Hypertension

Description

Hypertension or high blood pressure is divided into two main categories: primary or essential hypertension and secondary hypertension. Currently 92-94% of all diagnosed hypertension is termed essential, i.e., the underlying mechanism is unknown. It is believed a combination of genetic and environmental factors is responsible for the condition. In the other 6-8%, the hypertension is secondary to another disease.

The prevalence of hypertension (BP >160/95 mm HG) in the U.S. is estimated at 20% in the adult white population and 30% in black adults. These values are nearly doubled if the reading of 140/90 mm Hg is considered the upper limit of normal.

Since hypertension is associated with increase in cardiovascular morbidity and mortality, monitoring blood pressure offers an invaluable noninvasive diagnostic and prognostic aid. Some factors associated with an adverse prognosis in hypertension are: black racial background; youth; male; persistent diastolic pressure >115 mm Hg; smoking; diabetes mellitus; hypercholesterolemia; obesity; and evidence of end organ damage such as cardiac enlargement, ECG indications of ischemia or myocardial infarction, and congestive heart failure.

Although physicians are primarily concerned with diastolic pressure, systolic pressure is also an important factor. Males with a normal diastolic pressure (<82 mm Hg) but elevated systolic pressure (>158 mm Hg) have a 2x fold increase in their cardiovascular mortality rates when compared to normotensives with normal systolic pressures (<130 mm Hg).

Most cases of hypertension can be brought under control through changes in diet and lifestyle. In recent long-term clinical studies, it has been indicated people with hypertension not taking blood pressure lowering medicines actually fare much better than those taking the prescription drugs. However, antihypertensive medications are among the most widely prescribed drugs. Drug therapy usually involves the use of diuretics and/or beta-adrenergic blocking drugs. These drugs are associated with many side effects. There are other classes of hypotensive drugs which also may be used including vasodilators and reserpine alkaloids.

Causes

Although behavior patterns and stress play an important part, hypertension is closely related to dietary factors. Hypertension is another of the many diseases or syndromes associated with the Western diet, and is found almost entirely in developed countries. People living in remote areas of China, the Solomon Islands, New Guinea, Panama, Brazil and Africa show virtually no evidence of essential hypertension, nor do they experience a rise in blood pressure with advancing age. Furthermore, when racially identical members of these societies migrate to less remote areas and adopt a more "civilized" diet the incidence of hypertension increases dramatically.

Weight and Hypertension
Epidemiological and clinical studies have repeatedly demonstrated obesity is a major factor in hypertension. Possible mechanisms include: elevated cardiac output, increased body sodium due to increased insulin levels or abnormal aldosterone/renin relationships, and alterations in hormonal/nervous system control mechanisms. Weight reduction reduces blood pressure in normotensive, hypotensive and hypertensive individuals. Weight reduction should be a primary therapeutic goal for decreasing hypertension in obese patients, and may contribute to the management of moderately overweight hypertensives as well.

Lifestyle factors
Lifestyle factors are also very important causes of elevated blood pressure. Coffee consumption, ethanol alcohol intake, lack of exercise, and smoking are all things that may contribute to an elevated blood pressure reading.

Caffeine
The effects of long-term caffeine consumption on blood pressure have not yet been clearly determined. Short term studies consistently show elevation in blood pressure in both normotensive and hypertensive individuals which usually normalize after a few days. One large study (6,321 adults) demonstrated a small but statistically significant elevation in blood pressure when comparing those who drank five or more cups a day to non-coffee drinkers.

Alcohol
Even moderate amounts of alcohol produce acute hypertension in some patients via increased adrenaline secretion. Chronic alcohol consumption is one of the strongest predictors (sodium consumption being the other) of blood pressure.

Smoking
It is a well documented fact cigarette smoking is a contributing factor to hypertension. Smokeless tobacco, i.e., snuff, chewing tobacco, and plug, also induces hypertension via its nicotine and sodium content. Smoking is also positively associated with increased sugar, alcohol and caffeine consumption. The hypertensive response to nicotine is due to its adrenal stimulation, which results in increased adrenaline secretion. Furthermore, cigarette smokers are known to have higher concentrations of lead and cadmium and lower concentrations of ascorbic acid than non-smokers.

