Non-pharmacological Management Of Hypertension Research Articles

Hubungan Pengetahuan Dengan Perilaku Penderita Hipertensi Terhadap Cara Pengobatan Hipertensi Dengan Terapi Komplementer Di Puskesmas 1 Denpasar Timur

Background: Non-pharmacological management of hypertension through complementary medicine has now been developed in Indonesia. However, the interest of hypertensive patients in complementary medicine is not optimal because there are many factors that influence the behavior of patients in the use of complementary medicine. Methods: This study employed an analytic study design with a cross-sectional approach. This research was conducted at Puskesmas 1 East Denpasar for 1 month. This study involved 101 hypertensive patients using accidental sampling technique. Data collection was carried out using a questionnaire. Data were analyzed univariately and bivariately using SPSS version 20. Results: This study showed that most hypertensive patients had good knowledge of hypertension treatment with complementary therapies (64.4%). A total of 53.5% of hypertensive patients showed adequate behavior in the treatment of hypertension with complementary therapy. Based on the chi square test, it was found that there was a significant relationship between knowledge and behavior of hypertensive patients towards hypertension treatment with complementary therapy (p-value = 0.04). Conclusion: It is recommended for health workers to increase education and promotion about hypertension treatment with complementary therapy, especially for hypertensive patients with poor knowledge.

The effect of walking physical exercise on blood pressure of the pedestrian community in Penjaringan Sari Surabaya

Hypertension is a non-communicable disease that is one of the main causes of premature death in the world. Pharmacologically by administering anti-hypertensive drugs. In non-pharmacological management of hypertension can be done with a healthy lifestyle. A study states that the most appropriate non-pharmacological treatment for people with hypertension is exercise. This research is quantitative research with a quasi-experimental design. The dependent variable in this study was walking physical exercise, while the independent variables in this study consisted of heart rate, systolic blood pressure, and diastolic blood pressure. The subjects of this study were 30 members of the pedestrian community, who were divided by purposive sampling into the treatment group and the control group. The tools used to obtain primary data in this study were the results of measuring blood pressure before and after walking. The results of the study: 1) there is a difference in the average pulse rate between the pretest and post-test in both the treatment and control groups; 2) there is an effect of walking physical exercise on pulse rate; 3) there is a difference in the mean systolic blood pressure and diastolic blood pressure between pretest and post-test; 4) there is a difference in the average blood pressure between the pretest and post-test of the control group; 5) there is no effect of physical exercise walking on blood pressure; 6) There was no difference in blood pressure and pulse between the treatment and control groups. In conclusion, the physical exercise of walking for 1 week could reduce pulse rate but could not reduce systolic blood pressure and diastolic blood pressure.

NON-PHARMACOLOGICAL MANAGEMENT OF ZIGHTUDDAM QAWI (HYPERTENSION) IN UNANI SYSTEM OF MEDICINE

In Unani System of Medicine, the concept of Zightuddam Qawi (Hypertension) is described under the heading of Imtila (Congestion of fluid in the body) by many Unani physicians. Hypertension is basically a disease of blood vessels in which vessels have elevated pressure. The possible causes of this disease mentioned in Unani system of medicine are Sue Mizaj Damvi (abnormal sanguineous temperament), Sauda-e-Muhatriqa (burnt melanin) and Mizaj Haar Yabis (hot and dry temperament). In modern medicine, Hypertension is enlisted in the category of lifestyle disorders. The factors which predispose Hypertension include obesity, excessive salt intake, alcohol and smoking etc. In the view of Unani medicine, the non-pharmacological management of Hypertension can be achieved by Ilaj-bil-Ghiza (Dietotherapy) and Ilaj-bit-Tadbeer (Regimenal Therapy). The therapies which can be beneficial in the Hypertension are Fasd (Venesection), Hijamah (Cupping), Riyazat (Exercise), Dalak (Massage) and Hammam (Turkish bath/ Steam bath).

