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March 4, 1992

Predicting the Response to Nonpharmacologic Treatment in Mild Hypertension

Author Affiliations

From the Cardiovascular Center, the New York Hospital—Cornell University Medical Center.

JAMA. 1992;267(9):1256-1257. doi:10.1001/jama.1992.03480090104036

The physician whose patient presents with blood pressure in the gray zone between normotension and hypertension faces two problems. Should treatment be prescribed, and what can be done to prevent the pressure from rising any higher? Drug treatment, while undoubtedly effective, is expensive, frequently accompanied by side effects, and minimally cost-effective for such patients. Nonpharmacologic treatment offers a potential approach, but here again there are problems. A bewildering array of treatment modalities have been proposed, ranging from dietary modification to behavioral changes, the efficacy of which is in many cases poorly substantiated. Furthermore, it is becoming increasingly clear that individual patients differ widely in the degree to which their blood pressure responds to any type of treatment,

See also pp 1213 and 1221. whether pharmacologic or nonpharmacologic. Altering treatment is of no great consequence when it simply means writing a new prescription for a different medication, but many of the