(High Blood Pressure)
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ARTICLE #1 Systemic Hypertension
ARTICLE #2 High Blood Pressure (Hypertension)
ARTICLE #3 Natural Approach to Hypertension
ARTICLE #5 Recommendations for Hypertension
ARTICLE #7 Botanical Studies for Hypertension
ARTICLE #8 Kick the Blood Pressure Meds?
ARTICLE #9 Nutrients for High Blood Pressure
ARTICLE #10 Homocysteine and the Treatment of Hypertension
ARTICLE #12 The Homocysteine Threat
ARTICLE #13 Hawthorn: Nature's Cardiotonic
ARTICLE #14 Celery Seed and Hypertension
This article is the information an M.D. will know and follow. It is not necessarily what Dr. Warber follows and a few red notes are included by him. This article is only included to give you a basis of where your doctor may be thinking.
Over fifty million Americans have elevated blood pressure and of these, 70% are aware of their diagnosis, 50% are receiving treatment, and 25% are under control. Hypertension increases with age and is more common in blacks than in whites. The mortality rates for stroke and coronary heart disease, the major complications of hypertension, have declined by up to 60% over the past 30 years but have leveled off. The incidence of end-stage renal disease and of heart failure, two other conditions in which hypertension plays a major causative role, continues to rise.
Cardiovascular morbidity and mortality increase as both systolic and diastolic blood pressures rise, but in individuals over age 50 the pulse pressure is a better predictor of complications. As shown below, hypertension is diagnosed based upon elevations of either the systolic or diastolic blood pressure, and the objective of management is to achieve normalization of both.
|Category||Systolic Blood Pressure (mm Hg)||Diastolic Blood Pressure (mm Hg)||Follow-Up Recommended|
|Recheck in 2 years|
|Recheck in 2 years|
|Recheck in 1 year ***|
Stage 1 (mild)
|Confirm within 2 months|
Stage 2 (moderate)
|Evaluate or refer within 1 month|
Stage 3 (severe)
|Evaluate or refer within 1 week|
*** Consider offering counseling about lifestyle modifications as seen below
|Lifestyle modifications for Hypertension Prevention and Management|
|Lose weight if overweight|
|Limit alcohol intake to no more than 1 oz (30mL) of ethanol (eg, 24oz of beer, 10oz of wine, or 2oz of 100-proof whiskey) per day for men or 0.5 oz of ethanol per day for women and lighter-weight men|
|Increase aerobic physical activity (30-45 minutes most days of the week)|
|Reduce sodium intake to no more than 100 mmol/d (2.4 g of sodium or 6g of sodium chloride)|
|Maintain adequate intake of dietary potassium (approximately 90 mmol.d)|
|Maintain adequate intake of dietary calcium and magnesium for general health|
|Stop smoking and reduce intake of dietary saturated fat and cholesterol for overall cardiovascular health|
Continued hypertension does not necessarily indicate the need for pharmacological treatment. Nonpharmalogic approaches and individualized assessment of the benefit-to-risk ratio of drug therapy should precede pharmacological management in patients with stage 1 hypertension. Some patients with pressure in these ranges do not require therapy if they have no evidence of target organ damage or concomitant cardiovascular disease or diabetes.
MANAGEMENT OF HYPERTENSION
Etiology and Classification
A. Primary (Essential) Hypertension
In about 95% of cases, no cause can be established. ( I believe everything has a cause, finding it is where the work comes in) This occurs in 10-15% of white adults and 20-30% of black adults in the USA. The onset is usually between ages 25-55 and it is uncommon before age 20. In young people, secondary hypertension resulting from renal insufficiency, renal artery stenosis, or coarctation of the aorta makes up a greater (but still relatively small) proportion of cases.
Elevations in pressure are often intermittent early in the course. Even in established cases, the blood pressure fluctuates widely in response to emotional stress and physical activity. Blood pressures taken by the patient at home or during daily activities using a portable apparatus are often lower than those recorded in the office, clinic, or hospital and may be more reliable in estimating prognosis. Patients with daytime average pressures less than 135/85 mm Hg have a low rate of cardiovascular complications and a low prevalence of left ventricular hypertrophy, suggesting that this is an appropriate ambulatory blood pressure criterion for diagnosing hypertension.
The pathogenesis of essential hypertension is multifactorial. Genetic factors play an important role. Children with one (and more so with two) hypertensive parents have higher blood pressures.( This is because families tend to have the same lifestyle and diet. If your genes predispose you to a condition, it does not mean you will get it, it only means that you have to express or activate the situation for the gene. If lifestyles and diet are changed, the gene will most likely not express the disease). Environmental factors also are significant. Increased salt intake has long been incriminated. (Not entirely true anymore). It alone is probably not sufficient to elevate blood pressure to abnormal levels; a combination of too much salt plus a genetic predisposition is required. Other factors that may be involved in the pathogenesis of essential hypertension are the following:
1. Sympathetic nervous system hyperactivity- Sympathetic nervous system hyperactivity is most apparent in younger hypertensives, who may exhibit tachycardia and an elevated cardiac output. However, correlations between plasma catecholamines and blood pressure are poor. (Not true at all). Insensitivity of the baroreflexes may play a role in the genesis of adrenergic hyperactivity. (The sympathetic nervous system activity can be altered by biofeedback and chiropractic).
2. Renin-angiotensin system- Renin, a proteolytic enzyme, is secreted by the juxtaglomerular cells surrounding afferent arterioles in response to a number of stimuli, including reduced renal perfusion pressure, diminished intravascular volume, circulating catecholamines, increased sympathetic nervous system activity, increased arteriolar stretch, and hypokalemia. Renin act on angiotensinogen to cleave off the ten-aminoacid peptide angiotensin I. This peptide is then acted upon by angiotensin-converting enzyme to create the eight-aminoacid peptide angiotensin II, a potent vasoconstrictor and a major stimulant of aldosterone release from the adrenal glands. The incidence of hypertension and its complications may be increased in individuals with the DD genotype of the allele coding for angiotensin-converting enzyme. Despite the role of this system in the regulation of blood pressure, it probably does not play a primary role in the pathogenesis of most essential hypertension. Patients with low plasma renin activity may have higher intravascular volumes. Black hypertensives (changes here most likely show the genetics related to African vs. American types of diet. The black diet in America is appallingly bad as apposed to the high fiber ancestral diet from which they descended) and older patients tend to have lower plasma renin activity; plasma levels are classified in relation to dietary sodium intake or urinary sodium excretion. Approximately 10% of essential hypertension patients have high levels, 60% normal, and 30% low. Measure is of little clinical utility.
3. Defect in natriuresis- Normal individuals increase their renal sodium excreting in response to elevations in arterial pressure and to a sodium or volume load. Hypertensive patients, particularly when their blood pressure is normal, exhibit a diminished ability to excrete a sodium load. This defect may result in increased plasma volume and hypertension. However, during chronic hypertension, a sodium load is usually handled normally.
4. Intracellular sodium (Na+) and calcium (Ca++)- Intracellular Na+ is elevated in blood cells and other tissues in essential hypertension. This may result from abnormalities in Na+-K+ exchange and other Na+ transport mechanisms. An increase in intracellular Na+ may lead to increased intracellular Ca++ concentrations as a result of facilitated exchange and might explain the increase in vascular smooth muscle tome that is characteristic of established hypertension.
5. Exacerbating factors- A number of conditions elevate blood pressure, especially in predisposed individuals. Obesity is associated with an increase in intravascular volume and an elevated cardiac output. Weight reduction lowers blood pressure modestly. The relationship between sodium intake and hypertension remains controversial, and some - not all - hypertensives respond to high salt intake with substantial blood pressure increases. Hypertensive patients should consume no more than 100 mmol/d of salt (2.4 g of sodium, 6g of sodium chloride daily).
Excessive use of alcohol also raises blood pressure, perhaps by increasing plasma catecholamines. Hypertension can be difficult to control in patients who consume more that 40g of ethanol (two drinks) daily or drink in binges. Cigarette smoking raises blood pressure, again by increasing plasma norepinephrine.(possibly by also causing hypertrophy of vascular smooth muscle). Although the long-term effect of smoking on blood pressure is less clear, the synergistic effects of smoking and high blood pressure on cardiovascular risk are well documented. The relationship between stress and hypertension is not established. (According to whom? It is biochemically and physiologically established). Polycythemia, whether primary or due to diminished plasma volume, increases blood viscosity and may raise blood pressure. Non-steroidal anti-inflammatory agents (aspirin, Tylenol, etc.) produce increases in blood pressure averaging 5 mm Hg, and are best avoided in patients with borderline or elevated blood pressures. (Does that statement make you ask why then do doctors prescribe an aspirin a day? Find out here). Low potassium intake is associated with higher blood pressure in some patients; an intake of 90 mmol/d is recommended.
B. Secondary Hypertension
Approximately 5% of patients with hypertension have specific causes. (Everything has a cause). The history, examination, and routine laboratory tests may identify such patients. In particular, patients who develop hypertension at an early age without a positive family history, those who first exhibit hypertension when over age 50, or those previously well-controlled but who become refractory to treatment are more likely to have secondary hypertension. Causes include the following:
1. Estrogen use- A small increase in blood pressure occurs in most women taking oral contraceptives, but considerable rises are noted occasionally. This is caused by volume expansion due to increased activity of the renin-angiotensin-aldosterone system. The primary abnormality is an increase in the hepatic synthesis of renin substrate. Five percent of women taking oral contraceptives chronically will exhibit a rise in blood pressure above 140/90 mm Hg; this is twice the expected prevalence. Contraceptive-related hypertension is more common in women over 35 years of age, in those who have taken contraceptives for more than 5 years, and in obese individuals. It is less common in those taking low-dose estrogen tablets. In most, hypertension is reversible by discontinuing the contraceptive, but it may take several weeks. Postmenopausal estrogen does not cause hypertension. These agents maintain endothelium-mediated vasodilation.
2. Renal disease- Renal parenchymal disease is the most common cause of secondary hypertension. Hypertension may result from glomerular diseases, tubular interstitial disease, and polycystic kidneys. Most cases are related to increased intravascular volume or increased activity of the renin-angiotensin-aldosterone system. Hypertension accelerates progression of renal insufficiency, and rigorous control to target blood pressure of 130/85 or lower will retard this progression. Diabetic nephropathy is another cause of chronic hypertension. This process is exacerbated by intraglomerular hypertension, itself worsened by systemic hypertension. Dilation of the efferent arterioles by angiotensin-converting enzyme inhibition reduces the rate of progression.
3. Renal vascular hypertension- Renal artery stenosis is present in 1-2% of hypertensive patients. Its cause in most younger individuals is fibromuscular hyperplasia, which is most common in women under 50. The remainder of renal vascular disease is due to atherosclerotic stenoses of the proximal renal arteries. The mechanism of hypertension is excessive renin release due to reduction in renal blood flow and perfusion pressure. Renal vascular hypertension may occur when a single branch of the renal artery is stenotic, but in as many as 25% of patients both arteries are obstructed.
Renal vascular hypertension should be suspected in the following circumstances: 1) if the documented onset is below age 20 or after age 50; 2) if there are epigastric or renal artery bruits; 3) if there is atherosclerotic disease of the aorta or peripheral arteries; or 4) if there is abrupt deterioration in renal function after administration of angiotensin-converting enzyme inhibitors. Additional evaluation is indicated in such patients, especially if hypertension is difficult to control.
There is no ideal screening test for renal vascular hypertension. If the suspicion of renal vascular hypertension is sufficiently high, renal arteriography, the definitive diagnostic test, is the best approach. Where suspicion is moderate to low, radioisotope renography before and after administration of an angiotensin-converting enzyme inhibitors is one standard approach. The baseline study may show a smaller kidney with diminished function on the side of the stenosis. Post-drug (captopril or enalaprilat) uptake and clearance of the radiotracer are delayed. However, bilateral disease may be difficult to detect if both kidneys are equally affected, and this test becomes insensitive in the presence of renal insufficiency. Duplex doppler flow studies and noninvasive angiograms using CT or MRI each have proponents, but the results vary greatly between centers. Except when stenosis is critical (>80-90%) and unifocal, its significance may be assessed by measuring differences in renin activity between the renal veins. If the lesion is not associated with an increase in renin activity, hypertension often persists despite correction.
Young individuals and good-risk patients of any age who have not responded to medical therapy should have the lesion corrected. Percutaneous transluminal angioplasty or stent placement is the preferred approach for fibromuscular hyperplasia and for discrete stenotic arteriosclerotic lesions that do not involve the renal artery ostium. In older individuals with arteriosclerosis, only a minority experience complete normalization without continued drug therapy. Thus, renal function and blood pressure should be closely monitored during the first weeks of therapy in patients in whom this is a consideration.
4. Primary hyperaldosteronism and Cushing's syndrome- Patients with excess aldosterone secretion make up less than 0.5% of all cases of hypertension. The usual lesion is an adrenal adenoma, though some patients have bilateral adrenal hyperplasia. The diagnosis should be suspected when patients present with hypokalemia prior to diuretic therapy associated with excessive urinary potassium excretion and suppressed levels of plasma renin activity; serum sodium usually exceeds 140 meq/L. Aldosterone concentrations in urine and blood are elevated. The lesion can be demonstrated by CT scanning or MRI. Less commonly, patients with Cushing's syndrome (excess cortisol) may present with hypertension.
5. Pheochromocytoma- Although hypertension due to pheochromocytoma may be episodic, most patients have sustained elevations. (pheochromocytoma has intermittent hypertension, whereas neuroblastoma has constant hypertension. Neuroblastoma is the most common tumor of the adrenal medulla in children, but it can occur anywhere in the sympathetic chain). The majority of patients have orthostatic falls in blood pressure, the converse of essential hypertension; some develop glucose intolerance.
6. Coarctation of the aorta- (uncommon cause of hypertension. Usually the person is hypertensive in the arms, but has little pulse in the legs. Can be seen on X-ray as rib notching)
7. Hypertension associated with pregnancy- Hypertension occurring de novo or worsening during pregnancy is one of the commonest causes of maternal and fetal morbidity and mortality.
8. Other causes of secondary hypertension- Hypertension has also been associated with hypercalcemia due to any cause, acromegaly, hyperthyroidism, hypothyroidism, and a variety of neurologic disorders causing increased intracranial pressure. A number of medications may cause or exacerbate hypertension ( most importantly, cyclosporine and NSAIDs- aspirin).
Complications of Untreated Hypertension
Complications of hypertension are related either to sustained elevations of blood pressure, with consequent changes in the vasculature and heart, or to atherosclerosis that accompanies and is accelerated by long-standing hypertension. The excess morbidity and mortality related to hypertension are progressive over the whole range of systolic and diastolic blood pressures; the risk approximately doubles for each 6 mm Hg increase in diastolic blood pressure. However, target organ damage varies markedly between individuals with similar levels of office hypertension. Ambulatory pressures are more closely related to end organ damage.
A. Hypertensive Cardiovascular Disease
Cardiac complications are the major causes of morbidity and mortality in essential hypertension, and preventing them is a major goal of therapy. ECG evidence of left ventricular hypertrophy is found in up to 15% of chronic hypertensives. It is an indication of increased risk for morbidity and mortality; for any level of blood pressure, its presence is associated with incremental risk. ECG left ventricular hypertrophy is a powerful predictor of prognosis. Left ventricular hypertrophy may cause or facilitate many cardiac complications of hypertension, including congestive heart failure, ventricular arrhythmias, myocardial ischemia, and sudden death.
Left ventricular diastolic dysfunction, which may present with all of the signs and symptoms of congestive heart failure, is common inpatients with long-standing hypertension. The occurrence of heart failure is reduced by 50% with antihypertensive therapy. Hypertensive left ventricular hypertrophy regresses with therapy and is most closely related to the degree of systolic blood pressure reduction. Diuretics have produced equal or greater reductions of left ventricular mass when compared with other drug classes..
