Essential Hypertension: Therapy [Clinical Review Discussion]

Health related consequences of uncontrolled hypertension (HT) are severe.  Controlling hypertension can reduce incidence of stroke up to 40%, myocardial infarction up to 50% and heart failure up to 50% (1).   Unfortunately 43% of hypertensive patients have uncontrolled HT, even with pharmaceutical intervention (2).  Medical guidelines in the US recommend advice on lifestyle changes in addition to pharmaceutical interventions (1).  In reality lifestyle advice is far from universal (3-5) and the guidelines do not include recommendations for other conservative interventions.  Unfortunately chiropractic physicians appear to offer similar degrees of advice on modifiable risk behaviors as do medical physicians (6). 

In researching the material for this monograph the author could not help but notice the wide variety of conservative options available to the practitioner that may reduce blood pressure.  Unfortunately few interventions other than the first four on the following list have had substantial research performed.  Considering the safety of these interventions compared to drug therapy it is indeed unfortunate additional research in this area is so slow in coming. 

There is a major shortcoming in most studies on blood pressure control.  Most follow-up periods, if even performed, are short-term.  The lack of long term follow-up precludes the conclusion that short term control of blood pressure leads to reduced morbidity and mortality.

According to Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) the target level of blood pressure is <140/90 and <130/80 for those with diabetes or chronic kidney disease.  If lifestyle modification cannot reach goals then drug therapy is recommended (1).

The Strength of Recommendation Taxonomy (SORT) which is normally used in our monographs to measure strength of evidence is based on patient oriented outcomes not physiologic measures.  For the purpose of this monograph the strength of evidence recommendations are based on a physiologic measurement (blood pressure).  This is based on the strong evidence that reductions of blood pressure in the hypertensive patient results in improved patient centered outcomes if maintained over the long term.