Heavy Metals
Chronic exposure to lead from environmental sources, including drinking water, is associated with increased cardiovascular mortality. Elevated blood lead levels have been found in a significant number of hypertensives. Areas with a soft water supply have an increased lead concentration in drinking water due to the acidity of the water, and people living in these areas may be predisposed to hypertension. It should be noted soft water is also low in calcium and magnesium.

Cadmium has also been shown to induce hypertension, with untreated hypertensives showing blood cadmium levels three to four times those in matched normotensives. Cigarette smokers typically have much higher body cadmium levels due to cadmium's presence in cigarette smoke.

Stress
Stress can be the causative factor of high blood pressure in many instances. Relaxation techniques such as biofeedback, autogenics, transcendental meditation, yoga, progressive muscle relaxation and hypnosis have all been shown to have some value in lowering blood pressure.

Exercise
Exercise is strongly indicated since it reduces both stress and blood pressure. The exercise program should, of course, be carefully designed, taking into consideration the patient's needs and cardiovascular condition.

Signs & Symptoms

Hypertension is known as a "silent" disease: half of those affected have no symptoms. Usually, symptoms which do arise are due to complications to another organ.

Dizziness	Flushed face
Headache	Fatigue
Nervousness	Epistaxis
Cramps	Cor pulmonale (CP)
Left ventricle failure	Coronary heart disease
Heart failure	Other vascular disorders
Aneurysm	Renal failure

Cerebral vascular insufficiency and/or hemorrhage, especially retinal hemorrhages, exudates, and vascular accidents

Nutritional Supplements

Structure & Function: Cardiovascular Support

---------------------------------
General Supplements
---------------------------------

	Adult
Calcium	1,000 mg
CoQ10*	20 mg t.i.d.
DHEA*
EPO*
Fiber*
Garlic*
Lecithin*
Magnesium	1,000 mg
Proanthocyanidins*
Quercetin*
Vitamin C	1-2 grams
Zinc	15 mg
Polycosanol*

* Please refer to the respective topic for specific nutrient amounts.

Discussion:-

Most people fall short on recommended fiber levels and hypertensives probably have even more to gain than others e.g. guar gum. Supplements from plants are also considered to be effective e.g. chlorella, green barley and kelp.

The synthesis of lecithin from soy, rather than eggs or other animal sources, has encouraged its wider usage, including hypertension.

The inclusion of garlic in regular meals (3 cloves), or as a supplement, is also remarkably efficacious for some people.

Bovine renal extract

Bovine renal extract has also been shown to possess antipressor effects, i.e., it appears to diminish renin's pressor effect in animals and hypertensive human subjects.


Calcium and Magnesium

Epidemiological data reveals hypertensives consume less daily calcium than normotensives and may benefit from calcium supplementation. Several clinical studies have demonstrated calcium supplementation does indeed have a blood pressure lowering effect. It is generally agreed daily administration of 1 gram elemental calcium, along with other non-drug approaches, should be given a trial of at least 3 to 6 months in patients with mild to moderate hypertension.

Magnesium may be shown to be an even more important factor in lowering blood pressure than calcium. Magnesium was first recommended as a therapy for malignant hypertension as early as 1925. An intracellular deficiency of free magnesium is a major etiological factor in hypertension, as its levels are consistently low in hypertensives as compared with normotensives, and they show an inverse correlation with blood pressure. In one double-blind clinical study, magnesium supplementation lowered blood pressure by 12/8 mm Hg in 19 of 20 subjects in the experimental group, compared to 0/4 in the placebo group.


Essential Fatty Acids

Increasing dietary linoleic acid has a profound hypotensive action in man. This is due to normalization of the E series prostaglandins which are known to be decreased in hypertensive patients. This simple dietary effect is prevented by aspirin and other inhibitors of prostaglandin synthesis, implying use of these types of agents should be avoided in hypertensive individuals. Evening Primrose Oil has been singled out. Fish oils are also commonly used.


