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Subject Area

Plastic Surgery

Article Type

Original Study

Abstract

Objective The aim was to review the studies on nonpharmacological treatment of resistant hypertension (R-HTN). Materials and Methods A systematic search of MEDLINE (PubMed, Medscape, Science Direct, and EMF-Portal) and Internet was conducted on all articles published from 1986 to 2019. English-language reports of R-HTN were searched. The initial search presented 112 articles, where 31 fulfilled the inclusion criteria. Articles not reporting on the R-HTN in the title or abstract were not included. A total of 15 independent investigators extracted data on methods. Comparisons were made by structured review with the results tabulated. A total of seven studies were about R-HTN (epidemiology, prevalence, prognosis, and etiology), nine studies emphasized R-HTN and cardiovascular complications, and 15 studies emphasized nonpharmacological treatments of R-HTN. Findings The recommended lifestyle measures that have been shown to reduce blood pressure (BP) are salt restriction, moderation of alcohol consumption, high consumption of vegetables and fruits, weight reduction and maintaining an ideal body weight, and regular physical activity. In addition, tobacco smoking has an acute prolonged presser effect that may raise daytime ambulatory BP, but smoking cessation and other lifestyle measures are also important beyond BP. Conclusion This review found that nonpharmacological methods for treatment of R-HTN show great promise despite some open questions concerning their long-term effects and procedural safety. There are sufficient data to suggest that certain lifestyle modifications, such as weight loss and sodium intake reduction, are efficacious in lowering BP, reducing progression of pre-HTN to HTN, and perhaps diminishing long-term risk of CV events. However, the effectiveness of such lifestyle modifications needs to be further established in population-based studies, as implementation of healthier lifestyles is challenging.

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