Hypertension (High Blood Pressure)

DESCRIPTION

An elevated blood pressure is a major risk factor for a heart attack or stroke. The diagnostic summary is as follows:

• Borderline high blood pressure: 120-160 / 90-94
• Mild high blood pressure: 140-160 / 95-104
• Moderate high blood pressure: 140-180 / 105-114
• Severe high blood pressure: 160+ / 115+

Individuals with a normal diastolic pressure (<82mmHg) but elevated systolic pressure (>158mmHG), i.e. an increased pulse pressure, have a twofold increase in cardiovascular death rates when compared with individuals with normal systolic pressures (<130mmHg).

 
Therapeutic Considerations

Since 80% of patients with hypertension are in the borderline to moderate range, most cases of hypertension can be brought under control through changes in diet and lifestyle. In fact, in head-to-head comparisons, many non-drug therapies, such as diet, exercise, and relaxation therapies, have proved superior to drugs in cases of borderline to mild hypertension.

 
Conventional antihypertensive drugs

An increasing body of evidence is indicating that drugs may be doing more harm than good. Several well designed, long-term  clinical studies have found that people taking antihypertensive drugs (most often diuretics and/or beta-blockers) suffer from several side-effects including an increased risk for heart disease.
Virtually every medical authority (textbook, organization, journal etc.) including the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure, has recommended that non-drug therapies be used in the treatment of borderline to mild hypertension in place of drugs.

 
Lifestyle and dietary factors

Lifestyle factors: coffee, alcohol, lack of exercise, stress, smoking.
Dietary factors: obesity; high Na-to-K ratio; low-fiber, high-sugar diet; high saturated fat and low essential fatty acids; low calcium, magnesium and vitamin C.
 
• Diet: attain ideal body weight; increase proportion of plant foods in diet; vegetarians have lower BP and lower incidence of hypertension and other cardiovascular diseases than non-vegetarians; dietary levels of sodium do not differ between these two groups, but vegetarian diet contains more K+, complex carbohydrates, essential fatty acids, fiber, Ca, Mg, and vitamin C, and less saturated fat and refined carbohydrate; most useful foods for hypertensives are celery, garlic and onions, nuts and seeds or their oils (EFAs), cold-water ocean fish (salmon, mackerel, etc.), green leafy vegetables (Ca and Mg), whole grains and legumes (fiber), foods rich in vitamin C (broccoli and citrus fruits).

 
• Potassium and sodium: diet low in K+ and high in Na+ is linked to hypertension; total K+ content of food plus Na-to-K ratio; low-K, high-Na diet linked to cancer and cardiovascular disease; diet high in K+ and low in Na+ is protective against these diseases and therapeutic for hypertension; Many western countries have K:Na ratio < 1:2; studies indicate a K:Na ratio > 5:1 is necessary to maintain health; natural diet rich in fruits and vegetables provides K:Na > 100:1 (most fruits and vegetables have K:Na of 50:1); increasing dietary potassium can lower BP; K supplements alone can reduce BP in hypertensives at dosage = 2.5 – 5.0 g q.d. of potassium; supplements useful in persons over age 65; relatively safe, except for patients with kidney disease – inability to maintain K+ homeostasis may cause heart arrhythmias and other consequences of K+ toxicity; K+ supplements are also contraindicated when using some drugs (digitalis, K-sparing diuretics, and angiotensin-converting enzyme inhibitor antihypertensive drugs).

 
• Magnesium: K+ interacts in many body systems with Mg: low intracellular K+ may result from low Mg intake: Mg lowers BP by activating cellular membrane Na/K pump which pumps Na out of, and K into, cells; high intake of Mg is linked to lower BP; water high in minerals like Mg is called ‘hard water’ – inverse correlation between water hardness and high BP; hypertensive patients who respond to Mg supplements are those taking diuretics, with high levels of rennin, with low RBC Mg, and/or with elevated intracellular Na+ or decreased intracellular K+; ideal Mg intake = 6mg/kg body weight; therapeutic dose is twice as high; Mg bound to aspartate or Krebs cycle intermediates (malate, succinate, fumarate, citrate) preferred; supplements very well tolerated, sometimes cause looser stool (Mg sulphate [Epsom salts], hydroxide, or chloride); supplements must be used with great care in kidney disease or severe heart disease (high-grade atrioventricular block).