B. Hypertensive Cerebrovasular Disease and Dementia
Hypertension is the major predisposing cause of stroke, especially intracerebral hemorrhage but also ischemic cerebral infarction. Cerebrovascular complications are more closely correlated with the systolic than the diastolic blood pressure. The incidence of these complications is markedly reduced by antihypertensive therapy. Preceding hypertension is associated with a higher incidence of subsequent dementia, both the vascular and the Alzheimer types. Effective blood pressure control may modify the risk or rate of progression of cognitive dysfunction.
C. Hypertensive Renal Disease
Chronic hypertension leads to nephrosclerosis, a common cause of renal insufficiency; aggressive blood pressure control attenuates the process. In patients with hypertensive nephropathy, the blood pressure should be 130/85 mm Hg or lower when proteinuria is present. Secondary renal disease is more common in blacks, particularly when accompanying diabetes is present. Hypertension also plays an important role in accelerating the progression of other forms of renal disease, most commonly diabetic nephropathy. ACE inhibitors are particularly effective in preventing the latter complication, but these agents appear to prevent the progression of other forms of nephropathy.
D. Aortic Dissection
Hypertension is a contributing factor in many patients with dissection of the aorta.
E. Atherosclerotic Complications
Most Americans with hypertension die of complications of atherosclerosis, but the linkage between hypertension and atherosclerotic cardiovascular disease is much less close than that with the previously discussed complications. Effective antihypertensive therapy is thus less successful in preventing complications of coronary heart disease.
Mild to moderate essential hypertension is asymptomatic for many years. Suboccipital pulsating headaches, characteristically occurring early in the morning and subsiding during the day, are said to be characteristic, but any type of headache may occur. Accelerated hypertension is associated with somnolence, confusion, visual disturbances, and nausea and vomiting (hypertensive encephalopathy).
Patients with pheochromocytomas that secrete predominantly norepinephrine usually have sustained hypertension but may have episodic hypertension. Attacks of anxiety, palpitation, profuse perspiration, pallor, tremor, and nausea and vomiting occur; blood pressure is markedly elevated, and angina or acute pulmonary edema may occur. In primary aldosteronism, patients may have muscular weakness, polyuria, and nocturia due to hypokalemia; malignant hypertension is rare.
Chronic hypertension often leads to left ventricular hypertrophy, which may be associated with diastolic or, in late stages, systolic dysfunction. Exertional and paroxysmal nocturnal dyspnea may result. Severe left ventricular hypertrophy predisposes to myocardial ischemia (especially when concomitant coronary artery disease is present), ventricular arrhythmias, and sudden death.
Cerebral involvement causes (1) stroke due to thrombosis or (2) small or large hemorrhage from microaneurysms of small penetrating intracranial arteries. Hypertensive encephalopathy is probably caused by acute capillary congestion and exudation with cerebral edema. The findings are usually reversible if adequate treatment is given promptly. Although there is no strict correlation of diastolic blood pressure with hypertensive encephalopathy, it usually exceeds 130 mm Hg.
1. Blood pressure-Blood pressure should be measured after the patient has rested 10 or more minutes in familiar, quiet, warm surroundings. On the initial observation, pressure should be examined in both arms and, if lower extremity pulses are diminished, in the legs to exclude coarctation of the aorta. Supine and standing measurements should be made to detect a postural drop, usually present in pheochromocytoma. Elderly patients may have falsely elevated readings by sphygmomanometry because of noncompressible vessels. This may be suspected in the presence of Osler's sign - a palpable brachial or radial artery when the cuff is inflated above systolic pressure. Occasionally, it may be necessary to maker direct measurements of intra-arterial pressure, especially in patients with apparent severe hypertension who do not tolerate therapy.
2. Retinas-The Keith-Wagener (KW) classification of retinal changes in hypertension, in spite of deficiencies, presage a worse prognosis when stage II or higher changes are present.
3. Heart and arteries-A loud aortic second sound and an early systolic ejection click may occur. Left ventricular enlargement with a left ventricular heave indicates well-established disease. Older patients frequently have systolic ejection murmurs resulting from aortic sclerosis, and these may evolve to significant aortic stenosis in some individuals. Aortic insufficiency may be auscultated in up to 5% of patients, and hemodynamically insignificant aortic insufficiency can be detected by Doppler echocardiography in 10-20%. A presystolic (S4) gallop due to decreased compliance of the left ventricle is quite common.
4. Pulses-The timing of upper and lower extremity pulses should be compared to exclude coarctation of the aorta. All major peripheral pulses should be evaluated to exclude aortic dissection and peripheral atherosclerosis, which may be associated with renal artery involvement.
All patients with high normal or elevated blood pressure, those who have a family history of cardiovascular complications of hypertension, and those who have multiple coronary risk factors should be counseled about nonpharmacologic approaches to lowering blood pressure. Approaches of proved but modest value include weight reduction, reduced alcohol consumption, and in some patients reduced salt intake. Increased activity levels should be encouraged in previously sedentary patients, but strenuous exercise training programs in already active individuals may have less benefit. Stress reduction is of unclear value.(it is clear. It greatly helps through biofeedback and other found methods) Calcium and potassium supplements have been advocated, but their ability to lower blood pressure is limited and probably not applicable to most patients. (it has been clinically proven to help). Smoking cessation will reduce overall cardiovascular risk.
Antihypertensive Drug Therapy
An ideal antihypertensive drug would be effective as a single agent or in combination with other agents in all classes of patients; would lower blood pressure by a physiologic mechanism; would reduce morbidity and mortality rates; would have no long-term toxicity or unpleasant side effects that affect life-styles; could be taken once a day; would not require multiple-dose titration steps; and would be of moderate cost. No such agent currently exists, but the growing number of available drugs has allowed the physician to tailor treatment to the needs of individual patients.
A. The Stepped Care Approach: In the 1970s and for most of the 1980s, the "stepped care" approach to treatment of hypertension was advocated. Patients were initially started on a diuretic agent, or beta-blocker, and other drugs were added later if required. This approach was highly effective, with approximately 80% of compliant patients exhibiting adequate blood pressure control. Several trials using this approach demonstrated significant reductions in stroke and, in some cases, myocardial infarction and death..
A number of considerations have led some experts to question stepped care as a universal treatment plan. These include the availability of other effective and well-tolerated agents with different mechanisms of action, the recognition that patients not controlled by one agent may respond to another without moving directly to two-drug therapy, and concerns over the long-term implications of metabolic changes observed with diuretics and beta-blockers (especially unfavorable changes in plasma lipids and insulin sensitivity). However, unlike diuretics and beta-blockers, these newer agents have not been proved to prevent the complications of hypertension. Indeed, some of them, such as calcium blockers and alpha-blockers, have not been shown to improve outcomes for any indication. Therefore, the pendulum of opinion has begun to swing back in favor of the drugs with proved benefits.
B. Choice of Initial Medication: Diuretics and beta-blockers should be considered for first-line therapy in most patients, but the choice of medications should be individualized. Additional choices include ACE inhibitors, calcium channel blockers, alpha-blockers, and combined alpha- and beta-blockers. These medications are all effective and generally well tolerated (the alpha-blockers less so), but responses vary among demographic groups. Selection is based upon individual factors, which include age, race, life-style, cost, the experience of the physician, and the side effects of the agent. Accompanying illnesses are often the major factor in selection of medications, since these may exclude some medications or favor the use of others.
C. Current Antihypertensive Agents:
1. Diuretics- The diuretics remain the most widely used antihypertensive medications and are the only agents shown to reduce mortality and morbidity related to coronary artery disease in major trials. Diuretics lower blood pressure initially by decreasing plasma volume (by suppressing tubular reabsorption of sodium, thus increasing the excretion of sodium and water) and cardiac output, but during chronic therapy their major hemodynamic effect is reduction of peripheral vascular resistance by an as yet unknown mechanism. Most of the antihypertensive effect of these agents is achieved at lower dosages than used previously (typically, 25 mg of hydrochlorothiazide or equivalent), but their biochemical effects are dose-related. The thiazide diuretics are the most widely used. The loop diuretics (such as furosemide) may lead to electrolyte and volume depletion more readily than the thiazides and have short durations of action; therefore, they are not ordinarily used in hypertension except in the presence of renal dysfunction (serum creatinine above 2.5 mg/dL). Relative to the beta-blockers and the ACE inhibitors, diuretics are more potent in blacks, older individuals, the obese, and other sub-groups with increased plasma volume or low plasma renin activity. Interestingly, they are relatively more effective in smokers than in nonsmokers. Overall, diuretics administered alone, control blood pressure in 50% of patients and can be used effectively with all other agents. They are perhaps the most effective agents for lowering predominantly systolic hypertension.
The adverse effects of diuretics are relate chiefly to the metabolic changes. Impotence, skin rashes, and photosensitivity are also less frequent side effects. Hypokalemia, with the resulting potential for arrhythmias or renal dysfunction, has been a concern but is uncommon at the usual current dosages (12.5-25 mg hydrochlorothiazide). The risk can be minimized by limiting salt intake or eating a high-potassium diet, and potassium replacement is usually not required to maintain serum K+ at 3.5 mmol/L. Higher serum levels may be prudent in patients at special risk from intracellular potassium depletion (patients taking digoxin or having ventricular arrhythmias and diabetics in whom insulin release and insulin sensitivity are reduced by hypokalemia). It is noteworthy that several of the trials in which diuretic therapy proved most beneficial employed combinations of thiazide and potassium-sparing agents, such as triamterene or amiloride. These medications are more expensive, have additional side effects (primarily gastrointestinal), and may be dangerous in the presence of oliguria. However, it is reasonable to use these agents in appropriate patients receiving higher doses of diuretics and in place of potassium supplements. Diuretics also increase serum uric acid and may precipitate acute gout. Increases in blood glucose, triglycerides, low-density lipoprotein cholesterol, and plasma insulin may occur but are relatively minor during long-term low-dose therapy. Some experts feel that these lipid changes may limit the beneficial effect of blood pressure reduction on the progression of atherosclerosis.
2. Beta-adrenergic blocking agents- These drugs are effective in hypertension because they decrease the heart rate and cardiac output. Even after continued use of beta-blockers for a number of years, cardiac output remains decreased and systemic vascular resistance increased with agents that do not have intrinsic sympathomimetic or alpha-blocking activity. The beta-blockers also decrease renin release and are in general more efficacious in populations likely to have elevated plasma renin activity, such as younger white patients. They neutralize the reflex tachycardia caused by vasodilators such as hydralazine and alpha-adrenergic blockers in the treatment of hypertension. The beta-blockers are especially useful in patients with associated conditions that benefit from this mode of therapy. These include patients with angina pectoris, patients with previous myocardial infarction, and individuals with migraine headaches and somatic manifestations of anxiety.
The side effects of all beta-blockers include development of bronchial asthma in predisposed patients; bradycardia; atrioventricular conduction defects; left ventricular failure; nasal congestion; Raynaud's phenomenon, especially in women; and central nervous system symptoms with nightmares, excitement, and confusion. Fatigue, lethargy, and impotence may occur. All beta-blockers tend to increase plasma triglycerides. The nonselective and, to a lesser extent, the cardioselective beta-blockers tend to depress the protective HDL fraction of plasma cholesterol. This is not seen in agents with intrinsic sympathomimetic activity, and as with diuretics, the changes are blunted with time and dietary changes. Some experts believe that these lipid changes may have an adverse effect on coronary artery disease.
These agents are contraindicated in patients with congestive heart failure or symptomatic bronchospasm. Beta-blockers are relatively contraindicated in insulin-dependent diabetes, since they inhibit gluconeogenesis and may prolong hypoglycemic episodes. However, recent studies have not confirmed earlier suggestions that they may worsen symptoms of peripheral vascular disease.
3. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II blockers- These drugs are being increasingly used as the initial medication in mild to moderate hypertension. Their primary mode of action is inhibition of the renin-angiotensin-aldosterone system, but they also inhibit bradykinin degradation, stimulate vasodilating prostaglandin synthesis, and, sometimes, reduce sympathetic nervous system activity. These latter actions may explain why they exhibit some effect even in patients with low plasma renin activity. The ACE inhibitors appear to be most effective in younger whites. They are relatively less effective in blacks and in the elderly and in predominantly systolic hypertension. While as single therapy they achieve adequate antihypertensive control in only about 40-50% of patients, the combination of an ACE inhibitor and a diuretic or calcium channel blocker is potent.
An advantage of the ACE inhibitors is their relative freedom from troublesome side effects. Severe hypotension can occur in patients with bilateral renal artery stenosis; acute renal failure may ensue. Hyperkalemia may develop in patients with intrinsic renal disease and type IV renal tubular acidosis (commonly seen in diabetics) and in the elderly. A chronic dry cough due to bronchial or laryngeal irritation is seen in 5-15% of patients and may require stopping the drug. Skin rashes and taste alterations are seen more often with captopril than with the non-sulfhydryl-containing agents (enalapril and lisinopril) but often disappear with continued therapy. Angioneurotic edema is an uncommon but potentially dangerous side effect of all agents of this class. Proteinuria and neutropenia are very uncommon at the lower dosages now employed except in individuals with preexisting renal insufficiency or autoimmune disease.
4. Calcium channel blockers- All the agents of this class reduce blood pressure, and a number of new agents with a longer duration of action and perhaps less negative inotropic activity are available. They act by causing peripheral vasodilation, which is associated with less reflex tachycardia and fluid retention than other vasodilators. These agents are effective as single-drug therapy in approximately 60% of patients and appear to be effective in all demographic groups and all grades of hypertension. As a result, they may be preferable to beta-blockers and ACE inhibitors in blacks and older subjects. Calcium channel blockers and diuretics are less additive when given together than when either is combined with beta-blockers or ACE inhibitors. However, verapamil and diltiazem should be combined cautiously with beta-blockers because of their potential for depressing atrioventricular conduction and sinus node automaticity. Several recent reports have raised concern that calcium blocker therapy may be associated with an increased rate of cardiac events. These data primarily apply to short-acting formulations and are limited by their methodology, but nonetheless they highlight the need for prospective clinical trials. Until such data are available, it is prudent not to utilize short-acting formulations and to choose calcium blockers as first-line agents only in appropriately selected individuals.
The most common side effects of calcium channel blockers are headache, peripheral edema, bradycardia, and constipation (especially with verapamil in the elderly). The dihydropyridine agents¾nifedipine, nicardipine, isradipine, felodipine, and amlodipine - are more likely to produce symptoms of vasodilation, such as headache, flushing, palpitations, and peripheral edema. Calcium channel blockers have negative inotropic effects and may cause or exacerbate heart failure in patients with cardiac dysfunction. This tendency may be less with amlodipine. Most of these agents are now available in preparations that can be administered once or twice daily.
5. Alpha-adrenoceptor antagonists- Prazosin, terazosin, and doxazosin block postsynaptic alpha receptors, relax smooth muscle, and reduce blood pressure by lowering peripheral vascular resistance. These agents are effective as single-drug therapy in some individuals, but tachyphylaxis may appear during long-term therapy and side effects are relatively common. The major side effects are marked hypotension and syncope after the first dose, which, therefore, should be small and be given at bedtime. Postdosing palpitations, headache, and nervousness may continue to occur during chronic therapy. These side effects may be less frequent or severe with doxazosin because of its more gradual onset of action. Unlike the beta-blockers and diuretics, the alpha-blockers have no adverse effect on serum lipid levels - in fact, they increase high-density lipoprotein cholesterol while reducing total cholesterol. Whether this is beneficial in the long term has not been established. These drugs are most useful in combination with other agents in less responsive patients. One interesting attribute is a reduction in symptoms of prostatism in some men, which makes these drugs appropriate first-line agents for symptomatic patients.
6. Drugs with central sympatholytic action- Methyldopa, clonidine, guanabenz, and guanfacine lower blood pressure by stimulating alpha-adrenergic receptors in the central nervous system, thus reducing efferent peripheral sympathetic outflow. These agents are effective as single therapy in some patients, but they are usually employed as second- or third-line agents because of the high frequency of drug intolerance, including sedation, fatigue, dry mouth, postural hypotension, and impotence. An important concern is rebound hypertension following withdrawal. Methyldopa also causes hepatitis and hemolytic anemia and should be avoided except in individuals who have already tolerated chronic therapy. Clonidine is available in patches and may have particular value in patients in whom compliance is a troublesome issue.