Pemberian pesan Dietary Approaches to Stop Hypertensions-like diet melalui whatsApp untuk memperbaiki kepatuhan diet dan tekanan darah pasien hipertensi

Giving Dietary Approaches to Stop Hypertension-like diet messages via WhatsApp to improve dietary compliance and blood pressure in hypertensive patientsBackground: Dietary Approaches to Stop Hypertension-like diet (DASH-like diet) is a non-pharmacological management of hypertension. The delivery of health information is currently being developed through social media such as WhatsApp.Objective: To determine the effect of giving DASH-like diet messages via WhatsApp on the compliance of DASH-like diet and blood pressure in hypertensive patients. Methods: This study used a quasi-experiment by one group pretest-posttest design approach. The location was taken at Kasihan II Health Center Community with 26 hypertensive patients for the sample. Univariate analysis using the Shapiro-Wilk test. Wilcoxon test for analysis of the compliance scores of DASH-like diet and diastolic blood pressure analysis. Systolic blood pressure analysis used paired sample t-test with a 95% confidence level. Results: There was a significant difference in DASH-like diet compliance score (p=0,001) and systolic blood pressure (p=0,021) between before and after the intervention. In contrast, there was no significant difference in diastolic blood pressure before and after the intervention (p=0.110). Conclusion: Giving a DASH-like diet message can significantly increase compliance with a DASH-like diet and systolic blood pressure and reduce diastolic blood pressure, although not significantly.

Dietary Inflammatory Index and All-Cause Mortality in Older Adults with Hypertension: Results from NHANES.

Both diet and inflammation are strongly associated with hypertension. However, the relationship between the dietary inflammatory index (DII) and the prognosis of hypertensive patients over 65 years of age is unclear. The objective of this study is to investigate the correlation between DII and all-cause mortality in older adults with hypertension. Data were obtained from the 2011−2018 National Health and Nutrition Examination Survey (NHANES) and followed for survival through December 31, 2019. DII was calculated by the 24 h dietary history interview. Cox proportional hazards models were used to investigate the associations. A total of 2531 participants were finally included. During a median follow-up of 4.33 years, 471 participants were determined as all-cause mortality. After adjusting for confounding factors, DII was positively correlated with the risk of all-cause mortality (HR = 1.08, 95% CI = 1.01−1.16). Compared with the anti-inflammatory diet group (DII < 0), the pro-inflammatory diet group (DII > 0) had a 54% increased risk of all-cause death (HR = 1.54, 95% CI = 1.13−2.10). The results were robust in subgroup and sensitivity analyses. DII was positively correlated with the all-cause mortality of elderly hypertensive patients. The results provided an aid to dietary evaluation in the nonpharmacologic management of hypertension.

A hospital-based cross-sectional study on yoga and meditation in patients of hypertension in Western India

Background: Yoga and meditation hold promise as a non-pharmacological management of hypertension as they have shown to lower blood pressure. This study aimed at (1) assessing the awareness about benefits of yoga and meditation in hypertension among patients and finding its socio-demographic correlates, (2) estimating the practice of yoga and meditation in hypertensives, its pattern and impact on blood pressure control.Methods: This cross-sectional study was conducted on 400 hypertensive patients. Statistical association was tested with chi square and independent t tests.Results: It was observed that only 9% respondents were aware of the benefits of yoga and meditation in hypertension while 12.8% practised the same. On probing it was found that these 3.8% practised yoga and meditation only because their physician had advised them to do so without even knowing their benefits. This points out the importance of physician advice which can be even more effective if pros and cons are properly explained. People who were aware of the benefits were 51.9 times more likely to practise them (p&lt;0.001). Highly significant association was observed between awareness regarding lifestyle modifications like yoga and meditation and gender, socioeconomic status, education and locality (urban non-slum/urban slum/rural).Conclusions: The complementary use of non-pharmacological treatment or lifestyle modifications like yoga and meditation can go a long way to lower blood pressure and such options need to be provided by the health care providers and the gap in awareness elicited in our study needs to be addressed.

Utilization of short message service (SMS) in non-pharmacological management of hypertension. A pilot study in an URBAN public hospital of Multan, Pakistan