• Stress: causative factor of hypertensive in many patients; relaxation techniques (deep breathing exercises, biofeedback, autogenics, transcendental meditation, yoga, progressive muscle relaxation, hypnosis) are useful in lowering BP; effect modest, but stress reduction technique is a necessary component in natural BP-lowering program; diaphragm breathing helpful – shallow breathing increases Na+ retention of sodium.

 
• Vitamin C: the higher the intake of vitamin C, the lower the BP; modest blood pressure-lowering effect (drop of 5 mmHg) in people with mild hypertension; promotes excretion of Pb, which is linked to hypertension and increased cardiovascular mortality; soft water supplies have increased Pb in drinking water due to increased acidity of water (soft water also low in Ca and Mg, minerals protective against hypertension).

 
• Vitamin B6: supplements lower BP; oral dosage over a period of 4 weeks reduced systolic and diastolic BPs and serum norepinephrine; mean systolic dropped from 167 to 153 mmHg and diastolic dropped from 108 to 98 mmHg.

 
 • Calcium: hypertension linked to low intake of calcium; association is not as strong as for Mg and K; Ca supplements can lower BP in hypertension, but results are inconsistent; Ca supplements reduce BP in Blacks and salt-sensitive patients, but not patients with salt-resistance hypertension; better results with calcium citrate vs. calcium carbonate; elderly hypertensives respond to Ca.

 
• Coenzyme Q10 (CoQ10) (ubiquinone): synthesized within body, but deficiency in 39% of hypertensive patients; not typical BP-lowering drug; corrects metabolic abnormality, favourably influencing BP; reductions in systolic and diastolic BP = 10%; mechanism in hypertension is unknown – no changes in rennin, Na, or aldosterone levels; improves cholesterol levels and peripheral vascular resistance in arteries of arms and legs.

 
• Omega-3 oils: increased intake can lower BP; fish oil and flaxseed oil very effective; fish oils produce more pronounced effect than flaxseed oil; dosage of fish oils used quite high. Prefer fish oil lab-certified against peroxides, mercury, and other undesirable substances; compare effective dose pricing with flax oil to find better value; reduce saturated fat; use flaxseed oil – reduces systolic and diastolic by up to 9 mmHg; study – for every absolute 1% increase in body alpha-linolenic acid content, there is decrease of 5mmHg in systolic, diastolic, and mean BPs.

 
Botanical medicines

• Crataegus species: extracts of hawthorn berries and flowering tops lower BP and improve heart function; BP-lowering effect of hawthorn very mild; requires at least 2-4 weeks before effect apparent.
• Allium sativum and Allium cepa: antihypertensive additions to diet; reduce systolic BP in hypertensives by 3.1%
• Viscum album (mistletoe): hypotensive action in animal studies; mechanism of action not fully understood; inhibits excitability of vasomotor centre in medulla oblongata; possesses cholinomimetic activity; hypotensive activity may be dependent on form in which mistletoe is administered and host tree from which it was collected; aqueous extracts more effective; highest hypotensive activity – macerate of leaves of mistletoe parasitizing on willow and gathered in January.

 
Therapeutic approach

Mild hypertension (140/160 / 90/104)
• Reduce excessive weight
• Eliminate salt (sodium chloride) intake.
• Healthy lifestyle: avoid ETOH, caffeine, smoking; exercise and use stress reduction techniques.
• High-potassium diet rich in fiber and complex carbohydrates.
• Increase consumption of celery, garlic, and onions.
• Reduce/eliminate fats while increasing vegetable oils.
• Supplement diet with the following:
   - high-potency multiple vitamin-mineral formula
   - vitamin C
   - vitamin E
   - magnesium
   - garlic
   - flaxseed oil
Treatment period = 3-6 months; if BP has not normalised, antihypertensive medications indicated; when prescription drug is necessary, calcium-channel blockers of ACE inhibitors appear to be the safest.
Moderate hypertension (140-180 / 105-114)
• Employ all measures above.
• Coenzyme Q10
• Hawthorn extract
Treatment period 1-3 months; if BP has not normalised, antihypertensive medications indicated.
Severe hypertension (160+ / 115 +)
Drug intervention required; employ all measures above; when satisfactory BP control achieved, taper off medication gradually.

 
This article is not meant to be used for treatment but for information purposes only. If you feel that this approach is appropriate for you please contact ICIM Medics on 045 844 819 or www.icim.ie e-mail : info@icim.ie  An appointment can be arranged for you.

Tags: High Blood Pressure, Hypertenstion