7. Arteriolar dilators- Hydralazine and minoxidil relax vascular smooth muscle and produce peripheral vasodilation. When given alone, they stimulate reflex tachycardia, increase myocardial contractility, and cause headache, palpitations, and fluid retention. They are usually given in combination with diuretics and beta-blockers in resistant patients. Hydralazine produces frequent gastrointestinal disturbances and may induce a lupus-like syndrome. Minoxidil causes hirsutism and marked fluid retention; this agent is reserved for the most refractory of patients.
8. Peripheral sympathetic inhibitors- These agents are now used infrequently. Reserpine remains a cost-effective antihypertensive agent. Its reputation for inducing mental depression and its other side effects - sedation, nasal stuffiness, sleep disturbances, and peptic ulcers¾have made it unpopular, though these problems are uncommon at low dosages. Guanethidine and guanadrel inhibit catecholamine release from peripheral neurons but frequently cause orthostatic hypotension (especially in the morning or after exercise), diarrhea, and fluid retention. These agents are used chiefly in refractory hypertension.
D. Initiating Therapy
When an initial agent is selected, the patient should be informed of common side effects and the need for diligent compliance. Unless the initial blood pressure is very high (> 180/110), follow-up visits should be at 4- to 6-week intervals to allow for full medication effect to be manifest (especially with diuretics).
E. Combination Therapy
Most patients with hypertension can be controlled with one agent or with two-drug combinations such as (1) a diuretic plus a beta-blocker, (2) a diuretic plus an ACE inhibitor, (3) a diuretic plus a calcium channel blocker, or (4) a calcium channel blocker plus an ACE inhibitor. A minority may require triple-drug therapy. Particularly useful multidrug regimens are (1) a diuretic plus a beta-blocker plus a vasodilator or a calcium channel blocker; (2) a diuretic plus an ACE inhibitor plus either a calcium channel blocker or a sympatholytic (or both); and (3) a calcium channel blocker plus an ACE inhibitor plus either a sympatholytic or a beta-blocker (or both). Patients who are compliant with their medications and who do not respond to these combinations should usually be evaluated for secondary hypertension before proceeding to more complex regimens.
F. Treatment of Hyperlipidemia
A critical element in preventing hypertension-related morbidity is concomitant control of hyperlipidemia.
G. Follow-Up of the Treated Hypertensive
Once blood pressure is controlled on a well-tolerated regimen, follow-up visits can be infrequent and laboratory testing should be limited to tests appropriate for the patient and the medications utilized. During long-term treatment, twice-yearly visits are sufficient for stabilized patients. Testing, in addition to that required for health maintenance, includes renal function and potassium levels for diuretics and ACE inhibitors. In addition, yearly monitoring of blood lipids is recommended in patients with hypertension, and an ECG should be repeated at 2- to 4-year intervals depending on whether initial abnormalities are present, the presence of coronary risk factors, and age.
Patients who have had excellent blood pressure control for several years, especially if they have lost weight and initiated favorable lifestyle modifications, should be considered for "step-down" of therapy to determine if lower doses or discontinuing of medications is feasible.
Whether blood pressure is high, low, or normal depends on several factors: the output from the heart, the resistance to blood flow of the blood vessels, the volume of blood, and blood distribution to the various organs. All of these factors in turn can be affected by the activities of the nervous system and certain hormones.
If blood pressure is elevated, the heart must work harder to pump an adequate amount of blood to all the tissues of the body. Ultimately, the condition often leads to kidney failure, heart failure, and stroke. In addition, high blood pressure is often associated with coronary heart disease, arteriosclerosis, kidney disorders, obesity, diabetes, hyperthyroidism, and adrenal tumors.
Because high blood pressure usually causes no symptoms until complications develop, it is known as the "silent killer". Warning signs associated with advanced hypertension may include headaches, sweating, rapid pulse, shortness of breath, dizziness, and visual disturbances.
Blood pressure is usually divided into two categories, designated primary and secondary. Primary hypertension is high blood pressure that is not due to another underlying disease. The precise cause is unknown, but a number of definite risk factors have been identified. These include cigarette smoking, stress, obesity, excessive use of stimulants such as coffee or tea, drug abuse, and high sodium intake. Because too much water retention can exert pressure on the blood vessels, those who consume foods high in sodium may be at a greater risk for high blood pressure. Elevated blood pressure is also common in people who are overweight. Blood pressure can rise due to stress as well, because stress causes the walls of the arteries to constrict. Also, those with a family history may be more likely to suffer from high blood pressure.
When persistently elevated blood pressure arises as a result of another underlying health problem, such as a hormonal abnormality or an inhereted narrowing of the aorta, it is called secondary hypertension. A person may also have secondary hypertension because the blood vessels are chronically constricted or have lost elasticity from a buildup of fatty plaque on the inside walls of the vessel, a condition known as atherosclerosis. Arteriosclerosis and atherosclerosis are common precursors of hypertension. The narrowing and/or hardening of the arteries makes circulation of blood through the vessels difficult. As a result, blood pressure becomes elevated. Secondary hypertension can also be caused by poor kidney function, which results in the retention of excess sodium and fluid in the body. This increase in blood volume within the vessels causes elevated blood pressure levels. The kidneys may also elevate blood pressure by secreting substances that cause blood vessels to contrict.
It is IMPOSSIBLE for a health care provider to make a CORRECT diagnosis of high blood pressure with a single reading. The test must be repeated througout the day to be accurate. home testing is best because it enables you to monitor your condition periodically.
Below are some natural ways to help lower high blood pressure.
1,500-3,000 mg daily
Deficiencies have been linked to high blood pressure.
|magnesium||750-1,000 mg daily||as above|
|potassium||as directed on label||If you are taking cortisone or high blood pressure medication, take care to adjust for depletion or elevation.|
|Coenzyme Q10||as directed||Improves heart function|
|Essential Fatty Acids (black currant seed oil, flaxseed oil, OLIVE OIL, primrose oil)||as directed||Important for circulation and for lowering blood pressure|
|Garlic||2 capsules 3 times daily||Effective in lowering pressure|
|L-arginine||as directed||Shown to play an increaseingly important role in heart health by lowering blood pressure and cholesterol levels|
|L-carnitine||500 mg twice daily, on an empty stomach||Transports long fatty acid chains. Together with L-glutamic acid and L-glutamine, aids in preventing heart disease.|
|L-glutamic acid||500 mg daily on empty stomach.||as above|
|L-glutamine||as above||as above|
|Selenium||200 mcg daily||Deficiency has been linked to heart disease.|
|Vitamin E||as directed||Improves heart function. Vitamin E also acts as a blood thinning agent; use with caution if you are taking prescription blood thinners. Use d-alpha-tocopherol form.|
|Vitamin C||3,000-6,000 mg daily in divided doses||Improves adrenal function; reduces blood clotting tendencies|
|Lecithin Granules||1 tbsp 3 times daily before meals||They emulsify fat, improve liver function, and lower blood pressure|
|Proteolytic Enzymes||as directed||Aids in cleansing the circulatory system. Completes protein digestion.|
|Vitamin B complex||100 mg twice daily||Important for circulatory function and for lowering blood pressure|
|Niacin||50 mg twice daily|
|Choline||50 mg twice daily|
|Inositol||50 mg twice daily|
1. Follow a strict salt-free diet. This is essential for lowering blood pressure. Lowering your salt intake is not enough; eliminate all salt from your diet. Read labels carefully and avoid those food products that have "salt", "soda", "sodium", or the symbol "Na" on the label. Some foods and food additives that should be avoided on this diet include monosodium glutamate (Accent, MSG); baking soda; canned vegetables (unless marked sodium or salt free); commercially prepared foods; over the counter medications that contain ibuprofen (such as Advil or Nuprin); diet soft drinks; foods with mold inhibitors, preservatives, and/or sugar substitutes; meat tenderizers; softened water; and soy sauce.
2. Eat a high-fiber diet and take supplemental fiber.
3. Eat plenty of fruits and vegetables, such as apples, asparagus, broccoli, cabbage, cantaloupe, eggplant, garlic, grapefruit, green leafy vegetables, melons, peas, prunes, squash, and sweet potatoes.
4. Include fresh "live" juices in the diet. The following juices are healthful: beet, carrot, celery, currant, cranberry, citrus fruit, parsley, spinach, and watermelon.
5. Eat grains like BROWN rice, buckwheat, millet, and oats.
6. DRINK STEAM-DISTILLED WATER ONLY
7. Take 2 tablespoons of flaxseed oil daily
8. AVOID ALL ANIMAL FATS. Bacon, beef, bouillons, chicken liver, corned beef, dairy products, gravies, pork, sausage, and smoked or processed meats are prohibited. The only acceptable animal foods are broiled white fish and skinless turkey or chicken that has been raised hormone and antibiotic free. Get protein from vegetable sources, grains, and legumes instead.
9. Avoid foods such as aged cheeses, aged meats, anchovies, avocados, chocolate, fava beans, pickled herring, sherry, sour cream, wine, and yogurt.
10. Avoid all alcohol, caffeine, and tobacco
11. If you are taking an MAO inhibitor, avoid the chemical tyramine and its precursor tyrosine. Combining MAO inhibitors with tyramine causes the blood pressure to soar and could cause a stroke. Tyramine-containing foods include almonds, avocados, bananas, beef or chicken liver, beer, cheese, chocolate, coffee, fava beans, herring, meat tenderizers, peanuts, pickles, pineapples, pumpkin seeds, raisins, sausage, sesame seeds, sour cream, soy sauce, wine, yeast extracts, yogurt, and other foods. In general, any high protein fod that has undergone aging, pickling, fermentation, or similar processes should be avoided. Over the counter cold and allergy remedies should also be avoided.
12. Keep your weight down.
13. Fast for three to five days each month. Periodic cleansing fasts help to detoxify the body.
14. Get regular light to moderate exercise. Take care not to overexert yourself.
15. Be sure to get sufficient sleep.
16. Do not take antihistamines.
17. Avoid the artificial sweetener aspartame (Equal, Nutrasweet) which contains phenylalanine.
18. As much as possible, avoid stress.
THINGS TO CONSIDER
1. Because the use of diuretic drugs causes increased urinary excretion of magnesium, it can cause hypomagnesemia in people. Magnesium is needed in conjunction with calcium to prevent bone deterioration, as well as to maintain a normal heart rhythm and muscular contraction. Loss of potassium dure to diuretics may be dangerous, causing heart malfunction. Herbal diuretics are far safer.
2. People with hypertension often suffer from sleep apnea, in which they stop breathing for ten seconds or more throughout the night. Apnea is associated with loud snoring and restless sleep, and can cause the individual to feel excessively sleepy during the day.
3. According to the National Stroke Association, hypertension is the most important controllable risk factor for stroke, increasing the risk of stroke by seven times.
4. Approximately 80 million Americans have increased sensitivity to dietary sodium. African-Americans in particular are prone to salt-sensitive hypertension.
5. Heavy snorers are more likely to have high blood pressure or angina than silent sleepers. Research suggests that snorers may suffer from a malfunctioning of the part of the brain responsible for fluent breathing; this can put an unnatural strain on the heart and lungs due to oxygen shortage.
6. Researchers at the State University of New York found that the lower the level of magnesium in the body, the higher the blood pressure. This double-blind, placebo-controlled trial showed that taking supplemental magnesium can result in a significant, dose-dependent reduction in both systolic and diastolic blood pressure.
7. Apple pectin aids in reducing blood pressure.
8. Certain colors have a beneficial effect on blood pressure. (see Color Therapy). Music also can be used to reduce stress and thereby lower blood pressure.
9. Taking medication for high blood pressure may lead to low blood pressure (hypotension). Hypotension can cause fainting, fatigue, and weakness, possibly with nausea, sweating, and restlessness preceding a loss of consciousness. Postural hypotension, which is a very temporary lowering of blood pressure, is usually caused by standing up too suddenly. This leads to dizziness and wears off quickly. For older adults, low blood pressure can simple result from eating. This is called postprandial hypotension, and it happens because blood is diverted to the gastrointestinal tract to help with digesting the food. In older people, the heart is not as efficient at increasing blood flow by pumping more quickly, so, with too much blood going to help with digesting a meal, there is too little traveling to the brain. Drinking lots of fluids increases blood volume, which may alleviate this condition.
Farhang Khosh, ND, Mehdi Khosh, ND
Hypertension is a common problem facing many Americans today, with two million new cases being diagnosed each year. Although billions of dollars are spent annually in the United States for the treatment and detection of cardiovascular disease, current conventional treatments have done little to reduce the number of patients with hypertension. Alternative medicine offers an effective way to decrease the rising number of people with high blood pressure. Research has found a variety of alternative therapies to be successful in reducing high blood pressure including diet, exercise, stress management, supplements, and herbs. (Altern Med Rev 2001:6(6):590-600)
Hypertension is one of the leading causes of disability or death, due to stroke, heart attack, and kidney failure. Expenses related directly or indirectly to the treatment and detection of hypertension in the United States are approximately $10 billion yearly. Heart disease and stroke remain the first and third leading causes of death, respectively, in the United States. Despite the importance of these observations, for many people blood pressure is poorly controlled. (1 )
An estimated 50 million American adults (25 percent of all adults) have high blood pressure, but only 68 percent are aware of their condition, and only 27 percent have it under control. (2) Each year, two million new cases of hypertension are diagnosed.(3) The risk of hypertension increases with age in both men and women.( 4) Before age 55, more men than women have hypertension; the reverse is true for those over the age of 55. African Americans have significantly more risk of developing high blood pressure then Caucasians and Mexican Americans.
There are two types of high blood pressure: essential (primary) hypertension and secondary hypertension. Essential hypertension does not have a readily identifiable cause, and is the most common type of hypertension, accounting for 90 percent of all cases of high blood pressure. Genetics play a major role in essential hypertension. In the case of secondary hypertension, the cause can be identified and is usually treatable or reversible.
Optimal blood pressure (BP) is 120/80 mm Hg or less. (5) The systolic pressure measures the force that blood exerts on the artery walls as the heart contracts to pump blood, while the diastolic pressure measures the force when the heart relaxes to allow blood flow into the heart.
Beta-blockers, diuretics, or both are usually the first line of treatment for most physicians. (7)
Dietary Approaches to Hypertension
A diet low in saturated fat and high in complex carbohydrate is recommended. Such a diet includes whole grains, fruits, vegetables, nuts, seeds, legumes, fish, soy products, onions, garlic, foods rich in potassium, calcium, and magnesium (carrots, spinach, celery, alfalfa, mushrooms, lima beans, potatoes, avocados, broccoli, and most fruits), and restricts salt.
