EFFECTIVENESS OF LIFESTYLE MODIFICATION VS. PHARMACOLOGIC TREATMENT IN STAGE 1 HYPERTENSION

Background: Stage 1 hypertension is a prevalent cardiovascular risk factor, affecting a significant proportion of the adult population worldwide. While both lifestyle modification and pharmacologic therapy are endorsed in clinical guidelines, the optimal approach for initial management in patients without comorbidities remains unclear. Existing literature often evaluates these interventions separately, lacking direct comparisons specific to early-stage hypertension. Objective: This systematic review aims to evaluate and compare the effectiveness of lifestyle modification versus pharmacologic treatment in reducing blood pressure and preventing cardiovascular events in adults with stage 1 hypertension. Methods: A systematic review was conducted following PRISMA guidelines. Four databases—PubMed, Scopus, Web of Science, and Cochrane Library—were searched for articles published between January 2019 and April 2024. Eligible studies included randomized controlled trials and prospective cohort studies comparing lifestyle interventions (e.g., diet, exercise, weight loss) with antihypertensive medications in adults with stage 1 hypertension. Data extraction and risk of bias assessments were performed independently by two reviewers using standardized tools (Cochrane RoB 2 and Newcastle-Ottawa Scale). Results: Eight studies involving 3,846 participants were included. Pharmacologic treatments resulted in faster and slightly greater reductions in systolic and diastolic blood pressure (mean SBP reduction: 9–14 mmHg; p < 0.001), while lifestyle interventions produced sustained, clinically meaningful reductions (mean SBP reduction: 6–11 mmHg; p < 0.05). Four studies reported reduced cardiovascular event rates in lifestyle groups over extended follow-up periods. Risk of bias was generally low to moderate across studies. Conclusion: Both lifestyle modification and pharmacologic therapy are effective in managing stage 1 hypertension. Lifestyle interventions offer additional long-term cardiovascular benefits and may serve as a preferred initial strategy in select patients. Further large-scale, long-duration comparative trials are needed to reinforce these findings.