Vitamin C

There is an inverse relationship between serum vitamin C levels and blood pressure in hypertensive men. Whether this is due to better dietary habits or a hypotensive effect of vitamin C has yet to be determined.


Zinc

Zinc has been shown to effectively reverse cadmium-induced experimental hypertension in rats.



Note: All amounts are in addition to those supplements having a Recommended Dietary Allowance (RDA). Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.

Nutrient Depletion

Diuretics prescribed for Hypertension could rob your body of these valuable nutrients.

Potassium A low potassium level, aggravated by high sodium intake, can contribute to essential hypertension associated with decreased sodium excretion.

Magnesium Assists in the uptake of potassium and calcium and protects arteries from sudden changes in blood pressure. It is known to play a role in prevention of heart disease and may help reduce cholesterol levels. Low magnesium levels are associated with rapid heartbeat, cardiac arrhythmia and cardiac arrest. Regular magnesium screenings hsould be routine for people considered at risk for cardiovascular problems.

Calcium Low amounts of calcium may contribute to heart palpitations, elevated blood cholesterol and nervousness. Proper supplementation of calcium can help prevent osteoporosis.

Zinc Some diuretics can increase the excretion of dietary zinc in the urine. Zinc is crucial for its antioxidant capability and immune system protection. This mineral also plays a role in healthy prostate support and is critical in the healing of the body’s wounds. Supportive levels of zinc help increase the role of vitamin A and vitamin E.

References:

Dyckner, T. & Wester, O. Effect of magnesium on blood pressure. Br Med J 286:1847-9, 1983.

Foushee, D., Ruffin, J., & Banerjee U: Garlic as a natural agent for the treatment of hypertension: A preliminary report. Cytobios 34:145-52, 1982.

Hedges, H. H.: The Elimination Diet as A Diagnostic Tool. AFP Journal, November 1992;46(5):77S-85S.

Mahan, K. & Escott-Stump, S: Krause's Food, Nutrition and Diet Therapy. Saunders, 1996.

Pinto, J.T. & Rivlin, R.S. : Drugs that promote renal excretion of riboflavin. Drug Nutrient Interactions, 1987, 5: 143-151.

Dietary Considerations

Either a Mild Sodium Restriction Diet, Moderate Sodium Restriction Diet, or Severe Sodium Restriction Diet are recommended. Many dietary factors have been shown to correlate with blood pressure including: sodium to potassium ratio, percentage of polyunsaturated fatty acids, fiber and magnesium content, and levels of simple carbohydrates, total fats and cholesterol.

Sodium and Potassium
The role of a high sodium-low potassium intake in the pathogenesis of essential hypertension has been considered extensively and conclusively. Excessive consumption of dietary sodium chloride, coupled with diminished dietary potassium, induces an increase in extracellular fluid volume and an impairment of blood pressure regulating mechanisms. This results in hypertension in susceptible individuals.

A high potassium-low sodium diet reduces the rise in blood pressure during mental stress, reduces the pressor effect of exogenous noradrenalin and reduces the extracellular fluid volume, thus allowing the normal feedback mechanisms to function more effectively. Sodium restriction alone does not improve baroreceptor function, it must be accompanied by a high potassium intake. This combined approach also improves patient compliance, since it includes many foods that do not warrant salting.

In general, individuals with hypertension consume higher levels of salt than normotensives. This results in an elevated salt taste threshold, which means it takes more salt on the food before the individuals senses the saltiness. This abnormal salt threshold returns to normal after long-term sodium restriction.

As public consciousness of the harmful effects of excess sodium has risen, consumer purchases of table salt have decreased. Unfortunately, the salt content of processed and prepared foods has also risen. It is therefore important to properly educate the patient about the "hidden salt" in prepared food and condiments. Substituting potassium chloride for sodium chloride may have therapeutic effects. However, many of the "salt substitutes" still contain up to 50% sodium chloride; and there is experimental evidence suggesting chloride consumed concomitantly with sodium is the necessary factor in a salt sensitive individual's hypertensive response.

