COMBINATIONS OF LIFE-STYLE MODIFICATION AND DRUG-TREATMENT IN MANAGEMENT OF MILD-MODERATE HYPERTENSION - A REVIEW OF RANDOMIZED CLINICAL-TRIALS

Several randomized clinical trials have compared combined lifestyle and drug treatment of hypertension to drugs alone, lifestyle alone, or no treatment. Lifestyle interventions tested have included: weight loss, sodium reduction, potassium increase, and combinations of these and other modalities. Each trial has found combined therapy to be superior to the comparison group(s) in terms of blood pressure reduction and/or control, or to amount of drugs required, except in the U.S. TAIM study for the sodium/potassium regimen, where the lifestyle changes were small. Combined therapy has also been consistently better regarding side effects/quality of life, and there is evidence for greater reduction in cardiovascular risk. Some findings suggest variation among drugs for optimal combinations. Information on cost-effectiveness is lacking.