To the Editor.
—The editorial by Kopelman and Dzau,1 which emphasized a cautious approach to nonpharmacologic modalities for treatment of mild hypertension, was certainly timely, informative, and well balanced. Because of the enormous number of persons with mild hypertension (45 million Americans) and the current popularity of nondrug therapy, we would like to add additional words of caution for the clinician facing the decision of initiating therapy in patients with mild hypertension.As Kopelman and Dzau pointed out, most trials of nonpharmacologic therapy have been small short-term studies that have never addressed issues such as compliance and sustained effectiveness. The same rigid criteria used to assess drug therapy should also be applied to nondrug modalities. Twenty-four-hour ambulatory blood pressure (BP) monitoring is well suited to evaluate sustained BP reductions after repeated acute interventions such as meditation, progressive muscular relaxation, and biofeedback.The need for long-term observation and comparison with