Non-pharmaceutical intervention


A non-pharmaceutical intervention or non-pharmacological intervention (NPI) is any type of health intervention which is not a medication. Some examples include exercise,[1] sleep improvement,[2] or dietary habits.[3] In epidemiology, the term is also used to describe measures to prevent disease and improve public health.

This article is about the general concept. For the specific use of the term in epidemiology, see Non-pharmaceutical intervention (epidemiology).

Hypertension

The first line of treatment for hypertension is lifestyle changes, including dietary changes, physical exercise, and weight loss. Though these have all been recommended in scientific advisories,[4] a Cochrane systematic review found no evidence for effects of weight loss diets on death, long-term complications or adverse events in persons with hypertension.[5] The review did find a decrease in blood pressure.[5] Their potential effectiveness is similar to and at times exceeds a single medication.[6] If hypertension is high enough to justify immediate use of medications, lifestyle changes are still recommended in conjunction with medication. Dietary changes shown to reduce blood pressure include diets with low sodium,[7][8] the DASH diet (Dietary Approaches to Stop Hypertension),[9] vegetarian diets,[10] and green tea consumption.[11][12][13][14] Physical exercise regimens which are shown to reduce blood pressure include isometric resistance exercise, aerobic exercise, resistance exercise, and device-guided breathing.[15]

References
  1. Hilfiker, Roger; Meichtry, Andre; Eicher, Manuela; Nilsson Balfe, Lina; Knols, Ruud H.; Verra, Martin L.; Taeymans, Jan (2018). "Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis". British Journal of Sports Medicine. 52 (10): 651–658. doi:10.1136/bjsports-2016-096422. ISSN 1473-0480. PMC 5931245. PMID 28501804.
  2. Zoremba, N.; Coburn, M.; Schälte, G. (2018). "[Delirium in intensive care patients: A multiprofessional challenge]". Der Anaesthesist. 67 (11): 811–820. doi:10.1007/s00101-018-0497-3. ISSN 1432-055X. PMID 30298270.
  3. McKennon, Skye A. (2000), Feingold, Kenneth R.; Anawalt, Bradley; Boyce, Alison; Chrousos, George (eds.), "Non-Pharmaceutical Intervention Options For Type 2 Diabetes: Diets And Dietary Supplements (Botanicals, Antioxidants, and Minerals)", Endotext, South Dartmouth (MA): MDText.com, Inc., PMID 25905290, retrieved 2020-11-24
  4. Go AS, Bauman MA, Coleman King SM, Fonarow GC, Lawrence W, Williams KA, Sanchez E (April 2014). "An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention". Hypertension. 63 (4): 878–85. doi:10.1161/HYP.0000000000000003. PMID 24243703.
  5. Semlitsch T, Jeitler K, Berghold A, Horvath K, Posch N, Poggenburg S, Siebenhofer A (March 2016). "Long-term effects of weight-reducing diets in people with hypertension". The Cochrane Database of Systematic Reviews. 3: CD008274. doi:10.1002/14651858.CD008274.pub3. PMC 7154764. PMID 26934541.
  6. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. (July 2013). "2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)". European Heart Journal. 34 (28): 2159–219. doi:10.1093/eurheartj/eht151. PMID 23771844.
  7. He FJ, Li J, Macgregor GA (April 2013). "Effect of longer-term modest salt reduction on blood pressure". The Cochrane Database of Systematic Reviews (Systematic Review & Meta-Analysis). 30 (4): CD004937. doi:10.1002/14651858.CD004937.pub2. PMID 23633321. S2CID 23522004.
  8. Huang, Liping; Trieu, Kathy; Yoshimura, Sohei; Neal, Bruce; Woodward, Mark; Campbell, Norm R C; Li, Qiang; Lackland, Daniel T; Leung, Alexander A; Anderson, Cheryl A M; MacGregor, Graham A; He, Feng J (24 February 2020). "Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials". BMJ. 368: m315. doi:10.1136/bmj.m315. PMC 7190039. PMID 32094151.
  9. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER, Simons-Morton DG, Karanja N, Lin PH (January 2001). "Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group". The New England Journal of Medicine. 344 (1): 3–10. doi:10.1056/NEJM200101043440101. PMID 11136953.
  10. Yokoyama Y, Nishimura K, Barnard ND, Takegami M, Watanabe M, Sekikawa A, Okamura T, Miyamoto Y (April 2014). "Vegetarian diets and blood pressure: a meta-analysis". JAMA Internal Medicine. 174 (4): 577–87. doi:10.1001/jamainternmed.2013.14547. PMID 24566947.
  11. Hartley L, Flowers N, Holmes J, Clarke A, Stranges S, Hooper L, Rees K (June 2013). "Green and black tea for the primary prevention of cardiovascular disease" (PDF). The Cochrane Database of Systematic Reviews (Systematic Review and Meta-Analysis). 6 (6): CD009934. doi:10.1002/14651858.CD009934.pub2. PMC 7433290. PMID 23780706. Archived (PDF) from the original on 3 July 2018. Retrieved 3 July 2018.
  12. Liu G, Mi XN, Zheng XX, Xu YL, Lu J, Huang XH (October 2014). "Effects of tea intake on blood pressure: a meta-analysis of randomised controlled trials". The British Journal of Nutrition (Meta-Analysis). 112 (7): 1043–54. doi:10.1017/S0007114514001731. PMID 25137341.
  13. Khalesi S, Sun J, Buys N, Jamshidi A, Nikbakht-Nasrabadi E, Khosravi-Boroujeni H (September 2014). "Green tea catechins and blood pressure: a systematic review and meta-analysis of randomised controlled trials". European Journal of Nutrition (Systematic Review and Meta-Analysis). 53 (6): 1299–311. doi:10.1007/s00394-014-0720-1. hdl:10018/1239907. PMID 24861099. S2CID 206969226.
  14. Peng X, Zhou R, Wang B, Yu X, Yang X, Liu K, Mi M (September 2014). "Effect of green tea consumption on blood pressure: a meta-analysis of 13 randomized controlled trials". Scientific Reports (Meta-Analysis). 4: 6251. Bibcode:2014NatSR...4E6251P. doi:10.1038/srep06251. PMC 4150247. PMID 25176280.
  15. Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, Fuchs FD, Hughes JW, Lackland DT, Staffileno BA, Townsend RR, Rajagopalan S (June 2013). "Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the american heart association". Hypertension. 61 (6): 1360–83. doi:10.1161/HYP.0b013e318293645f. PMID 23608661.
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