Subjects (n=133) were enrolled in the Dietary Approaches to Stop Hypertension (DASH) trial in order to determine the effect of diet on blood pressure. Systolic blood pressures of participants ranged from 140-159 mm Hg, while diastolic BPs were 90-95 mm Hg. Subjects ate a control diet for three weeks before being randomized to receive either a diet rich in fruits and vegetables, that same diet but with elimination of red meat, sugar, and reduced in fats, or a control diet for another eight weeks. The low-fat, low-sugar diet rich in fruits and vegetables significantly reduced both systolic and diastolic BP. While the fruits-and-vegetables diet also significantly reduced systolic and diastolic blood pressures, the combination diet produced greater BP-lowering effects; changes were evident within two weeks of starting the diet. By the end of the eight-week trial, 70 percent of participants eating the combination diet had a systolic BP less than 140 mm Hg and diastolic BP less than 90 mm Hg, compared with 45 percent on the diet rich in fruits and vegetables and 23 percent on the control diet.(8)
More than one-third of the adult population of the United States is obese,(9) presenting a significant risk factor for hypertension. Many studies have shown obese hypertensive patients can reduce their medication with weight loss. A sedentary individual has a 35-percent greater risk of developing hypertension than does an athlete.(6)
One study found insufficient sleep can contribute to increased blood pressure in hypertensives. The researchers theorized this may be due to increased sympathetic nervous activity during the night.(10)
Stress management and relaxation techniques such as meditation can help in controlling high blood pressure. In one study researchers found nearly 70 percent of patients with mild to moderate hypertension using techniques to reduce stress were able to reduce their medication after six weeks; after one year, 55 percent required no medication.(11)
Specific Nutrient Supplementation
Minerals: Potassium and Magnesium
Potassium is one of the most important minerals for hypertension. It is well documented that a diet low in potassium and high in sodium is associated with hypertension. (12-17)
There have been several studies indicating magnesium (Mg) may help to lower blood pressure and even prevent hypertension. Its hypotensive effect is thought to be due to relaxation of the smooth muscles of the blood vessels. A recent study demonstrated magnesium supplementation prevented blood pressure elevation in hypertensive rats. Magnesium's mechanism of action was theorized to be associated with inhibition of platelet calcium uptake and decrease in intracellular free calcium concentrations.(18) In another study, researchers showed that taking magnesium in amounts as low as 365 mg per day with beta blockers can significantly reduce blood pressure compared to taking beta blockers alone.(19)
In a double-blind cross-over study of magnesium in hypertension, 17 subjects (diastolic BPs > 90 mm Hg) were supplemented with 15 mM Mg daily for three weeks, 30 mM Mg for another three weeks, and ending with 40 mM Mg for a final three weeks. Statistically significant decreases in average systolic and diastolic BPs were noted. (20)
Studies have clearly shown the potential benefit of coenzyme Q10 (CoQ10) in treatment of hypertension and congestive heart failure.(21-25) In one study, 109 patients with essential hypertension were supplemented with CoQ10 at an average oral dose of 225 mg/day in addition to their existing antihypertensive drug regimen. Eighty percent of patients in the study had been diagnosed with hypertension for an average of 9.2 years. Dosage was dependant on blood levels of CoQ10, the objective being to maintain blood levels of greater than 2.0 mcg/mL. Patients were gradually able to decrease antihypertensive drug therapy during the first one to six months. Fifty-one percent of patients were able to completely discontinue between one and three antihypertensive drugs an average of 4.4 months after starting CoQ10.(26)
In addition to normalizing blood pressure, another study found that CoQ10 may also be effective in reducing total cholesterol. In this study 26 hypertensives were supplemented with CoQ10 at a dose of 50 mg twice daily for 10 weeks. Plasma CoQ10, serum total and HDL cholesterol, and blood pressure were determined in all patients before and at the end of the 10-week period. At the end of the treatment, systolic blood pressure decreased from an average of 164 mm Hg to 146 mmHg, while diastolic blood pressure decreased from an average of 98 mm Hg to 86 mm Hg. Average serum total cholesterol decreased slightly, from 222 mg/dL to 213 mg/dL, while there was no significant change in HDL levels.(27) Long term studies on safety of CoQ10 have shown it to be a safe supplement.22 It may take as long as 4-12 weeks to note significant results.
Omega-3 Fatty Acids
Increasing the intake of omega-3 fatty acids can lower blood pressure.28 Recent research suggests that the omega-3 fatty acid, eicosapentanoic acid (EPA), directly modulates intracellular calcium ion (Ca2+) signaling in vascular smooth muscle cells, resulting in a vasodilation effect and lowering of blood pressure.(29-31)
Sixteen mild essential hypertensive male outpatients and 16 normotensive male controls were randomly assigned to receive either EPA and docosahexanoic acid (DHA) (2.04 g EPA and 1.4 g DHA) or olive oil (4 g/day) as a placebo for a period of four months. The effect of omega-3 fatty acids on blood pressure in the treatment group was maximized after two months with systolic BP decreasing an average of 6 mm Hg, (p<0.05) and diastolic blood pressure down an average of 5 mm Hg, (p<0.05).(32) Omega-3 oils are also effective in lowering triglycerides and LDLs, and increasing HDLs.
In a double-blind placebo-controlled study of 935 patients with hypertriglyceridemia and hypertension, researchers found omega-3 oil supplementation resulted in significant reductions in total cholesterol and blood pressure and significant increase in HDL (an overall mean rise of 7.4 percent).(33) In addition, omega-3 oils can prevent primary or secondary coronary heart disease.(34-37)
Amino Acids: L-Arginine and Taurine
L-arginine is a precursor to nitric oxide (endothelial-derived relaxing factor) which dilates blood vessels and lowers blood pressure. Several studies have shown that inhibiting the synthesis of nitric oxide in animal models results in hypertension.(38)
Dietary L-arginine supplementation has been proposed to reverse endothelial dysfunction in certain conditions, including hypercholesterolemia, coronary heart disease, and some forms of animal hypertension. Chronic oral administration of L-arginine prevented the blood pressure rise induced by sodium chloride loading in salt-sensitive rats.(39)
A single-blind, controlled, crossover dietary intervention was conducted on six healthy subjects in order to assess the effects of an L-arginine enriched diet on blood pressure. The subjects randomly received three different diets, each for a period of one week: 1) a control; 2) a natural foods diet enriched with L-arginine; or 3) a diet identical to the control diet with the addition of L-arginine supplementation. A decrease in BP was observed with both L-arginine-enriched diets. In addition, creatinine clearance was improved and fasting blood sugar decreased by the addition of L-arginine.(39)
Taurine, a sulfur-containing amino acid, has been reported to have antihypertensive and sympatholytic activity.(40) Nineteen patients with borderline hypertension were supplemented with 6 g taurine daily for seven days in a double-blind, placebo-controlled study. Systolic BP in the 10 taurine-treated patients decreased an average of 9 mm Hg compared with a 2 mm Hg decrease in the nine patients treated with placebo; diastolic BP in the taurine-treated patients decreased an average of 4 mm Hg compared with 1 mm Hg in the placebo-treated subjects. Taurine supplementation resulted in a significant decrease in plasma epinephrine but not norepinephrine levels. Individuals with hypertension tend to have higher epinephrine compared to people with normal blood pressure.(41) Research shows taurine relaxes blood vessels by enhancing endorphin production, resulting in lowered blood pressure.(42,43)
Vitamins C and E
Vitamins C and E may both play a beneficial role in the prevention and treatment of hypertension. Vitamin C has the potential to impact defective endothelium-dependent vasodilation. Although the mechanism has not been fully elucidated, it is believed that ascorbic acid functions as an antioxidant to either enhance the synthesis or prevent the breakdown of nitric oxide.(44) A 1999 Lancet randomized, double-blind, placebo-controlled study showed that treatment of hypertensive patients with vitamin C lowered blood pressure. Thirty-nine patients received either ascorbic acid (n=19) or placebo (n=20) in a one-time dose of 2 g, followed by 500 mg daily for 30 days. Mean systolic blood pressure decreased from 155 mm Hg to 142 mm Hg (p<0.001) after 30 days in the ascorbate group, while placebo had no effect. Mean diastolic BP decreased in the ascorbate group after one month but was not significantly different than placebo. There was no significant effect in blood pressure after the initial 2 g dose.(45)
Vitamin E has also been found to increase nitric oxide synthase activity, resulting in lowered blood pressure in hypertensive patients. An animal study found that for all alpha-tocopherol-treated groups, blood pressure was significantly reduced compared to a hypertensive control group; maximum reduction of blood pressure was achieved at a dosage of 34 mg alpha-tocopherol/kg diet.(46)
Specific Botanicals for Hypertension
Hawthorne (Crataegus oxycantha and monogyna)
Hawthorne has been used traditionally for cardiovascular disorders in many cultures. It contains a number of active constituents including flavonoids, catechins, triterpene saponins, amines, and oligomeric proanthocyanidins (OPCs). Hawthorne has been shown to exert a mild blood pressure lowering effect(47,48) that can take up to four weeks for maximal results. It is believed that the herb dilates coronary blood vessels.(48) One in vitro study on rat aorta found proanthocyanidins extracted from hawthorne relaxed vascular tone via endothelium-dependent nitric oxide-mediated relaxation.(49)
Arjuna Bark (Terminalia arjuna)
Terminalia arjuna is a deciduous tree found throughout India. Its bark has been used in Ayurvedic medicine for over three centuries. Terminalia's active constituents include tannins, triterpenoid saponins, flavonoids, gallic acid, ellagic acid, OPCs, phytosterols, calcium, magnesium, zinc, and copper.(50) Several studies have elucidated Terminalia's effects on various cardiac disorders including congestive heart failure, coronary artery disease, and hypertension. A study on its effects on stable and unstable angina patients found it effective for those with stable angina, with a 50-percent reduction in angina episodes and significant decrease in systolic blood pressure.(51)
In a double-blind crossover study, 12 subjects with refractory chronic congestive heart failure (idiopathic dilated cardiomyopathy (n=10); previous myocardial infarction (n=1), or peripartum cardiomyopathy (n=1)), received Terminalia arjuna, at a dose of 500 mg every eight hours, or placebo for two weeks, each treatment protocol separated by a two-week washout period, as an adjuvant to conventional therapy. Clinical, laboratory, and echocardiographic evaluations were carried out at baseline and at the end of therapy. Terminalia, compared to placebo, was associated with improvement in symptoms and signs of heart failure, decrease in echo-left ventricular end diastolic and end systolic volume indices, increase in left ventricular stroke volume index, and increase in left ventricular ejection fractions.(52) A study with similar dosing on primarily post-myocardial infarction angina patients found improvements in cardiac function. Prolonged use resulted in no adverse side effects or signs of renal, hepatic, or hematological abnormalities.(53)
Olive Leaf (Olea africana and Olea europea)
Olive leaf extract is derived from the leaves of the olive tree. The entire leaf extract contains several phytochemicals, including 20-percent oleuropein, a complex structure of flavonoids, esters, and multiple iridoid glycosides, which acts as a vasodilator, lowering blood pressure and preventing angina attacks. Oleuropein is also being recognized as a potent antioxidant.(54,55) The hypotensive action of olive leaf has been studied for two decades. A clinical study of Olea europaea L. aqueous extract was conducted on two groups of hypertensive patients, 12 patients consulting for the first time, and 18 patients on conventional antihypertensive treatment. An aqueous extract was given for three months, after 15 days of placebo supplementation. Researchers noted a statistically significant decrease of blood pressure (p<0.001) for all patients, without side effects.(56)
One of olive leaf's mechanisms of action is vasodilation. In an in vitro study a decoction of olive leaf caused relaxation of isolated rat aorta endothelium. The relaxant activity was independent of the integrity of the vascular endothelium. Oleuropeoside was found to be a component responsible for vasodilator activity; however, the researchers felt at least one other principle was either a vasodilator itself or potentiated the relaxant effect of oleuropeoside.(57)
European Mistletoe (Viscum album)
The use of mistletoe in medicine has become popular, not only because of its hypotensive activity, but also because of its anticancer properties. Mistletoe is known to possess hypotensive, cardiotonic, vasodilatory, antispasmodic, tumor-inhibiting, and thymus-stimulating activity.(58) Its pharmacological effects, including diuretic and hypotensive activity, were studied using an alcohol extract of Japanese and European mistletoe. Both extracts showed blood pressure lowering effects when administered intravenously and orally to cats.(59) Other researchers have reported similar hypotensive effects of mistletoe in experimental animal studies.(60)
Yarrow (Achillea wilhelmsii)
Achillea wilhelmsii C. Koch (Asteraceae) has flavonoids and sesquiterpene lactone constituents, which have been found effective in lowering blood pressure and lipids. A double-blind, placebo-controlled trial examined the antihyperlipidemic and antihypertensive effects of Achillea. The researchers randomly selected 120 men and women, aged 40-60 years, and divided them into two groups: (1) moderate hyperlipidemic and (2) hypertensive subjects. Each study group was treated either with an alcohol extract of Achillea or placebo at a dose of 15-20 drops twice daily for six months. Blood pressure and serum lipids (total cholesterol, triglycerides, LDL-cholesterol and HDL-cholesterol) were measured at the end of two, four, and six months. A significant decrease was noted in triglycerides after two months, and significant decreases in triglycerides and total- and LDL-cholesterol after four months. Levels of HDL-cholesterol were significantly increased after six months' treatment. A significant decrease was observed in diastolic and systolic blood pressure after two and six months, respectively (p<0.05).(61)
Black Cumin Seeds (Nigella sativa)
Nigella sativa (Ranunculaceae) has a long history of use in folk medicine as a diuretic and hypotensive agent. In an animal study, an oral dose of either Nigella sativa extract (0.6 mL/kg/day) or furosemide (5 mg/kg/day) significantly increased diuresis by 16- and 30 percent, respectively, after 15 days of treatment. In the same rat study, a comparison between Nigella sativa and nifedipine found mean arterial pressure decreased by 22- and 18 percent in the Nigella sativa and nifedipine treated rats, respectively.(62)
The essential oil of Nigella sativa seed has an antioxidant property that makes it useful in treating cardiovascular disorders. Active constituents of Nigella sativa are thymoquinone, dithymoquinone, thymohydroquinone, thymol,(63) carvacrol, t-anethole and 4-terpineol. Hypotensive action of Nigella is mainly due to its volatile oils. An animal study found the volatile oil has the potential of being a potent, centrally acting antihypertensive agent.(64) Thin-layer chromatography (TLC) has confirmed Nigella's antioxidant properties.(65)
Forskolin (Coleus forskohlii)
Coleus forskohlii has been used in Ayurvedic medicine for many years. In 1974 the Indian Central Drug Research Institute discovered that forskolin, a component of this plant, has hypotensive and antispasmodic action. Forskolin's blood pressure lowering effects appear to be due to relaxation of arterial vascular smooth muscle. In a study with isolated heart tissue, forskolin activated membrane-bound adenylatecyclase and cytoplasmic cAMP-dependent protein kinase. The researchers postulated the positive inotropic effect was via an enhanced calcium uptake by the heart muscle cell.(66) Another constituent from Coleus, ditermene coleonol, has been found to lower blood pressure in both rat and cat models.(67)
Indian Snakeroot (Rauwolfia serpentina)
Rauwolfia is cultivated for the medicinal use of its 30 alkaloids (particularly reserpine found in the root), many used in treating hypertension.(68) Besides reserpine, other alkaloids used in hypertension and other cardiac disorders are ajmaline, rescinnamine, serpentinine, sarpagine, deserpidine, and chandrine. Rauwolfia alkaloids work by controlling nerve impulses along certain pathways that affect heart and blood vessels, lowering blood pressure. Rauwolfia depletes catecholamines and serotonin from nerves in the central nervous system.(69) In a controlled intervention trial, 389 subjects, ages 21-55 years, with diastolic blood pressures 90-115 mm Hg were examined for 7-10 years. Subjects were randomly assigned to either a combination of a diuretic and Rauwolfia serpentina, or an identical placebo. Diastolic blood pressure was reduced an average of 10 mm Hg and systolic by16 mm Hg in the active treatment group, with no change in the placebo group.(70)
The Rauwolfia constituent ajmaline not only lowers blood pressure, but also has a potent antiarrhythmic effect. Studies have shown that ajmaline specifically depresses intraventricular conduction, suggesting this would be particularly effective in the treatment of re-entrant ventricular arrhythmias.(71,72)
In one study of 100 patients with essential hypertension, it was determined that serum cadmium levels were 43-percent higher and serum zinc levels 28-percent lower in hypertensives when compared with normotensive controls. When the patients were put on ajmaloon, a preparation from Rauwolfia serpentina, blood pressure was lowered significantly. It also appeared to decrease the elevated serum cadmium levels in these individuals.(73)
Garlic (Allium sativum)
Garlic is eaten in Asia, the Middle East, and in many other cultures on a daily basis. It is an ancient home remedy that has been used for many different purposes, including hypertension, and reduces a number of risk factors associated with cardiovascular disease including: 1) reducing total and LDL-cholesterol, 2) increasing HDL-cholesterol, 3) lowering triglycerides and fibrinogen, 4) lowering blood pressure, 5) improved circulation, 6) enhancing fibrinolysis, 7) inhibition of platelet aggregation, and 8) reducing plasma viscosity. The blood pressure effect is thought to be due to an opening of (Ca) ion channels in the membrane of vascular smooth muscle, affecting hyperpolarization, resulting in vasodilation.(74) A garlic preparation containing 1.3-percent allicin at a large dose (2400 mg) was evaluated in an open-label study in nine severely hypertensive patients (diastolic blood pressure 115 mm Hg or greater). Approximately five hours after taking the garlic, the systolic blood pressure fell an average of 7 mm Hg while diastolic BP dropped an average of16 mm Hg. A significant decrease in diastolic blood pressure lasted from 5-14 hours after the dose and no significant side effects were reported.(75)
Lifestyle change, including diet, exercise, and stress management, may contribute significantly to lowering of blood pressure. Supplements such as potassium, magnesium, CoQ10, omega-3 fatty acids, amino acids L-arginine and taurine, and vitamins C and E have been effectively used in the treatment of cardiovascular disease, including hypertension. Botanicals have been used for centuries to treat various diseases including cardiovascular disorders. It is no surprise they have proven effective in lowering blood pressure and improving heart function. Among the most researched and frequently utilized for hypertension are hawthorne, Terminalia arjuna, olive leaf, European mistletoe, yarrow, black cumin seeds, forskolin, Indian snakeroot, and garlic. More research is indicated to determine the full potential that alternative medicine has to offer in the management of hypertension. With the increasing numbers of patients suffering from hypertension and conventional medicine failing to effectively control the problem, alternative therapies offer hope.
