Comparative Effectiveness of Pharmacological and Non-pharmacological Interventions for Hypertension Management: A Systematic Review and Meta-Analysis

TL;DR

This study compares drug and lifestyle treatments for high blood pressure, finding both effective but with different benefits.

Contribution

A systematic review and meta-analysis comparing pharmacological and non-pharmacological hypertension interventions.

Findings

Pharmacological and non-pharmacological interventions both significantly reduce blood pressure.

Combined strategies show the greatest impact on blood pressure and metabolic outcomes.

Pharmacological therapies achieve better target blood pressure control and lower mortality.

Abstract

Hypertension is a major global health burden, which is strongly linked to stroke, heart disease, kidney failure, and premature death. Pharmacological therapies remain the cornerstone of management, but adherence, cost, and side effects pose significant challenges. Lifestyle interventions such as diet, exercise, and stress reduction provide comparable benefits with fewer risks. We conducted a PRISMA-guided systematic review (2015-2025) across PubMed and Google Scholar. The eligible studies included adult hypertensive patients receiving pharmacological or non-pharmacological interventions. Our review of 21 studies (n > 63,000) showed consistent blood pressure (BP) benefits across intervention types. The pooled systolic BP reduction was -6.95 mmHg (95% CI: 4.79-10.09) across all the studies, with the pharmacological interventions (-6.83 mmHg), non-pharmacological (-6.03 mmHg), and combined (-8.37 mmHg) interventions yielding comparable effects. The diastolic reductions were greatest with the non-pharmacological interventions (-6.77 mmHg), compared with pharmacological (-2.52 mmHg) and combined (-3.34 mmHg). The target BP achievement was highest with pharmacological therapy (67.8%), followed by the combined (58.9%) and the non-pharmacological (26.4%) approach only. The mortality was lower with pharmacological management (3.7%) compared to combined interventions (14%, single study). The secondary outcomes included modest BMI reduction (-0.80 kg/m²) and cholesterol lowering (-7.04 mg/dL), with the greatest effects from combined strategies. This study shows that both pharmacological and non-pharmacological interventions effectively reduce BP, with the combined strategies showing the greatest impact. Pharmacological therapies achieved superior target control and lower mortality, while lifestyle changes improved metabolic outcomes.

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