People who say they are making lifestyle changes in addition to taking medication to reduce high blood pressure may actually be less likely to have their blood pressure under control than people relying on drugs alone, new research from Canada shows.

“Whether we like it or not, the only thing which we can definitely offer which really works is drug treatment,” Dr. George J. Fodor of the University of Ottawa Heart Institute in Ontario told Reuters Health. “I don’t like it and most people don’t like it, but this is the simple truth.”

Exercise, weight loss and other lifestyle modifications are widely recommended as the first line of treatment for people recently diagnosed with hypertension. While clinical trials have shown that these measures are effective, there is less information on how readily people make these changes in real life, and how effective they are outside the clinical trial setting.

To investigate, the researchers surveyed a representative sample of 2,551 Ontario residents aged 20 to 79. About 1 in every 5 had hypertension, and most of them reported receiving some type of treatment - 41 percent were taking drugs only and 42 percent were making lifestyle changes in addition to taking medications.

Among people who reported changing their habits, 86 percent said they were eating differently, 60 percent were exercising more, and 13 percent were using other non-drug approaches.

The investigators found that 85 percent of those on drugs alone had their blood pressure under control, compared to 78 percent of those using drugs and lifestyle changes.

The findings show, Fodor and his colleagues say, that in the real world, for the great majority of people, lifestyle change is not effective in lowering blood pressure.

“When reflecting on clinical guidelines that recommend lifestyle measures for BP management, the fact that nondrug interventions are neither cheap nor necessarily harmless is ignored,” they write.

This is because people put off starting medication while trying lifestyle changes, Fodor explained. “The harm comes from the fact that there is a long delay in embarking on something which is the only proven method of reducing blood pressure,” he said, pointing out that living for even a relatively short time with untreated hypertension increases the risk of having a heart attack or stroke.

People who try to control the amount of salt in their diet face a huge challenge, Fodor added, because there is so much sodium in processed food, and so much of the food that people eat is processed.

Rather than pushing people to make lifestyle changes, he concluded, public health efforts might be more profitably directed toward pressuring the food industry to reduce its sodium use. In the UK, Fodor noted, such efforts have had some success.

SOURCE: The Journal of Clinical Hypertension, January 2009.