Vegetarians generally have lower blood pressure levels and a lower incidence of hypertension and other cardiovascular diseases. Dietary levels of sodium do not differ significantly between these two groups. However, a typical vegetarian's diet contains more potassium, complex carbohydrates, polyunsaturated fat, fiber, calcium, magnesium, vitamin C and vitamin A which may have a favorable influence on blood pressure.

Fiber
The lack of dietary fiber is a common underlying factor in many diseases of "Western civilization". The high-fiber diet has been shown to be effective in preventing and treating many forms of cardiovascular disease including hypertension. As even mild hypertension is associated with an increased risk of cardiovascular disease, the dietary plan outlined for the prevention of atherosclerosis is indicated in treating hypertension.

Sucrose
Sucrose elevates blood pressure. Mechanisms which have been proposed to explain this include: increased sodium retention, increased aldosterone secretion, elevated insulin levels and increased catecholamine (adrenaline) secretion. The most plausible of these appears to involve increased catecholamine production resulting in increased sympathetic tone and increased sodium retention.

Homeopathic Remedy

1.* Lycopus virginicus - 30C - long term use
2. Glonoinum tinct. - 15C
3.* Viscum album tinct. - 15C

Note: Best to use 1 and 3 together

Treatment Schedule

Doses cited are to be administered on a 3X daily schedule, unless otherwise indicated. Dose usually continued for 2 weeks. Liquid preparations usually use 8-10 drops per dose. Solid preps are usually 3 pellets per dose. Children use 1/2 dose.

Legend

X = 1 to 10 dilution - weak (triturition)
C = 1 to 100 dilution - weak (potency)
M = 1 to 1 million dilution (very strong)
X or C underlined means it is most useful potency

Asterisk (*) = Primary remedy. Means most necessary remedy. There may be more than one remedy - if so, use all of them.

References

Boericke, D.E., 1988. Homeopathic Materia Medica.

Coulter, C.R., 1986. Portraits of Homeopathic Medicines.

Kent, J.T., 1989. Repertory of the Homeopathic Materia Medica.

Koehler, G., 1989. Handbook of Homeopathy.

Shingale, J.N., 1992. Bedside Prescriber.

Smith, Trevor, 1989. Homeopathic Medicine.

Ullman, Dana, 1991. The One Minute (or so) Healer.

Herbal Approaches

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Herbs
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Coleus forskohlii
Garlic plant
Gugulipid
Hawthorn berry
Mistletoe
Onion plant
Valerian Root
Yarrow

Note: The misdirected use of an herb can produce severely adverse effects, especially in combination with prescription drugs. This Herbal information is for educational purposes and is not intended as a replacement for medical advice.

Discussion:

Coleus forskohlii is another new entrant on the herbal scene in America, although it is a very old remedy in its native India (see also Gugulipid, below). Its primary chemical, forskolin, has proven effective as a hypotensive agent. It increases the force of heart contraction and relaxation of arteries. The net effect is improved cardiovascular functioning. It reduces diastolic pressure and combines well with hawthorn.

Garlic plant Although most recent research has focused on its blood lipid lowering effects, garlic has been shown to have hypotensive qualities. Garlic has been shown to decrease systolic pressure by 20-30 mm Hg and diastolic by 10-20 mm Hg. The pharmaceutical mechanism of garlic's hypotensive effect is related to its effect on the autonomous nervous system, hypolipidemic properties, and perhaps its high content of sulfur containing compounds. It has been shown that there are decreased levels of sulfur containing amino acids in the plasma of patients with essential hypertension.

Gugulipid is approved by the Indian government for the lowering of cholesterol and triglyceride levels. It may also reduce atherosclerotic plaques and protect the heart from free radicals.

A hawthorn berry product has been used as a cardiovascular agent in Europe and Japan for many years. Its healing properties are attributed to: improvement of coronary blood supply by dilation of the coronary vessels, improvement of metabolic processes within the myocardium resulting in improvement in functional heart activity, and elimination of some forms of rhythm disturbances. Hawthorn preparations are considered ideal anti-hypertensive medications due to their absence of harmful side effects.

