. Science 175: 90–93, 1972.PubMedCrossRefGoogle Scholar
  94. 94.
    Shapiro AP, Schwartz GE, Ferguson DCE, Redmond DP, Weiss SM: Behavioral methods in the treatment of hypertension. A review of their clinical status. Ann Intern Med 86: 626–636, 1977.Google Scholar
  95. 95.
    Frumkin K, Nathan RJ, Prout MF, Cohen MC: Nonpharmacologic control of essential hypertension in man: A critical review of the experimental literature. Psychosom Med 40: 294–320, 1978.PubMedGoogle Scholar
  96. 96.
    Reiser MF, Brust AA, Ferris EB, Shapiro AP, Harrison MB, Ransohoff W: Life situations, emotions, and the course of patients with arterial hypertension. Psychosom Med 13: 133–319, 1951.PubMedGoogle Scholar
  97. 97.
    Shapiro AP: Consideration of multiple variables in evaluation of hypotensive drugs. JAMA 160: 30–39, 1956.Google Scholar
  98. 98.
    Laughlin KD, Fisher L, Sherrard DJ: Blood pressure reductions during self-recording of home blood pressure. Am Heart J 98: 629–634, 1979.PubMedCrossRefGoogle Scholar

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© Martinus Nijhoff Publishers, The Hague 1982

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  • Henry R. Black

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