To investigate the effectiveness of short message service (SMS) in promotion of non-pharmacological treatment approach in hypertension patients. A prospective, randomized control study to measure the effect of short message service in improving self-management of hypertension by educating patients. One hundred and twenty hypertensive patients who had manual sphygmomanometers were selected, and were divided into two groups, i.e., an intervention group and a control group. But only the intervention group had mobile numbers of related health care professionals for SMS assistance. All of them were briefed on how they can improve HTN control by achieving a healthy life style, proper diet, and exercise (non-pharmacological approach in addition to pharmacological therapy). Patients were educated about the non-pharmacological approach for managing hypertension at each clinic visit, and were sent regular text messages about healthy diet, exercise, and adherence. Apart from educational text messages, reminder SMSs were also sent to them twice daily to remind them about taking their medicines. Patients’ feedback was collected to assess improvement in adherence and reduction in blood pressure. At the end of the study, the intervention group showed better hypertension control, with systolic blood pressure (SBP) declining by 8 mmHg to 141.15 ± 5.73 mmHg, and diastolic blood pressure (DBP) declining by 6 mmHg to 88 ± 3.97 mmHg. The control group showed a 2 mmHg and 3 mmHg decline in SBP and DBP respectively. SMS proved to be very useful to enhance adherence to non-pharmacological treatment of HTN (hypertension). It also improved patient compliance.

Non-pharmacological management of hypertension: in the light of current research.

Hypertension is a major risk factor for a number of cardiovascular diseases. Proper management of hypertension may require both pharmacological and non-pharmacological interventions. Non-pharmacological interventions help reduce the daily dose of antihypertensive medication and delay the progression from prehypertension to hypertension stage. Non-pharmacological interventions include lifestyle modifications like dietary modifications, exercise, avoiding stress, and minimizing alcohol consumption. Nutritional requirements of hypertensive individuals can be addressed through adopting either the DASH diet or through traditional Mediterranean diet. These dietary guidelines promote the consumption of fruits, vegetables, grains, dairy products, and food rich in K+, Mg+2, Ca+2, and phosphorus. Restriction of Na+ intake has the greatest role in lowering the blood pressure. The DASH diet alone has the effect equal to that of a single drug therapy. After dietary modifications, exercise and weight loss are the second major intervention for hypertension management. Avoiding stressful lifestyle, depression, and anxiety also help to reduce elevated blood pressure. Minimizing alcohol intake also favors the blood pressure reduction. However, lifestyle modification is a dynamic process and requires continuous adherence. It is a multi-factorial approach targeting more than one intervention. However, 6-12-month lifestyle modifications can be attempted in stage-1 hypertensive patients without any cardiovascular complication, in the hope that they may be sufficiently effective to make it unnecessary to use medicines.

Hypertension in Children and Adolescents.

1. Donald J. Weaver Jr, MD, PhD* 1. *Division of Nephrology and Hypertension, Department of Pediatrics, Levine Children’s Hospital at Carolinas Medical Center, Charlotte, NC * Abbreviations: ABPM: : ambulatory blood pressure monitoring ACE: : angiotensin-converting enzyme ADE: : adverse drug event ARB: : angiotensin receptor blocker CCB: : calcium channel blocker CT: : computed tomographic LV: : left ventricular MR: : magnetic resonance Hypertension in children and adolescents is often underdiagnosed. Blood pressure should be assessed at every medical encounter in children aged 3 years and older, as well as high-risk children younger than 3 years. Pharmacologic therapy is safe and effective for controlling blood pressure and preventing end-organ changes in this population. After completing this article, readers should be able to: 1. Recognize and properly classify hypertension in children and adolescents. 2. Develop a differential diagnosis and diagnostic approach for evaluation of hypertension, based on signs and symptoms. 3. Initiate a discussion with patients and their families on the nonpharmacologic management of hypertension. 4. Discuss the classes of antihypertensive medications used in children and adolescents. Danielle is a 16-year-old who presents to your office for a routine health maintenance visit. She has generally been feeling well, except for occasional headaches. They do not localize to a specific location, and they occur weekly and resolve spontaneously. They are not associated with any other neurological symptoms. Her past medical history is unremarkable. She is not taking any medications. Her family history is remarkable for hypertension in both the maternal and paternal grandparents. The review of systems has yielded otherwise negative findings. The physical examination showed a height at the 25th percentile and a weight in the 75th percentile. Initial blood pressure obtained by using an automated oscillometric device was 154/82 mm Hg. At examination, she was well appearing and in no distress. Her physical examination findings were normal, except for a dark, velvety discoloration on her neck. A manual auscultatory blood pressure obtained at the end of the physical examination with the appropriately sized cuff and with the patient sitting was 134/78 mm Hg. Most data …

Nonpharmacologic management of hypertension: a multidisciplinary approach.

