make food getting and eating difficult. High blood pressure is also a major cause of multiinfarct dementia and may be responsible for milder and more subtle losses of intellectual capacity that occur occasionally with older people and are probably due to subclinical cerebrovascular disease.41,46,82

Treatment for high blood pressure has potent effects on the risk of stroke and of cardiovascular disease. It is likely that, in both middle-aged and older people, reductions in moderate or severe high blood pressure add more to life expectancy than most other interventions.62,108,119 Indeed, because many elderly people are already taking medications for other reasons, there are distinct advantages to treating high blood pressure by nonpharmacological means. Diet and exercise constitute two such means that are given particular emphasis in this report.

The effectiveness of altering high blood pressure and subsequent mortality and morbidity from cardiovascular and renovascular disease is well documented. Among the measures for achieving such control are dietary counseling to bring about weight reduction, sodium restriction, and in some cases abstinence from alcohol.

There is good reason to think that weight control and moderation in sodium intake are reasonable health measures for all aging adults. Studies have shown that weight loss per se decreases blood pressure by about 1 to 2 mmHg systolic and 1 mmHg diastolic per pound lost.17,44,48,102,115 Restriction of sodium also appears to be effective in some persons who are sodium sensitive, although such individuals cannot be identified in advance.50 Data on the efficacy of increasing the intake of other nutrients (e.g., calcium and magnesium) to lower blood pressure are more controversial. These findings have been reviewed in another recent Institute of Medicine report.17

The costs and effectiveness of various dietary therapies to control high blood pressure have been well reviewed by Disbrow.23 Few of these studies involved individuals over 65 years of age. At present there is too little age-specific information to determine the effectiveness of nonpharmacologic therapies for hypertension in the elderly. Theoretically, they offer three potent advantages: a low cost in comparison with the sometimes expensive antihypertensive drug therapies that are often used, decreased side effects, and avoidance of drug-drug interactions common in the elderly. Indeed, studies have shown that blood pressure control can often be maintained by dietary means even after medications are withdrawn or reduced.65,101,102,114 Therefore, tests of the effectiveness of nonpharmacologic therapies, including but not limited to diet, should be encouraged in the elderly.

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