Resource savings from non-pharmacological control of hypertension

Treatment of acute cardiovascular illness is expensive, and a preventative approach may be cheaper. Since pharmacological costs account for a large proportion of costs in prevention programmes, a non-pharmacological approach such as that used by us in Ashkelon on mild hypertensives, relying on stress management, weight management and exercise aimed at reducing risk factors, might prove to be more cost-effective. After six months on a 1,000 calorie/day diet, 69 obese subjects (initial body mass index >28 kg/m²) had reduced their weight by an average of 7.3 kg (P<0.005). This weight reduction contributed to a significant decrease in systolic blood pressure (SBP) from 157.3 to 137.6 mmHg (P<0.005) and diastolic blood pressure (DBP) from 101.1 to 85.2 mmHg (P<0.005), which was sustained at two-year follow-up. Pharmacological treatment could be stopped in about one-quarter of these cases. In non-obese mild-hypertensives, deep muscle relaxation and biofeedback techniques were prescribed. Significant decreases in SBP (153.1 to 138.3 mmHg, P<0.005) and DBP (101.2 to 90.1 mmHg, P<0.005) were achieved at six months. In nine out of 19 cases pharmacological treatment was stopped after six to eight months. Smoking cessation was achieved by individual instruction together with stress management techniques, physical exercise and a nicotine-based chewing gum. After six months 18 out of 30 heavy smokers had stopped smoking, and the remaining 12 had reduced their cigarette consumption. Operating the Ashkelon programme nationwide would result in a saving from drug reduction alone ($80.8 million using a 10% discount rate over ten years) of around twice the cost of the actual programme ($38.1 million).