Onion plant Like garlic, onion has also been shown to possess lipid lowering and blood pressure lowering activity.

Valerian Root contains iridoids (valepotriates) that have blood pressure lowering, coronary-dilating and anti-arrhythmic effects. Valerian is a useful agent in relieving neurotic states and producing sedation and therefore considered most useful in stress induced hypertension.

Newall (1996) has compiled an extensive list of hypotensive herbs:

Herb	Effect
Agrimony	In vivo
Asafetida	In vivo
Avens / Bennet	In vivo
Black Cohosh	Human
Calamus / Sweet Flag	In vivo
Celery Seed	Human
Cornsilk	In vivo
Cowslip	[Hypertensive In vivo]
Devil's Claw	In vivo
Elecampane	In vivo
Fenugreek
Fucus / Kelp / Bladderwrack
Fumitory	In vivo
Garlic Plant	In vivo
Ginger
Ginseng, Panax	Human
Goldenseal	Alkaloid
Hawthorn	In vivo
Horehound, White [Black Horehound]	Vasodilator
Horse radish	In vivo
Mistletoe	In vivo
Nettle	In vivo
Parsley Plant	In vivo
Plantain Tree	In vivo
Pokeroot	In vivo
Prickly Ash	In vivo
Sage
Shepherd's Purse
Squill	Vasodilator
St. John's Wort	In vivo
Vervain
Wild Carrot [Carrot Seeds]	In vivo
Yarrow	In vivo

It is also necessary to be aware of herbs which may exert an hypertensive action (after Newall, 1996) and may need to be avoided:

Hypertensive Herbs

Drug	Effect
Bayberry	Mineralocorticoid side-effect
Broom	Alkaloid effect,
Capsicum	Increased catecholamine secretion
Cohosh, Blue	Methylcytisine has nicotinic action, alkaloid effect
Cola	Caffeine
Coltsfoot	Pressor activity
Gentian	Contra-indicated in hypertensive individuals
Ginger	Hypertensive
Ginseng, Panax	Hypertensive
Goldenseal	Hydrazine
Licorice	Mineralocorticoid side effect
Mate	Caffeine
Vervain	Hypertensive

References:

Hoffmann, D: The New Holistic Herbal. Element, 1983. Third edition 1990.

Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-care Professionals. London: The Pharmaceutical Press, 1996.

Walji, H: Hypertension: the silent killer. Natural health Series, Kian Press, 1997.

Aromatherapy - Essential Oils

Clary Sage Essence,	Lavender Essence,
Lemon Essence,	Marjoram Essence,
Ylang-Ylang Essence.

Drug Interactions

Hypertension is a disease of modern industrialized nations. Consequently, diet (refined and processed foods) is considered to be the major contributing factor.

Dietary management comprises, typically: weight reduction, exercise and restricted salt intake.

Additional dietary factors may include: minerals (calcium, magnesium, potassium and zinc) and fats (fatty acids).

Standard treatments involve diuretics (some of which, like furosemide or thiazide diuretic compromise potassium) and calcium channel blockers (beta-adrenergic blocking agent or "beta blockers").

[Potassium-sparing diuretics include: spironolactone or triamterene.]

Sodium and potassium levels are significant and need to be routinely monitored.

Diuretic usage also seems to diminish magnesium and zinc levels.

The calcium-hypertension link is highlighted by the efficacy of "beta blockers", although calcium supplements have also shown to be of benefit. (These calcium supplements should also include vitamin D.)

The German Commission E warns against an increase in blood pressure (i.e. hypertension) with the simultaneous administration of brewer's yeast and MAO inhibitors.

References:

Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.

Related Health Conditions

Aging	Kidney disorders
Alcoholism	Nervousness
Cirrhosis	Neurologic disorders
Coronary heart disease	Obesity
Cramp	Obstructive uropathy
Endocrine disorders	Oral contraceptives
Fatigue	Pregnancy
Headache	Smoking
Heart disorders	Vascular disorders
Hemorrhage

Abstracts

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