Nonpharmacologic lifestyle modification interventions (LMIs), such as increasing physical activity, dietary modification, weight-loss, reducing alcohol consumption and smoking cessation, are effective strategies to lower resting blood pressures (BPs) in prehypertensive or hypertensive patients. However, the limited time shared between a physician and a patient is not adequate to instill an adoption of LMI. The purpose of this review is to therefore highlight evidence-based BP lowering, LMI strategies that can feasibly be implemented in clinical practices. Interventions focusing on modifying physical activity, diet, weight-loss, drinking and smoking habits have established greater efficacy in reducing elevated BP compared with providing guideline recommendations based on national guidelines. Alone greater reductions in BP can be achieved through programmes that provide frequent contact time with exercise, nutrition and/or wellness professionals. Programmes that educate individuals to lead peer support groups can be an efficient method of ensuring compliance to LMI. Evidence of a multidisciplinary approach to LMI is an effective and attractive model in managing elevated BP. This strategy is an attractive model that provides the necessary patient attention to confer lifestyle maintenance.

Beneficial Effects of Dietary Nitrate on Endothelial Function and Blood Pressure Levels.

Poor eating habits may represent cardiovascular risk factors since high intake of fat and saturated fatty acids contributes to dyslipidemia, obesity, diabetes mellitus, and hypertension. Thus, nutritional interventions are recognized as important strategies for primary prevention of hypertension and as adjuvants to pharmacological therapies to reduce cardiovascular risk. The DASH (Dietary Approach to Stop Hypertension) plan is one of the most effective strategies for the prevention and nonpharmacological management of hypertension. The beneficial effects of DASH diet on blood pressure might be related to the high inorganic nitrate content of some food products included in this meal plan. The beetroot and other food plants considered as nitrate sources account for approximately 60–80% of the daily nitrate exposure in the western population. The increased levels of nitrite by nitrate intake seem to have beneficial effects in many of the physiological and clinical settings. Several clinical trials are being conducted to determine the broad therapeutic potential of increasing the bioavailability of nitrite in human health and disease, including studies related to vascular aging. In conclusion, the dietary inorganic nitrate seems to represent a promising complementary therapy to support hypertension treatment with benefits for cardiovascular health.

HIGH INTENSITY AEROBIC EXERCISE TRAINING INDUCES SIMILAR OR EVEN SUPERIOR BLOOD PRESSURE REDUCING EFFECTS IN CONTROLLED HYPERTENSIVE PATIENTS

Aerobic exercise training is currently used in the nonpharmacologic management of hypertension, however there is controversy on the optimal training intensity that should be recommended. Objective: To compare the effects two exercise training intensities on 24 hour blood pressure monitoring in

Effect of interval training programme on pulse pressure in the management of hypertension: A randomized controlled trial

Pulse pressure (PP), might be a stronger determinants of cardiovascular risk. To investigate the effect of interval training program on PP in subjects with hypertension. Two hundred and forty five male patients with mild to moderate (Systolic Blood Pressure [SBP] between 140-179 & Diastolic Blood Pressure [DBP] between 90-109 mmHg) essential hypertension were age-matched and grouped into exercise and control groups. The exercise (work: rest ratio of 1:1) groups involved in an 8-weeks interval training programs of between 45-60 minutes, at intensities of 60-79% of HR max (maximum heart rate), while the control group remained sedentary during this period. SBP, DBP, VO2max and PP were assessed. Findings of the study revealed significant correlation between PP and blood pressure; correlation of PP with SBP was much stronger (95% variance). Also, there was significant effect of the exercise training program on SBP, DBP and PP. Changes in VO2max also negatively correlated with changes in PP (r= -.285) at p<0.05. Moderate intensity interval training programs is effective in the non-pharmacological management of hypertension and may prevent cardiovascular event through the down regulation of PP in hypertension.