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Sodium Induces Hypertrophy of Cultured Myocardial Myoblasts and Vascular Smooth Muscle Cells
(The following study may be a great reason to cut down on sodium when trying to lower blood pressure)
Jian-Wei Gu; Vivek Anand; Eugene W. Shek; Michael C. Moore; Ann L. Brady; Whitney C. Kelly; ; Thomas H. Adair
From the Department of Physiology and Biophysics and Center for Excellence in Cardiovascular-Renal Research, University of Mississippi Medical Center (Jackson).
Correspondence to Dr Thomas H. Adair, Department of Physiology and Biophysics, University of Mississippi Medical Center, 2500 N State St, Jackson, Mississippi 39216-4505. E-mail firstname.lastname@example.org
AbstractThe mechanisms of sodium-induced myocardial hypertrophy and vascular hypertrophy are poorly understood. We tested the hypothesis that a high sodium concentration can directly induce cellular hypertrophy. Neonatal rat myocardial myoblasts (MMbs) and vascular smooth muscle cells (VSMCs) were cultured in a 50:50 mixture of DMEM and M199 supplemented with 10% fetal bovine serum. When the monolayers reached 80% confluence, normal sodium medium (146 mmol/L) was replaced with high sodium media (152 mmol/L, 160 mmol/L, and 182 mmol/L) for up to 5 days. Increasing sodium from a baseline concentration of 146 mmol/L to the higher concentrations for 5 days caused dose-related increases in cell mean diameter, cell volume, and cellular protein content in both MMbs and VSMCs. Increasing the sodium concentration by only 4% (from 146 mmol/L to 152 mmol/L) caused the following respective changes in MMbs and VSMCs: 8.5% and 8.7% increase in cell mean diameter, 27.6% and 27.0% increase in cell volume, and 55.7% and 46.7% increase in cellular protein content. The rate of protein synthesis, expressed as [3H]leucine incorporation, increased by 87% and 99% in MMbs after exposure to 152 mmol/L and 160 mmol/L sodium, respectively, compared with the 146-mmol/L sodium control group. Exposure of MMbs to medium with a sodium concentration of 10% above normal, ie, 160 mmol/L, caused a significant decrease (range, 26% to 44%) in the rate of protein degradation at multiple time points over a 48-hour period compared with normal sodium control cells. The increase in cellular protein content caused by 160 mmol/L sodium returned to normal within 3 days after MMbs were returned to a normal sodium medium. These findings support the hypothesis that sodium has a direct effect to induce cellular hypertrophy and may therefore be an important determinant in causing myocardial and/or vascular hypertrophy in subjects with increased sodium concentration in the extracellular fluid.
Amino Acid / Protein
Theanine (L-Theanine): High blood pressure is a feature of stress that can be lowered by lowering the stress. The simple act of drinking a cup of tea (which contains theanine) can lower blood pressure by forcing a person to slow down and relax.
Fish Oils: In a review of 36 clinical studies, just under 4gm of fish oil per day was associated with modest reductions in both systolic and diastolic pressure, especially if subjects were older and had hypertension. [Journal of Hypertens 2002;20(8): pp.1493-1499]
Gingko Biloba: One effect of Ginkgo extract is that of promoting vasodilation and blood flow.
Chlorella / Algae Products: Fifty-five subjects with fibromyalgia, 33 with hypertension, and 9 with ulcerative colitis consumed 10gm of pure chlorella in tablet form and 100mL of a liquid containing an extract of chlorella each day for 2 or 3 months. Daily dietary supplementation with chlorella was seen to reduce high blood pressure, lower serum cholesterol levels, accelerate wound healing and enhance immune functions. Researchers concluded that the potential of chlorella to relieve symptoms, improve quality of life, and normalize body functions in patients with fibromyalgia, hypertension, or ulcerative colitis suggests that larger, more comprehensive clinical trials of chlorella are warranted. [Altern Ther Health Med. 2001 May-Jun; 7(3): pp.79-91. Review]
Garlic: One study found that aged garlic extract at 7.2gm per day reduced total and LDL cholesterol, as well as systolic and diastolic blood pressure.
Noni: Research indicates that noni stimulates the immune system, regulating cell function and cellular regeneration of damaged cells. The fact that noni seems to operate on the very basic and critical cellular level may explain why it is useful for a wide variety of conditions. Limited animal studies have been done and some human cancer studies are underway. Most of the evidence for its use is anecdotal. Since many noni products are sold via multilevel marketing, some caution is necessary regarding exaggerated claims.
Mistletoe (Viscum album): Mistletoe is known to relieve pain from headaches caused by high blood pressure. Mistletoe reduces the heart rate, and at the same time strengthens the capillary walls. Its cardiotonic action is thought to be due to the lignans, while the hypotensive action is believed to be due to a choline derivative related to acetylcholine. Choline derivatives bring about parasympathetic stimulation and vasodilatation.
Stephania tetrandra: Stephania tetrandra is a Chinese medicinal herb also known as han-fang-chi or fen-fang-qi. In the Chinese Pharmacopoeia, the herb is recommended for treating general symptoms such as inflammation, fever, and pain; however, it also has been used extensively to manage water retention and edema, eliminate stagnant bronchial mucous, and detoxify. For the past 50 years, however, stephania has been used in China principally as an agent to control blood pressure. Although its use in humans has been limited to China, stephania has been studied in animal models in laboratories throughout the world, and many of its pharmacological properties are relatively well described.
Weight Loss: At least a half dozen controlled studies of patients with hypertension concluded that short-term weight loss is usually associated with a reduction of blood pressure. In patients who experienced a weight loss of 11.7 kg ( about 25.7 lbs), an average blood pressure reduction of -20.7/-12.7mm Hg was recorded. A similar study found that a decrease in blood pressure of -2.5/-1.5mm Hg per kilogram of reduction of weight, and further demonstrated a significant correlation between weight change and blood pressure change.
Raw Food Diet: In a study of 32 patients whose diets were changed to include 62% of calories from raw foods, their mean diastolic pressure reduction was 17mm Hg. This study was conducted over a period of 6 months. Of these patients, 28 were also overweight. [South Med J 1985 Jul;78(7): pp.841-4]
Increased Fruit/Vegetable Consumption: Fruit and vegetable consumption (minimum of five portions daily) was associated with modest reductions of systolic and diastolic blood pressures in a controlled study of 690 healthy people ages 25-64. [Lancet May 28, 2002]
Soy Isoflavones (genistein, daidzein): Soy milk consumption (about 2 cups twice per day) reduced systolic and diastolic blood pressure in a double-blind study of 40 men and women with mild to moderate hypertension, when compared to cow's milk. [J Nutr 2002;132(7): pp.1900-1902] The average systolic blood pressure was reduced 18.4mm Hg, diastolic 15.9mm Hg and mean blood pressure 16.7mm Hg. The mechanism of action may be independent of isoflavone content, as another study showed no blood pressure lowering benefits with the use of isoflavones alone.
Therapeutic Fasting: Fasting is a way to correct high blood pressure without drugs. Fasting will normalize blood pressure in the vast majority of cases; the blood pressure will remain low after the fast if a person follows a health-supporting diet and lifestyle.
High/Increased Fiber Diet: A study suggests that oatmeal can improve blood pressure and reduce drug costs for 60 million hypertensive Americans. The study found that 73% of participants, each of whom who ate oat cereal daily for 12 weeks, were able to reduce or eliminate their need for blood-pressure medication. Consumption of high-fiber cereals is an easy and simple way for a person to increase total and soluble fiber intakes, thus helping to reach the dietary fiber goal of 25-30gm per day. [Preventive Medicine in Managed Care; March 1, 2002]
Low Fat Diet: The DASH diet is rich in fruits, vegetables, and lowfat dairy foods and reduced in total and saturated fat . It also is reduced in red meat, sweets, and sugar-containing drinks. It is rich in potassium, calcium, magnesium, fiber, and protein. One month of a DASH (Dietary Approaches to Stop Hypertension) diet and reduced sodium intake were each associated with reduced blood pressure in untreated hypertension (systolic blood pressure of 120-160 mm and diastolic blood pressure of 80-95 mm. DASH diet plus reduced sodium intake produced the greatest reductions in blood pressure. [Ann Intern Med 2001;135(12): pp.1019-1028]
Coconut oil: that has been kept at room temperature for a year has been tested, and showed no evidence of rancidity. In animal studies, feeding unprocessed coconut and coconut oils prevented tumor development, both malignant or benign. It lowers cholesterol if it is high and raises it if it is too low. Coconut oil is anti-viral, anti-bacterial and anti-fungal in the originating plant, in our gut and in our blood. Reducing seed oil consumption and using coconut milk or coconut oil as the dietary staple is reversing viral loads in HIV, eliminating all types of herpes virus and reducing or preventing other viral diseases including the yearly 'flus' and measles. The antiviral effect seems to be against lipid-enveloped viruses and is due to the presence of lauric acid in coconut oil. It has been reported that coconut oil helps prevent weight-gain by stimulating the metabolism, but further evidence needs to be presented to support this claim. It is quickly metabolized, and functions in some ways as an antioxidant. Every study using natural, unprocessed coconut oil found a normalizing of cholesterol, blood sugar and blood pressure. This is also true of extra virgin olive oil, peanut oil and avocado oil. Within a week, abnormal cortisol levels show improvement indicating adrenal restoration using vitamin B1, B complex and coconut milk. Patients seem more awake, their mood, energy and memory improves, and sleep becomes more normal.
Vegetarian/Vegan Diet: Fact: only 20% of Americans eat at least the recommended 5 servings per day of fruits and vegetables. In it's statement of position on the vegetarian diet , the American Dietetic Association states:
"Scientific data suggest positive relationships between a vegetarian diet and reduced risk for several chronic degenerative diseases and conditions, including obesity, coronary artery disease, hypertension, diabetes mellitus, and some types of cancer. Vegetarian diets, like all diets, need to be planned appropriately to be nutritionally adequate." "It is the position of The American Dietetic Association (ADA) that appropriately planned vegetarian diets are healthful, are nutritionally adequate, and provide health benefits in the prevention and treatment of certain diseases."
Sugars Avoidance / Reduction
Cabbage Family Vegetables: Researchers put broccoli sprouts to the test and found that they contain high levels of glucoraphanin, also known as sulforaphane glucosinolate (SGS). In addition to being a cancer preventative, SGS boosts production of Phase 2 enzymes, which are part of the body's antioxidant system. This extra boost lowers blood pressure and the body's inflammatory response, leading to better cardiovascular health overall. Just 5 grams of broccoli sprouts contain concentrations of SGS equal to that found in 150 grams of mature broccoli.
Caffeine/Coffee Avoidance: An increased risk of developing hypertension was associated with drinking five or more cups of coffee per day in a large study of former white male medical students followed for an average of 33 years. [Arch Intern Med 2002;162(6): pp.657-662]
Olive Oil: The relationship between dietary fats and blood pressure is not definitively answered. However, evidence suggests that the multiple components of the Mediterranean diet, i.e. low saturated fatty acids (SFAs), high monounsaturated fatty acids (MUFAs), and carbohydrate, fiber, and micronutrient content have favorable blood pressure effects, and therefore that this diet is desirable for health. Dietary MUFAs may have a greater protective effect than initially realized. In 207 men without hypertension, 175 men with hypertension, 406 women without hypertension and 232 women with hypertension, the risk of hypertension was positively and independently associated with the intake of cooking oil polar compounds (read polyunsaturated oils), and inversely related to blood levels of monounsaturated fatty acids (read primarily olive oil). [Am JClin Nutr. 2003;78: pp.1092-1097] Examples of foods high in MUFA are olives, olive oil, canola oil, peanuts, peanut oil, almonds, pecans, hazelnuts, cashew nuts, macadamia nuts, pistachio nuts, and avocados.
Bromelain: While bromelain is considered to have very low toxicity, caution is advised when treating individuals with hypertension. One report has indicated that those with pre-existing hypertension might experience tachycardia following high doses of bromelain. [Hawaii Med J 1978;37: pp.143-146]
Conventional Drugs While hypertension may be controlled naturally, if you have very elevated pressure and are having trouble getting it down, prescription drug use may be necessary. When additional factors in your live change down the road, you can try tapering off your medication to see if it is still needed. It is best to do this with your doctor's help. The dangers of untreated hypertension are too great to ignore.
Hypertension is caused by a variety of factors, and different classes of drugs are used to treat these different factors. The main classes of hypertension drugs and the added benefits they can provide are listed below.
Diuretics (furosemide, hydrochlorothiazide, indapamide, others). Commonly referred to as water pills, diuretics reduce the amount of fluid in your body. They cause your kidneys to excrete more sodium in your urine than they would normally. The sodium takes with it water from your blood. This means there's a smaller volume of blood pushing through your arteries and, consequently, less pressure on your artery walls.
Beta blockers (atenolol, metoprolol, propranolol, others). Beta blockers primarily work by blocking the effects of certain adrenaline-related chemicals in your body, causing your heart to beat more slowly and less forcefully.
Angiotensin-converting enzyme (ACE) inhibitors (benazepril, enalapril, lisinopril, others). ACE inhibitors help relax your blood vessels by blocking the formation of a natural chemical inside your body that narrows blood vessels.
Angiotensin II receptor blockers (ARB) (candesartan, irbesartan, losartan, others). ARBs act in a manner similar to ACE inhibitors, but they block the action of the chemical instead of the formation of the chemical.
Calcium channel blockers (calcium antagonists) (amlodipine, diltiazem, nifedipine, verapamil, others). These medications help relax blood vessel muscles. Some slow your heart rate.
Each of these classes may have additional benefits which will help your doctor select the one that is the most appropriate for you.
GHB (Gamma-Hydroxybutyrate) GHB should be avoided in cases of severe hypertension.
Biofeedback: One device that could be considered using feedback methods has been proven to lower blood pressure through changing breathing habits. Information about RESPeRATE can be found here. RESPeRATE is the first and only non-drug medical device clinically proven to lower high blood pressure with no side effects. It provides you with a new option for lowering blood pressure, and can be safely used along with your current medication(s) and lifestyle modifications such as diet and exercise.
