Comparing weight reduction and medications in treating mild hypertension: A systematic literature review

Hypertension is a major health issue in the United States. Currently, one in four American adults have hypertension at an estimated cost of $33 billion in 1999. Studies have established the benefit of secondary prevention programs in the treatment of hypertension, with weight loss showing the most effective results. In addition, The Sixth Report of The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, recommend that risk factor modification be tried initially, in most cases, of mild hypertension. However, controversy remains over the appropriate initial therapy for treating mild hypertension. Many practitioners recommend weight loss as an initial therapy, while others believe medications are the best initial treatment. The purpose of this literature review is to examine the effect of weight reduction through diet modification compared to medications, as a first step approach to decrease mild hypertension in the adult population. Four randomized clinical trial studies published between 1992-1999 were reviewed. Using change in blood pressure as outcome criteria, all of the studies showed a decrease in blood pressure using weight reduction alone. However, in all of the studies, antihypertensive me dications showed the greatest reduction in blood pressure. In conclusion, many patients with mild hypertension can lower and maintain their blood pressure using weight loss as monotherapy. Patients with moderate to severe hypertension who are taking antihypertensive medications should be placed on a weight loss program to not only lower blood pressure, but to possibly lower the required dosage of medication. Hypertension is a major public health issue in the United States. The sequelae of uncontrolled hypertension includes heart disease, kidney disease, and stroke .1 Studies have established the benefit of secondary prevention programs such as weight loss, physical activity, cholesterol lowering, and smoking cessation, in the treatment of hypertension.2,3,4 The advanced practice nurse (APN) is in a key position to encourage secondary preventative interventions. The purpose of this literature review is to examine the effect of weight reduction through diet modification compared to medications, as a first step approach to decrease mild hypertension in an adult population.