Diet or diuretic? Treatment of newly diagnosed mild to moderate hypertension in the elderly

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Abstract
The aim of this study was to assess the effectivity of dietary measures in the treatment of hypertension. Therefore, a single-blind randomised clinical trial was carried out in elderly persons with recently diagnosed hypertension. Patients were recruited from a general practice (6555 persons) during visits or after written invitation or invitation by phone. New hypertensive patients (with measurements taken on three different occasions >159 mm Hg systolic and/or >94 mm Hg diastolic), aged 60-80 years, without target-organ damage, dementia, diabetes mellitus or malignant disease entered a 3-month intervention programme of either intensive dietary counselling, receiving a sodium-reduced (75 mmol/24h), and weight-reducing diet (BMI <25), or only 25 mg chlorthalidone a day. Forty-two newly diagnosed hypertensive subjects met the inclusion criteria. Two dropped out from the chlorthalidone group, one with side effects and another after a myocardial infarction. Although blood pressure (BP) in the diet group decreased less than in the drug group, of the patients in the diet group 45% fell back to a normal systolic and 50% to a normal diastolic BP (drug treatment group, systolic 75% and diastolic 85%). In contrast with the diet group, lipid spectrum and blood glucose concentration in the diuretic group, however, deteriorated slightly. The dietary intervention was effective in elderly patients with a systolic or diastolic BP in the range of 160-180 and 95-100 mm Hg, respectively. Reduction in weight should be the primary aim. It is argued that sodium reduction can be achieved better by collective measures. In patients with a BP of more than 180 mm Hg systolic or 100 mm Hg diastolic, dietary advice and drug treatment should be combined.

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