Non-pharmacological methods of blood pressure reduction in elderly hypertensives evaluated by 24-hour ambulatory BP monitoring.

This Thesis examines the effects of non-pharmacological methods on lowering blood pressure and the potential mechanisms for their action in elderly hypertensive and normotensive persons. Changes in blood pressure following these interventions were evaluated by conventional clinic blood pressure measurements and 24-hour ambulatory blood pressure monitoring. The reproducibility of individual 24-hour ambulatory blood pressure measurements in elderly subjects was shown to be greater than clinic measurements, enabling smaller blood pressure changes to be detected in a given number of subjects; other advantages are the ability to assess blood pressure changes over the 24 hour period and the lack of observer bias and placebo effect. Moderate restriction of dietary sodium intake (from 174 to 95 mmol/24 hour) resulted in a fall in clinic systolic blood pressure only, while a moderate increase in potassium intake using diet supplements produced falls in clinic systolic and diastolic blood pressure and also in 24-hour ambulatory systolic blood pressure. Sustained caffeine use was found to have no significant effect on the clinic or ambulatory blood pressure levels. The substitution of non-pharmacological methods including reduction of weight and sodium intake and increases in dietary potassium intake following withdrawal of anti-hypertensive drug therapy in elderly hypertensive patients with controlled blood pressure allowed 20% of such patients to remain normotensive off medication for over 1 year. The main limitations on the replacement of anti-hypertensive drugs with non-pharmacological therapies was the high prevalence of poorly controlled blood pressure levels in currently treated elderly hypertensives. The routine use of non-pharmacological methods by general practitioners to lower high blood pressure in elderly hypertensive patients was found to be limited, only a minority use such methods as first line treatment. In conclusion, significant reductions in blood pressure with certain non- pharmacological methods have been observed in some elderly hypertensive persons. However it appears that non-pharmacological therapy will need to be combined with drug therapy to achieve satisfactory blood pressure control in many elderly hypertensive subjects.