Effect Of Interval Training On Blood Pressure And Exercise Capacity In Hypertension: A Randomized Controlled Study

Mean arterial blood pressure (MAP) is a determinant of cardiovascular risk in patient with hypertension. The primary purpose of the present study was to investigate the effect of interval training program on MAP in black African subjects with hypertension. Two hundred and forty five male patients with mild to moderate (Systolic Blood Pressure [SBP] between 140-179 & Diastolic Blood Pressure [DBP] between 90-109 mmHg) essential hypertension were age-matched and randomly assigned to interval(n=140) and control groups (n=105). The interval (work: rest ratio of 1:1) groups involved in an 8-weeks interval training programs of between 45-60 minutes, at intensities of 60-79% of HR max, while the control group remained sedentary during this period. SBP, DBP, VO 2 max and MAP were assessed. Findings of the study revealed significant correlation between MAP and BP (SBP, r=.958; DBP, r=.342); correlation of MAP with SBP was much stronger (54% variance). Also, there was significant effect of exercise training program on MAP (p=0.000). Changes in VO 2 max also negatively correlated with changes in MAP (r= -.237) at p<0.05. It was concluded that moderate intensity interval training programs is effective in the non-pharmacological management of hypertension and may prevent cardiovascular event through the down regulation of MAP in hypertension. Our findings support the recommendations of moderate intensity interval training program as an adjunct non-pharmacological management of essential hypertension. Key words: Hypertension; Interval exercise; Mean arterial blood pressure; Blood pressure

Therapeutic Role of Continuous Training Program on High Density Lipoprotein Cholesterol in Men with Hypertension: A Randomized Controlled Trial

Objective: Some of the reported factors that increased the risk for coronary events in hypertensive individuals included elevated total cholesterol (TC) and low density lipoprotein cholesterol (LDL), reduced high density lipoprotein cholesterol (HDL) and physical inactivity. The purpose of the present study was to investigate the effect of interval training programme on blood pressure and lipid profile in subjects with hypertension. Methods: Two hundred and seventeen male patients with mild to moderate (systolic blood pressure [SBP] between 140-180 & diastolic blood pressure [DBP] between 90-109 mmHg) essential hypertension were age matched and grouped into interval and control groups. The interval (n=112; 58.63 ± 7.22 years) group involved in an 8 weeks continuous training (60-79% HR max reserve) programme of between 45minutes to 60 minutes, while age-matched controls hypertensive (n=105; 58.27 ± 6.24 years) group remain sedentary during this period. Cardiovascular parameters (SBP & DBP), VO 2 max, TC, LDL, HDL and Artrogenic Index (AI) were assessed. Students’t test and Pearson correlation test were used in data analysis. Results: Findings of the study revealed significant decreased effect of interval training programme on SBP, DBP, TC, LDL and significant increased effects on VO 2 max and HDL level at p < 0.05. Also there was a significant negative and positive correlation between changes VO 2 max and changes in TC and HDL respectively. Conclusions: it was concluded that interval training programme is an effective adjunct non-pharmacological management of hypertension and a means of normal regulation of lipid profile.

Comparative Effect of Interval and Continuous Training Programs on Serum Uric Acid in Management of Hypertension: A Randomized Controlled Trial

The purpose of the study was to investigate the effect of interval and continuous training program on blood pressure and serum uric acid (SUA) levels in subjects with hypertension. Three hundred and fifty-seven male patients with mild to moderate systolic blood pressure (SBP) between 140 and 179 and diastolic blood pressure (DBP) between 90 and 109 mm Hg essential hypertension were age-matched and grouped into interval, continuous, and control groups. The interval (work:rest ratio of 1:1) and continuous groups were involved in an 8-week interval and continuous training program of 45-60 minutes, at intensities of 60-79% of heart rate maximum, whereas the control group remained sedentary during this period. SBP, DBP, maximum oxygen uptake (VO2max) and SUA concentration were assessed. One-way analysis of variance and Scheffe and Pearson correlation tests were used in data analysis. Findings of the study revealed significant effect of exercise training program on VO2max, SBP, DBP, and SUA. However, there was no significant difference between the interval and continuous groups. Changes in VO2max negatively correlated with changes in SUA (r = -0.220) at p < 0.05. It was concluded that both moderate-intensity interval and continuous training programs are effective and neither seems superior to the other in the nonpharmacological management of hypertension and may prevent cardiovascular events through the downregulation of SUA in hypertension. Findings of the study support the recommendations of moderate-intensity interval and continuous training programs as adjuncts for nonpharmacological management of essential hypertension.

