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Information for Patients: Treatment of Hypertension Can Hypertension Be Treated? The good news is that high blood pressure is eminently treatable. The objective of treatment is not simply to lower the blood pressure, but to prevent its consequences, such as strokes and heart attacks. The benefits of treatment were first convincingly demonstrated in a landmark Veterans Administration study conducted by Dr Edward Fries, the first results of which were published in 1967. This study included 143 men with severe hypertension who had diastolic pressures between 115 and 129 mm Hg. Half of the men were treated with medication to lower the blood pressure, while the others received inert placebo pills. After only one and a half years, the results were quite clear: in the untreated group, four men had died, and 23 had developed complications such as strokes and heart attacks, while in the treated group none had died, and only two developed complications. This type of study is called a randomized clinical trial. Since this study was published, numerous larger trials involving tens of thousands of patients have been conducted, which have demonstrated conclusively that drug treatment can cut the number of strokes by about half and the number of heart attacks by a somewhat smaller amount. These studies have included younger people in whom both systolic and diastolic are elevated and older people in whom only systolic pressure is high. Both groups have shown similar benefit. Non-Drug Treatment of Hypertension People often think that the treatment of hypertension invariably involves having to take medications for the rest of one's life, but this is not necessarily the case. There is much that can be done with diet and exercise to lower the blood pressure. The traditional recommendation about diet was to restrict the intake of salt (to about 6 grams a day, or just over half the average American's typical intake), and while this method is still effective, it does not work in everyone. Some people (about one third of the hypertensive population) are "salt sensitive," which means that their blood pressure will respond to changing salt intake, while the rest are "salt resistant," in whom cutting out salt will have little effect on the blood pressure. Unfortunately, there is no simple test to decide who is salt sensitive and who is not.
The DASH Diet The DASH (Dietary Approaches to Stop Hypertension) diet was designed to provide a palatable diet that would be good for general health and lower the blood pressure. It contains a lot of potassium, magnesium, and calcium, minerals that have been shown to lower blood pressure. The potassium and magnesium are provided by fruits and vegetables, and the calcium by low-fat dairy products. The diet was first tested in a very tightly controlled study sponsored by the National Institutes of Health in which participants were fed one of three diets for an 8-week period. The first was a "control" diet, equivalent to the average American diet; the second was a diet rich in fruits, grains, and vegetables, and the third was the "DASH" diet, which was similar to the fruit and vegetable diet but with the addition of low-fat dairy products. Salt intake was not reduced in any of the diets. The combination DASH diet produced the greatest reduction of blood pressure (11 mmHg systolic and 6 mmHg diastolic). The fruit and vegetable diet also lowered blood pressure (by 7 mmHg systolic and 3 mmHg diastolic). African-Americans showed a bigger response than whites.
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A major advance in the treatment of hypertension has been the DASH (Dietary Approaches to Stop Hypertension) diet, which has been shown to lower blood pressure as much as medications.