Aerobic Exercise: Postmenopausal women with hypertension who walked 3km per day experienced an 11 point drop in systolic blood pressure over 6 months. [Med Sci Sports Exerc 2001;33(11): pp.1825-1831]
Salt Intake Reduction: If you have high blood pressure, reducing the level of salt in your diet may reduce your blood pressure. In some people with mild high blood pressure this could free them from blood-pressure-lowering medications entirely. In people with marked high blood pressure, it should mean that a reduction in medications is possible. If you are taking medication for high blood pressure, particularly diuretics, let your doctor know that you are reducing your salt intake. Salt restriction is recommended for those individuals with hypertension who are "salt-sensitive" or are prone to retaining sodium, gaining weight, and developing a rise in blood pressure as a result of a high-salt diet. Those who are "salt-resistant", on the other hand, do not experience change in weight or blood pressure on either high- or low-salt diets. For the salt-sensitive population, extreme amounts of salt restriction are not needed for improvement of blood pressure. Several studies have shown that diets containing 1600 to 2300mg of sodium per day are associated with average reductions in systolic pressure of -9 to -15mm Hg and in diastolic pressure of -7 to -16mm Hg in salt-sensitive individuals. Thus, salt restriction in this range is recommended in the dietary management of most individuals with hypertension. However, for those who like salt, it was found in a review of many studies, that the degree of reduction in sodium intake and change in blood pressure were NOT related. This review included a total of 2,326 normotensive people, 387 with untreated hypertension and 801 being treated for hypertension [BMJ 2002;325(7365): pp.628-632]. So you may not have to limit salt strictly, but you will need to experiment to find out if, and to what degree, you are sensitive.
Potassium: The blood pressure lowering effect of supplemental potassium may be greater in patients receiving a high-salt diet. The amount of dietary potassium required to achieve this effect is, however, not easily obtained.
Calcium: Calcium is found in foods such as dairy products, dark-green leafy vegetables, sea vegetables, canned salmon, sardines, tofu and sesame seeds. There is twice as much calcium in a cup of spinach as in a cup of milk. Inorganic calcium forms (calcium sulfate, calcium phosphate and calcium carbonate) are poorly absorbed. Organic forms have better absorption rates which can run anywhere from 25% to as high as 95%. Calcium orotate (90 to 95% absorbed) is the best, closely followed by calcium aspartate (85% absorbed). However, these are not only the most expensive, but they're also the harder to find. That means they may not be an option for many people. Another good one is calcium ascorbate, which also provides vitamin C as the other part of the molecule, along with the fact that it's no longer an acidic form of vitamin C. The amino acid chelates (65-80% absorption) are still fairly expensive, and not as easily found (though easier than the preceding two). These are probably the best compromise if you're willing to spend just a bit more. The best compromise of price, percentage of elemental calcium, and absorption would probably be calcium citrate. The absorption is 30 to 35%, and the citric acid reduces the amount of stomach acids required for absorption. For most people, calcium citrate would be the most reasonable choice.
Calcium Content of Foods (mg per 100 g/3.5 oz portion)
Human Breast Milk
Beans (can: pinto, black)
Beet greens (cooked)
Swiss Chard (raw)
Collards (raw leaves)
Kale (raw leaves)
Kale (cooked leaves)
Lettuce (light green)
Lettuce (dark green)
Molasses (dark-213 cal.)
Mustard Green (raw)
Mustard Green (cooked)
Okra (raw or cooked)
Peanuts (roasted & salted)
Sweet Potatoes (baked)
Turnip Greens (raw)
Turnip Greens (boiled)
Magnesium: In a double-blind, placebo-controlled trial, it was demonstrated that oral magnesium resulted in a significant dose-dependent reduction of systolic and diastolic blood pressure. A mean reduction of 6mm Hg in diastolic pressure in patients with hypertension results in approximately 10% lower risk of coronary artery disease, and a 40% reduction in risk of strokes. When magnesium levels are low, more calcium flows into the vascular muscle cells, which contracts them - leading to tighter vessels and higher blood pressure. Adequate magnesium levels prevent this.
Increased Salt Consumption
CoQ10 (Ubiquinone): Eighty-three hypertensive patients were treated with either coenzyme Q10 (60mg bid with 150IU of vitamin E) or placebo with vitamin E. The coQ10 treated group experienced an average reduction in systolic blood pressure of 17.8mm without any significant side effects. [S Med J, November 2001;94(l]): pp.1112-1117]
Acupuncture: A doctor Arabinda Das, MD reported using acupuncture points LIV-3, SP-9 and GB-34 bilaterally. After 2-3 visits he sutured the points. He reported immediate and lasting normalization of pressure in 80% of cases.[Townsend Letter for Doctors and Patients, Aug/Sept 2002; p.66]. A separate study suggests 12 treatments over a course of 6 weeks. It was found that acupuncture at the Heart otoacupoint produced marked immediate depressor effects, with a short-term effective rate of 100% and long-term effective rate of 63%. [Journal of Traditional Chinese Medicine, 1992 Jun, 12(2): pp.133-6 ]
Calming / Stretching Exercises: The relaxation and exercise components of yoga have a major role to play in the treatment and prevention of high blood pressure. A combination of biofeedback and yogic breathing and relaxation techniques has been found to lower blood pressure and reduce the need for high blood pressure medication. In 20 patients with high blood pressure who practiced biofeedback and yoga techniques, 5 were able to stop their blood pressure medication completely, 5 were able to reduce significantly the amount of medication they were taking, and another 4 experienced lower blood pressure at the end of the 3 month study.
Bioflavonoids: Researchers reported that consuming dark chocolate and cocoa improves the function of blood vessels. In one study, consumption of cocoa in healthy volunteers, aged 18 to 77, resulted in significantly improved vascular responsiveness. The measure the researchers used looked at the "stiffness" of blood vessels. In patients whose blood vessels that are "stiff," hypertension is common. The beneficial effect was most pronounced in patients over 50 years of age and was due to the high flavonoid (polyphenol) content of dark chocolate. In a second study, after volunteers ate 100 grams (3.5 ounces) of dark chocolate vascular responsiveness was again significantly improved. Investigators postulate that it is the flavonoids in chocolate that causes vascular improvement. Dark chocolate contains more flavonoids than lighter chocolate - and adding milk to chocolate (milk chocolate) inhibits the absorption of flavonoids. Any benefit gained by eating chocolate may be limited to dark chocolate (and cocoa). These short-term studies demonstrated an immediate benefit, but it remains to be proven if there will be a long-term benefits. Polyphenols are a broad class of phytochemical compounds, to which flavanols belong. [JAMA, August 27, 2003]
Vitamin C (Ascorbic Acid): A 1999 study found that in systolic and diastolic hypertension as well as elevated pulse rate, blood plasma vitamin C levels were reduced. 30 adults with adult onset diabetes experienced reduced blood pressure and improved arterial stiffness with 500mg of vitamin C per day. [Hypertension 2002;40(6): pp.804-9]. However, vitamin C at 50mg or 500mg had no effect on blood pressure in a controlled study of 439 Japanese patients. These patients had atrophic gastritis. [Hypertension 2002;40(6): pp.797-803]
Summaries of the latest research concerning the treatment of hypertension
Olive oil lowers blood pressure
NAPLES, ITALY. Several studies have shown that replacing saturated fat with unsaturated fat in the diet can help lower blood pressure in hypertensive individuals. Research has shown that some unsaturated fats (oils) are more effective in lowering blood pressure than others. Fish oils containing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), for example, have been found quite effective in lowering both blood pressure and triglyceride levels. Now researchers at the University of Naples report that olive oil is also highly effective in lowering blood pressure.
Their one-year study involved 23 men and women with mild hypertension (systolic pressure less than 165 mm Hg and diastolic pressure less than 104 mm Hg at the start of the study). The participants were randomized into two groups. One group was told to add olive oil to their food after cooking while the other group was told to add sunflower oil (a rich source of linoleic acid). Men added 40 grams/day (approx. four spoonfuls) and women added 30 grams/day (approx. three spoonfuls) to arrive at a diet containing 8368 kJ and 6276 kJ respectively. The overall composition of the diet was 17 per cent protein, 57 per cent carbohydrates, and 26 per cent fat.
The participants' blood pressures were measured every two months. After six months the average systolic blood pressure in the olive oil group had dropped to 127 mm Hg from the 134 mm Hg recorded at the start and the diastolic pressure had dropped from 90 mm Hg to 84 mm Hg. There were no significant changes in the sunflower oil group.
The level of antihypertensive medication was adjusted during the experiment by a separate group of doctors who did not know which diet their patients were following. The ones in the olive oil group were able to reduce their medication use by an average 48 per cent and eight of them were able to discontinue their medications completely. None of the ones in the sunflower oil group were able to discontinue their medications and the average reduction in medication usage was only 4 per cent.
The researchers conclude that a reduction in saturated fat intake combined with the increased use of extra-virgin olive oil lowers the need for antihypertensive medication. They speculate that the high content of polyphenols in olive oil may be a major factor in its beneficial effects.
Ferrara, L. Aldo, et al. Olive oil and reduced need for antihypertensive medications. Archives of Internal Medicine, Vol. 160, March 27, 2000, pp. 837-42
Fish oil supplementation reduces blood pressure
CINCINNATI, OHIO. Conventional blood pressure lowering medications often have detrimental effects on quality of life and may lead to unfavourable changes in cholesterol levels. Several studies have found that supplementation with large amounts of fish oil (5-15 grams/day) lowers blood pressure significantly in hypertensive individuals. Whether smaller amounts are equally effective has been open to question.
Researchers at the University of Cincinnati (Ohio) College of Medicine now report that daily supplementation with low doses of fish oil is indeed effective in lowering blood pressure in mildly hypertensive patients. Their study involved 33 patients (men and women) with a diastolic pressure between 90 and 104 mm Hg. After a four-week wash-out period during which the participants discontinued all medications the patients were randomly allocated to one of two groups. Group 1 supplemented with 2.04 grams/day of fish oil containing 410 mg of eicosapentaenoic acid and 285 mg of docosahexaenoic acid. Group 2 was given a placebo capsule daily containing safflower oil (80% linoleic acid). After 12 weeks and a four-week wash- out period the groups switched supplementation so that group 1 now received the placebo. Blood pressure, heart rate, and body weight were recorded at two-week intervals during the study and blood samples were collected and analyzed at the beginning and end of each treatment period.
The researchers found that fish oil supplementation reduced diastolic pressure (sitting) by an average of approximately 4.4 mm Hg and systolic pressure by an average of 6.5 mm Hg when compared to values obtained prior to the start of treatment. There were no adverse effects on cholesterol levels. They conclude that fish oil supplementation is a safe and effective way of lowering blood pressure in mildly hypertensive subjects, but noted that the beneficial effects wear off relatively quickly once supplementation is discontinued. NOTE: This study was funded by a grant from RP Scherer Ltd. a manufacturer of fish oil products.
Radack, Kenneth, et al. The effects of low doses of n-3 fatty acid supplementation on blood pressure in hypertensive subjects. Archives of Internal Medicine, Vol. 151, June 1991, pp. 1173- 80
Salt restriction and fish oil supplementation lower blood pressure
ADELAIDE, AUSTRALIA. Salt (sodium) restriction can help lower blood pressure in people with hypertension, but is less effective in people with normal pressure. Blood pressure tends to rise with age and there is some evidence that sodium restriction may help reduce this age-related increase. Fish oil supplementation is also effective in lowering blood pressure in hypertensive individuals, but its effect on people with normal pressure is unclear.
Australian researchers report that a combination of fish oil supplementation and salt restriction is highly effective in lowering both systolic and diastolic blood pressure in elderly people with normal pressures. Their study involved 50 healthy volunteers aged 60 to 80 years whose mean initial systolic and diastolic blood pressures were 133 and 77 mm Hg respectively. The participants were randomly assigned to one of four groups. Group 1 supplemented with 8 fish oil capsules per day (providing 4.2 g of omega-3 fatty acids) while maintaining a normal sodium intake. Group 2 supplemented with fish oil while consuming a low-sodium diet. Group 3 supplemented with sunflower oil combined with normal sodium intake while group 4 took sunflower oil while consuming a low-sodium diet. After 4 weeks the mean systolic blood pressure in group 1 had decreased by 8.9 mm Hg and the diastolic pressure by 6.0 mm Hg. There were no significant changes in blood pressure in the group supplementing with fish oil while maintaining a normal sodium intake. The researchers conclude that sodium restriction combined with fish oil supplementation effectively lowers blood pressure. They suggest that this finding may be of particular relevance in the treatment of hypertension in the elderly.
Cobiac, Lynne, et al. Effects of dietary sodium restriction and fish oil supplements on blood pressure in the elderly. Clinical and Experimental Pharmacology and Physiology, Vol. 18, 1991, pp. 265-68
Controlled trials confirm blood pressure reduction with fish oils
BOSTON, MASSACHUSETTS. Numerous studies have concluded that fish oil consumption lowers blood pressure, but a few have found no effect and others have been inconclusive. Researchers at the Harvard Medical School have just completed a major evaluation of the results of 31 placebo-controlled trials involving 1356 subjects. They found that fish oil supplementation (mean dose of 5.6 grams/day) lowers systolic blood pressure (first [highest] reading of blood pressure measurement) by an average of 3.4 mm Hg and diastolic pressure (second [lowest] reading) by an average of 2.0 mm Hg. The effect is highly dose-dependent with 1 gram/day of fish oil lowering systolic pressure by an average of 0.66 mm Hg and diastolic pressure by an average of 0.35 mm Hg. Fish oil supplementation does not affect blood pressure in people with normal blood pressure, but relatively dramatic effects are seen in patients with high cholesterol levels and in patients with atherosclerosis. Both eicosapentaenoic and docosahexaenoic acids (the main components of fish oils) are effective in blood pressure reduction with docosahexaenoic acid being slightly superior. The Harvard researchers conclude that supplementation with 7.7 to 9 grams/day of fish oils will reduce systolic blood pressure by 4 mm Hg and diastolic pressure by 3 mm Hg in hypertensive individuals. Blood pressure reductions may be substantially larger among patients with atherosclerosis or high cholesterol levels.
Morris, Martha Clare, et al. Does fish oil lower blood pressure? A meta-analysis of controlled trials. Circulation, Vol. 88, No. 2, August 1993, pp. 523-33
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Vitamin C combats hypertension
BOSTON, MASSACHUSETTS. There is increasing evidence that free radicals (reactive oxygen species) play a significant role in essential hypertension (high blood pressure). Now researchers at the Boston University School of Medicine report that daily supplementation with vitamin C (ascorbic acid) can significantly reduce blood pressure in people suffering from hypertension. Their randomized, placebo-controlled study involved 39 patients (average age of 49 years) 29 of whom were taking antihypertensive medication.
The study participants had diastolic blood pressure between 90 and 110 mm Hg and did not suffer from diabetes, coronary artery disease or heart failure. They also did not take estrogens or antioxidants within one month of the start of the study. After fasting overnight the patients had their blood pressures (systolic, mean, and diastolic) measured and had urine and blood samples collected. The measurements were repeated two hours after receiving a 2-gram oral dose of ascorbic acid or placebo and again after 30 days of oral supplementation with 500 mg/day of ascorbic acid or placebo.
The researchers found that blood pressures were similar at baseline and after the acute treatment (2-gram dose). At the end of the 30-day period, however, the average systolic pressure in the vitamin C group had decreased from 155 mm Hg to 142 mm Hg and the mean pressure had decreased from 110 to 100 mm Hg. No changes were observed in the placebo group. The average diastolic pressure in the vitamin C group also decreased, but the difference from the placebo group was not statistically significant. Blood plasma levels of ascorbic acid increased significantly in the vitamin C group during the study; from 50 micromol/L to 149 micromol/L two hours after ingesting the 2-gram dose and levelling out at 99 micromol/L at the end of the 30-day test period. The researchers conclude that oral supplementation with 500 mg/day of ascorbic acid is useful for blood pressure control in patients with high blood pressure.