Comparing Physical Activity Patterns of Hypertensive and Nonhypertensive US Adults

Nonpharmacologic management of hypertension is an important strategy in treating people with hypertension, but little is known about patterns of physical activity among such people. We compared patterns of physical activity of adults with and without hypertension in the United States using the most recent guidelines for physical activity. We used data from 391,017 adults aged > or =18 years from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) and physical activity categories based on 2008 Department of Health and Human Services (DHHS) guidelines. All information was self-reported. The age-adjusted prevalence of hypertension was 27.2%, whereas the age-adjusted prevalence of meeting DHHS recommendations was 60.2% among participants with hypertension and 66.9% among participants without hypertension. After adjusting for age, gender, race or ethnicity, education, body mass index (BMI), smoking status, and histories of diabetes and cardiovascular disease (CVD), the odds ratio (OR) for meeting DHHS recommendations among participants with hypertension was 0.85 (95% confidence interval (CI) 0.82, 0.88) compared with those who did not have hypertension. Although the majority of adults with hypertension are currently meeting national guidelines for physical activity, they are less active overall than adults who do not have hypertension.

Effect of low intensity continuous training programme on serum uric acid in the non pharmacological management of hypertension: a randomized controlled trial

Elevated serum uric acid (SUA) is considered to be positively associated with cardiovascular event risk factor in hypertension. Also, the positive role of exercise in the management of Hypertension has been well and long established. However the relationship between SUA level and hypertensive management particularly in non pharmacological technique is ambiguous and unclear. Therefore the purpose of the present study was to determine the effect of continuous low intensity training programme on SUA level and cardiovascular parameters in male subjects with hypertension. Two hundred andseventeen male patients with mild to moderate (systolic blood pressure [SBP] between 140-180 & diastolic blood pressure [DBP] between 90-109 mmHg) essential hypertension were age matched and grouped into continuous and control groups. The continuous (n=112; 58.63 +/- 7.22 years) group involved in on 8 weeks interval training (35-9% HR max reserve) programme of between 45 minutes to 60 minutes, while age-matched controls hypertensive (n=105; 58.27 +/- 6.24 years) group remain sedentary during this period. Cardiovascular parameters (SBP, DBP & VO2max) and SUA were assessed. Students' t and Pearson correlation tests were used in data analysis. Findings of the study revealed significant effect of interval training programme on VO2 max, SBP, and DBP and SUA concentration at p < 0.05 and changes in VO2max negatively correlated with SUA (r = -.266) at p < 0.05. it was concluded that low intensity continuous training programme is an effective nonpharmacological management and may prevent cardiovascular event through the down regulation ofSUA in hypertension.

Primary care management of childhood and adolescent hypertension

To educate advance practice nurses on the diagnosis, pharmacologic, and nonpharmacologic management of hypertension in children and adolescents. Information was collected through a search of published literature and clinical practice guidelines. Increasing rates of hypertension in children and adolescents are correlated to risk for coronary artery disease in adulthood. Nonpharmacologic management includes lifestyle modifications addressing weight reduction, physical activity, and dietary modification. Pharmacologic management is typically reserved for patients with severe hypertension or those who do not respond to lifestyle modifications. Early intervention is critical for preventing target-organ damage and complications of long-term hypertension. Nurse practitioners must identify and address elevated blood pressure levels in children and adolescents. Many children and adolescents can successfully lower blood pressure readings through nonpharmacologic lifestyle changes. Education about lifestyle modification strategies should focus on family-based changes in order to increase likelihood of successful implementation.

Non-pharmacological management of hypertension

Hypertension is a silent killer. Indians are racially predisposed to cardiovascular disease and the increasing burden of hypertension has only added to the problem. Economic constraints and the allure of additional benefits without adverse effects have made lifestyle modifications an attractive proposition in developing and developed countries alike. Blood pressure is a continuum and any increase above optimal confers additional independent risk of vascular disease, even in ranges previously considered normal. While antihypertensive agents have been used for those patients with blood pressure above the traditional cutoff, there has been increasing emphasis on the prevention and treatment of hypertension by non-pharmacological means, termed 'lifestyle modifications.' A MEDLINE search was done for relevant references with emphasis on original studies, randomized controlled trials and meta-analyses. Lifestyle modifications that effectively lower blood pressure are increased physical activity, weight loss, limited alcohol consumption, reduced sodium intake and the Dietary Approaches to Stop Hypertension diet. Lifestyle modification is recommended as initial therapy in stage 1 hypertension before initiation of drug therapy and as an adjunct to medication in persons already on drug therapy. In pre-hypertensives, it can reduce the incidence of hypertension and lower end-organ damage. It is emphasized that simple advice from physicians can have a positive influence on patients' motivation to make lifestyle changes.