Duffy, Stephen J., et al. Treatment of hypertension with ascorbic acid. The Lancet, Vol. 354, December 11, 1999, pp. 2048-49 (research letter)
Beta-blockers may be a poor choice as an antihypertensive medication for patients who engage in vigorous exercise
ALBUQUERQUE, NEW MEXICO. This review of the effect of blood-pressure-lowering drugs on exercise performance found that the converting enzyme inhibitors, calcium channel blockers, and alpha blockers have the least potential for adverse effects. Beta-blockers and the CCB, verapamil, were found to impair left ventricular function during exercise. The CCB's nifedipine and diltiazem preserved myocardial contractility better while other antihypertensive agents had negligible effects. Beta-blockers and CCB's (verapamil and diltiazem) have mild antiarrhytmic properties and may provide some protection against ventricular tachycardia. Beta-blockers however, reduce time to exhaustion - nonselective beta-blockers to a greater extent than selective beta-blockers.
Chick, Thomas W., et al. The effect of antihypertensive medications on exercise performance: a review. Medicine and Science in Sports and Exercise, Vol. 20, No. 5, October 1988, pp.447- 52
Cigarette smoking may interfere with treatment of hypertension
MIAMI, FLORIDA. A comparative study of the efficacy of propranolol and hydrochlorothiazide in treatment of hypertension was analyzed to determine if patients who were non-smokers reacted differently than did smokers. The study involved 105 smokers, 81 former smokers, and 147 who never smoked. It was found that smokers responded less to propranolol than did non-smokers; however, further stratification of the data showed that most of the effect was attributable to black patients. A similar trial involving nadolol and bendroflumethiazide showed no difference between smokers and non-smokers in their response to nadolol. This study involved 96 smokers and 187 non-smokers.
Materson, Barry J., et al. Cigarette smoking interferes with treatment of hypertension. Archives of Internal Medicine, Vol. 148, No. 10, October 1988, pp. 2116-19
Potassium proves effective in lowering blood pressure
NAPLES, ITALY. Researchers at the University of Naples have concluded a one-year trial to determine if an increased potassium intake decreases the need for anti-hypertensive medication. A group of 54 patients who were all controlling their high blood pressure with medication participated in the study. Half of the group maintained their regular diet while the diet of the other half was modified to increase the amount of potassium-rich food. The extent of the dietary modification was such that the sodium to potassium ratio was 1:1 rather than the customary 3.5:1. At the end of the trial period the group on the high potassium diet consumed less medication than the other group and 38% of them had discontinued medication altogether. The group on the potassium-rich diet also reported a significant (55%) reduction in symptoms related to their hypertension. NOTE: Increasing potassium intake may be dangerous when taking certain diuretics such as spironolactone.
Supplemental dietary potassium reduced the need for antihypertensive drug therapy. Nutrition Reviews, Vol. 50, No. 5, May 1992, pp. 144-5
Fish oils reduce blood pressure
BALTIMORE, MARYLAND. The daily consumption of fish oils (omega-3 polyunsaturated fatty acids) can significantly lower blood pressure in people suffering from hypertension. The benefit of the fish oils is comparable to that obtainable by sodium reduction and weight loss. A group of medical researchers at the Johns Hopkins Medical School evaluated the results of 17 clinical trials involving supplementation with fish oils for periods of three months or less. They found that the consumption of 3 grams per day of fish oil (6-10 capsules) or more led to impressive reductions in the blood pressure of hypertensive individuals. Systolic pressure was lowered by an average of 5.5 mm Hg and diastolic pressure was lowered by 3.5 mm Hg. The effect was found to be more pronounced at higher blood pressures and no significant effects were noted in people with normal blood pressure. Twenty-eight percent of the participants in the trials reported side effects such as a fishy taste or belching. The doctors suggest that fish oil supplementation may be a valuable therapy in patients with borderline hypertension who would otherwise be candidates for conventional drug therapy. They point out that the effects of long term (> 3 months) supplementation are unknown and that lower dosages than 3 g/day may be desirable and perhaps as effective. NOTE: Systolic pressure is the first (highest) reading given for a blood pressure measurement, diastolic is the second (lowest) reading, i.e. 120/80.
Appel, Lawrence J., et al. Does supplementation of diet with "fish oil" reduce blood pressure? Archives of Internal Medicine, Vol. 153, June 28, 1993, pp. 1429-38
Vitamin C lowers blood pressure
AUGUSTA, GEORGIA. Researchers at the Medical College of Georgia have confirmed that people with a high vitamin C concentration in their blood have lower blood pressures than do people with little vitamin C. They tested 168 healthy people, 56 of which were taking supplements containing ascorbic acid. Among their findings: plasma ascorbic acid levels were 11% higher in supplement users than in non-users; both diastolic and systolic blood pressure were about 5 mm lower in people having a high plasma level of vitamin C than in people having a low level. Blood levels of selenium, vitamin A and vitamin E were not found to affect blood pressure, but both obesity and smoking had a significant adverse effect.
Moran, John P., et al. Plasma ascorbic acid concentrations relate inversely to blood pressure in human subjects. American Journal of Clinical Nutrition, Vol. 57, March 1993, pp. 213-17
Magnesium supplement lowers blood pressure
ROTTERDAM, THE NETHERLANDS. A double-blind controlled trial was recently carried out by Dutch and Belgian researchers in order to determine if oral supplementation with magnesium is an effective way of lowering blood pressure in women suffering from mild to moderate hypertension. Their experiment involved 91 women between 35 and 77 years of age who did not take anti-hypertensive medication. All the women had a systolic blood pressure between 140 and 185 mm Hg and a diastolic pressure between 90 and 105 mm Hg. After a two-week period where all subjects received a placebo, the participants were randomly assigned to two groups. One group continued to receive the placebo while the other group received 485 mg per day of magnesium aspartate-HCl. Both the placebo and the magnesium supplement were supplied in the form of four packets of water-soluble powder per day to be taken with meals. At the end of the six-month trial period the systolic blood pressure in the magnesium supplementation group had decreased by 2.7 mm Hg and the diastolic pressure by 3.4 mm Hg when compared to the placebo group. The researchers conclude that oral supplementation with magnesium aspartate- HCl may be effective in lowering blood pressure in people suffering from mild to moderate hypertension who are not taking anti-hypertensive drugs.
Witteman, Jacqueline C.M., et al. Reduction of blood pressure with oral magnesium supplementation in women with mild to moderate hypertension. American Journal of Clinical Nutrition, Vol. 60, July 1994, pp. 129-35
Natural mineral salt lowers blood pressure
ROTTERDAM, THE NETHERLANDS. Medical researchers at the Erasmus University Medical School have discovered a natural mineral salt which significantly lowers blood pressure in people suffering from mild to moderate hypertension. The salt, "SagaSalt" (Akzo Nobel, Netherlands) occurs naturally in Iceland and contains 41 per cent sodium chloride, 41 per cent potassium chloride, 17 per cent magnesium salts and 1 per cent trace minerals. The researchers tested the salt in a randomized double blind placebo controlled trial involving 100 men and women aged 55 to 75 years. The participants had systolic blood pressures between 140 and 200 mm Hg or diastolic pressures between 85 and 100 mm Hg. Half the group used the mineral salt in food preparation and at the table while the other half used common table salt (sodium chloride). Blood pressures were measured at the start of the experiment and after 8, 16 and 24 weeks. After eight weeks the average blood pressure in the mineral salt group had fallen significantly. The systolic blood pressure (mean of measurement at weeks 8, 16 and 24) fell by 7.6 mm Hg and the diastolic pressure by 3.3 mm Hg in the mineral salt group as compared with the control group. After 24 weeks all participants went back to using common table salt and at week 25 there was no longer any difference in blood pressures between the two groups. The researchers conclude that replacing common table salt with a low sodium, high potassium, high magnesium mineral salt is an effective way of lowering blood pressure in older people suffering from mild to moderate hypertension. NOTE: Systolic pressure is the first (highest) reading given in a blood pressure measurement, diastolic is the second (lowest) reading, i.e. 120/80
Geleijnse, J.M., et al. Reduction in blood pressure with a low sodium, high potassium, high magnesium salt in older subjects with mild to moderate hypertension. British Medical Journal, Vol. 309, August 13, 1994, pp. 436-40
Calcium combats high blood pressure
PORTLAND, OREGON. Researchers at the Oregon Health Sciences University have just published a major overview on the current knowledge concerning the effect of dietary minerals on high blood pressure. They conclude that the effect of sodium intake on blood pressure is still not clear. It may be that only a subset of people with a genetic defect are sensitive to salt intake. The chloride ion in itself does not seem to increase blood pressure, but when combined with sodium it does cause hypertension in salt-sensitive individuals. A four-year study of 60,000 nurses concluded that women who have a calcium intake of 800 mg/day or more have a 23 per cent lower risk of developing high blood pressure than women with an intake of 400 mg/day or less. The benefits of calcium are even greater among pregnant women. Controlled trials have found that women who consume between 1500 - 2000 mg/day of calcium reduce their risk of developing pregnancy-induced hypertension by as much as 50 per cent. It has also been shown that maternal calcium intake directly affects the infant's blood pressure. Women with a high calcium intake gave birth to babies with higher birth weights and lower blood pressures. This lower pressure persisted throughout at least the first five years of life. The effect of potassium on blood pressure is still being actively investigated. One trial found that a 50 per cent increase in potassium from natural foods lowered blood pressure and dramatically reduced the need for blood pressure-lowering drugs. Another trial found that supplementation with potassium lowered blood pressure by 10 - 14 mm Hg. Several studies suggest that a low magnesium intake is associated with hypertension, stroke, and ischemic heart disease. It has been proposed that supplementation with about 900 mg/day of magnesium, about 2.5 times the RDA, is required in order to effectively lower blood pressure. (71 references)
Reusser, Molly E. and McCarron, David A. Micronutrient effects on blood pressure regulation. Nutrition Reviews, Vol. 52, No. 11, November 1994, pp. 367-75
Fish oils recommended for diabetes and hypertension
TROMSO, NORWAY. Fish and fish oils help protect against the development of atherosclerosis and heart disease. It is believed that fish oils exert their protective effect by lowering blood pressure and the levels of triglycerides and very-low-density lipoprotein (VLDL). Fish oils are also believed to reduce platelet aggregation and to suppress the growth of smooth-muscle cells in the arterial walls. Many people with hypertension also suffer from diabetes and there has been concern that fish oil supplementation may aggrevate problems with glucose intolerance. Researchers at the University of Tromso now report that fish oil supplementation lowers blood pressure significantly in people with hypertension and has no effect on glucose control even in people with mild diabetes. The study involved 78 obese volunteers with essential hypertension. The participants were randomly assigned to one of two equal-sized groups. The fish oil group received four fish oil capsules a day (containing a total of 3.4 grams of a mixture of eicosapentaenoic acid and docosahexaenoic acid) for a period of 16 weeks. The control group received four corn oil capsules a day. At the end of the test period the average (mean) systolic blood pressure had dropped by 4.4 mm Hg and the diastolic pressure by 3.2 mm Hg in the fish oil group. The average blood pressure in the control group did not change. The researchers also found that plasma triglyceride and VLDL levels in the fish oil group decreased significantly (by about 9 per cent) while they increased significantly (by about 12 per cent) in the control group. There were no changes in total or low-density-lipoprotein levels in either group. Extensive tests (oral glucose tolerance, hyperglycemic and hyperinsulemic clamps) were done to evaluate the effect of fish oil supplementation on glucose control. No adverse effects were found. An editorial accompanying the research report concludes that fish or fish oil is useful in the prevention of vascular disease in diabetics. Patients with diabetes should eat fish two to three times a week or, as an alternative, supplement with two to three one gram capsules of fish oil per day.
Toft, Ingrid, et al. Effects of n-3 polyunsaturated fatty acids on glucose homeostasis and blood pressure in essential hypertension. Annals of Internal Medicine, Vol. 123, No. 12, December 15, 1995, pp. 911-18
Connor, William E. Diabetes, fish oil, and vascular disease. Annals of Internal Medicine, Vol. 123, No. 12, December 15, 1995, pp. 950-52
Qigong effective in treatment of many illnesses
SAN FRANCISCO, CALIFORNIA. Qigong is an integral part of Traditional Chinese Medicine and has been used for over 3,000 years to improve health and achieve longer life. The types of qigong used for healing and health maintenance involve meditation, breathing exercises, and physical movements. It is estimated that 60 million Chinese practice qigong daily. Reports of long term scientific studies of the medical benefits of qigong are beginning to appear. Researchers at the Shanghai Institute of Hypertension recently released the results of a 30-year study of the benefits of qigong in combatting hypertension. Their investigation involved 242 patients with high blood pressure who were randomly assigned to one of two groups. One group of 122 patients, the qigong group, performed Yan Jing Yi Shen Gong for 30 minutes twice a day; the other group of 120 patients was used as a control group. Both groups received standard drug therapy to control blood pressure. At the end of the 30-year period 32.5 per cent of the members of the control group had died from a stroke compared to only 15.6 per cent in the qigong group. The researchers also found that the blood pressure of the qigong group stabilized over the study period whereas that of the control group kept increasing. Required dosages of anti-hypertensive drugs decreased for the qigong group and was completely eliminated for 30 per cent of the patients. Required drug dosages for members of the control group generally increased throughout the study period.
The regular practice of qigong has also been found to increase bone density in men, to reverse the unfavourable shift in the production of sex hormones caused in aging, to improve heart function, and to effectively combat many of the side effects of cancer. Studies have also shown that drug therapy combined with qigong exercises is more effective than drug therapy on its own.
Sancier, Kenneth M. Medical applications of qigong. Alternative Therapies, Vol. 2, No. 1, January 1996, pp. 40-46
Relaxation therapy controls high blood pressure
TAIPEI, TAIWAN. Hypertension (diastolic blood pressure of 90 mm Hg or higher or systolic pressure of 140 mm Hg or higher) is widespread in northern Taiwan. A recent survey found that 27.2 per cent of males and 13.6 per cent of females suffer from this condition. A team of researchers from the National Taiwan University and the University of Hawaii now reports that relaxation techniques, frequent blood pressure measurements, and educational techniques are all effective in controlling hypertension. Their experiment involved 590 patients. The patients were randomly asssigned to practise relaxation techniques at home, to have frequent, routine blood pressure measurements by health professionals, to read information packages about hypertension control or to receive no treatment (control group). The relaxation techniques involved one-on-one instruction sessions, taped messages of progressive relaxation procedures, and encouragement to perform Buddhist meditation. At the end of the two-month test period the average drop in systolic pressure in the relaxation group was 11 mm Hg and the drop in diastolic pressure was 4.7 mm Hg greater than in the control group. The patients who participated in the frequent blood pressure measurement program also lowered their pressure significantly as did the self-learning group. Almost 50 per cent of the members of the relaxation and self-learning groups achieved a drop in systolic pressure of 10 mm Hg or more and a drop in diastolic pressure of 5 mm Hg or more as a result of the program.
Yen, Lee-Lan, et al. Comparison of relaxation techniques, routine blood pressure measurements, and self-learning packages in hypertension control. Preventive Medicine, Vol. 25, No. 3, May/June 1996, pp. 339-45
Blood pressure drugs increase risk of heart attack
MALMOE, SWEDEN. It is generally accepted practice to treat people with high blood pressure with antihypertensive drugs in order to prevent heart attacks (myocardial infarctions). This despite the fact that clinical trials and recent population studies have both raised serious questions about the effectiveness of antihypertensive drugs in reducing the incidence of heart attacks. Nevertheless, the prescription of antihypertensive drugs for the prevention of heart attacks continues and there is an increasing trend to prescribe them for people having only a marginal elevation above normal. Now Swedish researchers report that treating elderly men who have a diastolic blood pressure less than 90 mm Hg with antihypertensive drugs increases their risk of having a heart attack by a factor of four. The study involved 484 Swedish men born in 1914. The men were first examined in 1969-70 and again in 1982-83. They were followed-up until December 31, 1992. In 1969-70 only about 3 per cent of the men were taking antihypertensive drugs, in 1982-83 over 23 per cent were doing so. Thirty-six men (13 per cent) with a diastolic pressure below 90 mm Hg were taking antihypertensive drugs while 231 men were not. During the follow-up period the incidence of heart attacks in the men taking antihypertensive drugs was 3.9 times greater than among the men not taking blood pressure medication. This significantly increased risk remained even when the data was adjusted for the presence of heart disease, diabetes, smoking, high cholesterol, etc. The risk of having a heart attack among men with a diastolic blood pressure greater than 90 mm Hg was twice as high among men taking antihypertensive drugs; however, this increased risk largely disappeared when other cardiovascular risk factors were taken into account. The researchers conclude that treating men with a diastolic blood pressure of 90 mm Hg or less with antihypertensive drugs significantly increases their risk of having a heart attack.
Merlo, Juan, et al. Incidence of myocardial infarction in elderly men being treated with antihypertensive drugs: population based cohort study. British Medical Journal, Vol. 313, August 24, 1996, pp. 457-61
Popular hypertension drug is dangerous
NEW ORLEANS, LOUISIANA. An international team of medical researchers strongly recommend that the use of short-acting nifedipine be abandoned as a treatment for emergencies involving hypertension. Nifedipine capsules have, over the past two decades, become a very popular treatment option in emergency situations brought on by high blood pressure. It is widely used in hospitals and doctors' offices to swiftly lower an excessively high blood pressure brought on by such conditions as renal failure and pregnancy-induced hypertension. The popularity of short-acting nifedipine has continued despite the fact that its use has been linked to serious adverse effects such as stroke, heart attacks, arrhythmias, fetal distress, uncontrollable fall in blood pressure, and even death. The drug has never been approved by the Food and Drug Administration (FDA) for use in hypertensive emergencies. It is often given in the form of sublingual capsules which the research team found to be next to useless unless swallowed. Apparently the drug is only absorbed in the intestine not in the mouth. The use of short-acting nifedipine for hypertensive emergencies was condemned as early as 1985 by the Cardiorenal Advisory Committee of the FDA. The committee concluded that the use of the drug should be abandoned because it is neither safe nor efficacious. The reseachers believe that the reason short-acting nifedipine is still being used to treat hypertensive emergencies is that the manufacturers of the drug have not informed physicians that it is highly dangerous. The research team points out that while the approval of a drug is usually rapidly brought to the attention of physicians, the denial of approval because of lack of efficacy or safety concerns is not. NOTE: The concerns about short-acting nifedipine does not apply to time-release versions of the drug (Procardia XL, Adalat CC).
Grossman, Ehud, et al. Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? Journal of the American Medical Association, Vol. 276, No. 16, October 23/30, 1996, pp. 1328-31
Sour milk reduces blood pressure
TOKYO, JAPAN. Calpis sour milk has been used traditionally in Japan for many years. It is prepared by fermenting skim milk with a starter culture containing Lactobacillus helveticus and Saccharomyces cerevisiae. The fermented milk contains about 0.7 billion L. helveticus and 2.5 million S. cerevisiae cells per milliliter. Researchers at the Kyorin University School of Medicine have discovered that Calpis sour milk is effective in lowering blood pressure in patients with hypertension. Their experiment involved 30 hypertensive patients, 26 of which were receiving antihypertensive medication such as calcium antagonists, beta-blockers, diuretics, and ACE inhibitors. Seventeen of the patients were fed 95 ml of Calpis sour milk daily for an eight-week period. The remaining 13 patients were given a placebo sour milk prepared by adding lactic acid to skim milk. At the end of the trial period the systolic blood pressure in the Calpis milk group had decreased by an average of 14.1 mm Hg and diastolic pressure by 6.9 mm Hg. No significant blood pressure changes were observed in the placebo group. The blood pressure decreases in the Calpis milk group remained four weeks after the end of treatment. The researchers conclude that daily supplementation with sour milk is a useful and practical way of reducing blood pressure in patients with hypertension. NOTE: This work was done in cooperation with Calpis Food Industry Co., the manufacturer of Calpis sour milk.
Hata, Yoshiya, et al. A placebo-controlled study of the effect of sour milk on blood pressure in hypertensive subjects. American Journal of Clinical Nutrition, Vol. 64, November 1996, pp. 767- 71
Potassium supplementation lowers blood pressure
BALTIMORE, MARYLAND. Researchers at the Johns Hopkins University School of Medicine have come out in favour of using supplementation with potassium in the treatment and prevention of hypertension (high blood pressure). A group of seven medical researchers reviewed 33 randomized, controlled supplementation trials involving over 2600 participants. They conclude that potassium supplementation is effective in lowering both systolic and diastolic blood pressure. The average observed decrease in hypertensive patients was 4.4 mm Hg and 2.5 mm Hg for systolic and diastolic pressure respectively. In people with normal blood pressure the observed decreases were 1.8 mm and 1.0 mm. The amount of elemental potassium used in the studies varied from 60 mmol (2.5 grams) to 120 mmol (5.0 grams) daily. Sixty mmol of potassium is equivalent to 4.5 grams of potassium chloride, 6 grams of potassium bicarbonate or 20 grams of potassium citrate. Oral potassium supplementation appeared to be well tolerated in all the studies examined. The researchers conclude that potassium supplementation "should be considered as part of recommendations for prevention and treatment of hypertension." Potassium supplementation is particularly important in people who are unable to reduce their intake of sodium.
Whelton, Paul K., et al. Effects of oral potassium on blood pressure. Journal of the American Medical Association, Vol. 277, May 28, 1997, pp. 1624-32
Combination diet lowers blood pressure
BALTIMORE, MARYLAND. High blood pressure (hypertension) is a major problem in the United States. It is estimated that 24 per cent of all American adults (about 43 million people) have high blood pressure, ie. systolic pressure greater than 120 mm Hg and diastolic pressure greater than 80 mm Hg. Among older adults the proportion of people with hypertension is substantially higher. It is clear that diet affects blood pressure. Vegetarians, for example, tend to have lower blood pressures than non-vegetarians. Now researchers at the Johns Hopkins Medical School report that a diet rich in fruits, vegetables and low-fat dairy products is highly effective in lowering blood pressure. Their study involved 459 adults with systolic blood pressures below 160 mm Hg and diastolic pressures between 80 and 95 mm Hg. For the first three weeks of the experiment the participants were fed a control diet typical of the average diet in the United States (high in fat, low in fruits, vegetables, and dairy products). They were then randomly assigned to three groups. One group continued on the control diet, another group consumed a diet similar to the control diet except it provided more fruits and vegetables and less sweets and snacks, and the third group received a combination diet with reduced amounts of fats and cholesterol and increased amounts of fruits, vegetables and low-fat dairy foods. The calorie content of all diets was identical as was the sodium content at about three grams per day. After eight weeks on the three diets the participants' blood pressures were again measured. The combination diet resulted in an average (mean) drop in systolic and diastolic blood pressure of 5.5 mm Hg and 4.0 mm Hg respectively when compared to the control diet. The fruits and vegetables diet (modified control diet) produced a drop in systolic and diastolic blood pressure of 2.8 mm Hg and 1.1 mm Hg respectively. The reduction in blood pressure began to take effect within two weeks and was maintained for the next six weeks. The combination diet provided a daily intake of saturated fat of seven per cent of energy, a potassium intake of 4.4 g/day, magnesium 480 mg/day, and calcium 1265 mg/day. In contrast, the control diet provided a saturated fat intake equalling 14 per cent of energy, potassium 1.89 g/day, magnesium 176 mg/day, and calcium 443 mg/day. The researchers conclude that the combination diet may help reduce blood pressure and could serve as an effective alternative to drug therapy in people with mild (stage 1) hypertension.
Appel, Lawrence J., et al. A clinical trial of the effects of dietary patterns on blood pressure. New England Journal of Medicine, Vol. 336, April 17, 1997, pp. 1117-24
L-arginine and heart disease
STANFORD, CALIFORNIA. The inside of blood vessels are lined with a layer of single cells called the endothelium. Among other functions, the endothelium produces nitric oxide which serves to relax (vasodilate) the blood vessels so as to facilitate the flow of blood. It is now generally accepted that many heart problems involve a dysfunction of the endothelial vasodilator mechanism. This dysfunction can, in a number of cases, be reversed by antioxidants, estrogen, exercise, folic acid, and fish oils. Now researchers at the Stanford University School of Medicine report that supplementation with the amino acid L-arginine is highly effective in reversing endothelial dysfunction. It has been established that L-arginine is the precursor for endothelium- derived nitric oxide (EDNO). EDNO, in turn, is a potent vasodilator and inhibits platelet aggregation and the adherence of circulating blood cells to blood vessel walls. L-arginine administration, either orally or intravenously, has been found useful in preventing and reversing atherosclerosis, in increasing coronary blood flow in heart disease patients, in alleviating intermittent claudication, and in improving functional status of heart failure patients. L-arginine infusions have been found to lower blood pressure and to inhibit restenosis (reclosing of arteries) after balloon angioplasty. The most common used dosage of L-arginine is between six and thirty grams per day (113 references).
Maxwell, Andrew J. and Cooke, John P. Cardiovascular effects of L-arginine. Current Opinion in Nephrology & Hypertension, Vol. 7, January 1998, pp. 63-70
Garlic (Allium Sativum) and Onion (Allium Cepa):
Experimental Double-Blind Crossover Study- 20 normal volunteers (mean BP range form 88-108 mmHg) were randomly divided into 2 groups, each of which rotated for 4 week periods through two different sequences during which they received 18 mg of garlic oil (extracted from 9 grams of fresh garlic) and placebo laced with garlic oil. During garlic administration, mean BP decreased significantly (J Orthomol Med 2(1):15-21,1987)
Experimental Study- Crude Onion oil was given to 34 patients with moderate hypertension or hypercholoesterolemia, or both at a dose of 1 tbsp, 2-3 times daily. In 13 of 20 patients with hypertension, there was a clear blood pressure reduction of an average of 25 mmHg for systolic and/or 15mmHg for the diastolic readings. In 9 of 18 patients with hypercholesterolemia, the total cholesterol levels fell between 7% and 33% (Curr Ther Res 37(1):127-31,1985)
Patients with high blood pressure were able to reduce the amout of medication they needed by 48% after switching to a diet low in saturated fats (6% of total calories) and rich in OLIVE OIL, according to a recent report. Eight of the 23 participants were able to stop taking their blood pressure medication completely. Researchers speculate that the polyphenols in olive oil may help dilate arteries, lowering blood pressure.
Hawthorne - 160 mg per day
Khella - 200 mg per day
Garlic - 5000 mcg Allicin daily
Calcium - 1500-3000 mg per day
Magnesium - 750-1000 mg per day
Vitamin C - 3000-6000 mg per day
L-Carnitine - 500 mg twice daily
Selenium - 200 mcg per day
Primrose oil - as directed
Ginkgo - 120-240 mg per day
Kava - 140-210 mg per day
Valerian - 300-400 mg per day
CoQ 10 - 100 mg per day
*** Herbs can take up to 1 month to exert their effects, but when discontinued have a long phase before there benefits are lost.
Homocysteine is a substance that is worse than cholesterol (Braverman 1987; McCully 1996). Homocysteine damages the artery and is now widely recognized by scientists as the single greatest biochemical risk factor for heart disease. Homocysteine may be a participant in 90% of cardiovascular problems. Two pathways detoxify homocysteine: the remethylation pathway and the trans -sulfuration pathway. If homocysteine is not detoxified, plaque builds up in the endothelial cells lining the arteries. Homocysteine speeds the oxidation of cholesterol, and then macrophages take up the particles to become foam cells in plaque (Naruszewicz et al. 1994; Cranton et al. 2001). Homocysteine plays a key role in every pathophysiologic process that leads to arteriosclerotic plaque (McCully 1996).
Homocysteine promotes coagulation factors, favoring clot formation (Magott 1998). About 40% of all stroke victims have elevated homocysteine levels compared to only 6% of controls (Brattstrom et al. 1992). Elevations in homocysteine with peripheral vascular disease (28%) have been reported (Clarke et al. 1991). Hyperhomocysteinemia encourages smooth muscle cell proliferation (Magott 1998; Sandrick 2000). Homocysteine blocks production of nitric oxide, causing vessels to become less pliable and more susceptible to plaque buildup (Boger et al. 2000). Vessels lose their expansion capacities as homocysteine reduces nitric oxide's availability (Tawakol et al. 2002). Homocysteine significantly hampers microvascular circulation by impairing dilation functions. Nitric oxide (also known as endothelium-derived relaxing factor) normally protects endothelial cells from damage by reacting with homocysteine, forming S-nitrosohomocysteine, which inhibits hydrogen peroxide formation.
However, as homocysteine levels increase, this protective mechanism becomes overloaded, allowing damage to the endothelial cells to occur (Stamler et al. 1992, 1993, 1996). Homocysteine activates genes in blood vessels, encouraging the coagulation process and the proliferation of smooth muscle cells (Outinen et al. 1999). Based on a random testing of 600 hospitalized elderly patients, researchers found evidence of hyperhomocysteinemia in over 60% of those with serious chronic conditions: 70% presented with vascular disease (Ventura et al. 2001). The use of drugs (particularly diuretics), and malnutrition were suspected as causes of age-related hyperhomocysteinemia. Homocysteine levels should be kept below 7 micromoles/L, however, laboratories regard levels up to 15 micromoles/L as normal, while epidemiological data reveal that homocysteine levels above 6.3 reflect a steep, progressive increase in the risk of a heart attack (Robinson et al. 1995). The incidence of hypertension and peripheral vascular disease escalates as homocysteine levels increase.
Homocysteine is a significant biochemical risk factor for heart disease (McCully 1996). A combination of folic acid, vitamin B12, and pyridoxine reduced homocysteine levels (Schnyder et al. 2001). Pretreatment with 800 IU of vitamin E and 1000 mg of C (before an oral methionine load to experimentally produce homocysteine) blocked the damaging effects of hyperhomocysteinemia (Kumar and Das 1993). Coagulation and circulating adhesion molecule levels significantly increased after methionine ingestion alone but not after methionine ingestion with vitamins (Nappo et al. 1999). Medications to treat congestive heart failure commonly result in multiple B vitamin deficiencies, disrupting metabolism of homocysteine (Sinatra 2001).
Insulin resistance is strongly linked to type-2 diabetes, obesity, hypertension, and heart disease. Insulin resistance is found in approximately 25% of healthy humans. Insulin resistance is characterized by cells that are desensitized to insulin that otherwise normally take up glucose. To compensate for higher levels of circulating glucose, insulin production increases. Elevated glucose leads to diabetes and degenerative complications in the vasculature.
GLA and DHA improve insulin sensitivity. Dietary intake of EFAs increases the proportion of unsaturated fatty acids in phospholipid (cellular) membranes, making the cell more insulin sensitive (Storlien et al. 1986, 1987; Borkman et al. 1993; Vessby et al. 1994; Pan et al. 1995; Storlien et al. 1996). Scientists now understand the mechanisms of EFAs on insulin resistance.
Recently developed drugs, called glitazones or thiazolidinediones that bind to and activate PPAR, increase insulin sensitivity. We now know that GLA and DHA, and certain other essential fatty acids, work in the same way by binding to and activating PPARs. It is possible to hypothesize that the different responses noted to sodium intake in hypertensive patients may be related to subtle differences in gene transcription that relate to altered proportions of EFAs in tissue membranes.
Hydrogenation is a common way of changing natural oils to more solid fats with longer shelf life but profoundly altered biochemical properties. Double bonds are either saturated or switched from cis - to trans -configuration. Trans -fatty acids act as antagonists to essential fatty acids and interfere with the production of good prostaglandins. Partially hydrogenated products rich in trans -fatty acids are margarines, shortenings and hydrogenated oils. We need to reduce the intake of omega-6 oils, except GLA, and increase omega-3 fatty acids, particularly DHA. Cold-water fish, nuts and seeds provide a balanced mix of omega-3 and omega-6 fatty acids.
It has been called the mysterious killer, appearing in cases of atherosclerosis that show no signs of elevated serum cholesterol, diabetes mellitus or hypertensionit's homocysteine. (McCully, l 990) Homocysteine is an amino acid that can be deadly if it is not properly metabolized. There are two nutrient dependent enzymes which convert homocysteine to methionine or cysteine, and when there is a defect with these enzymes, homocysteine levels can rise. (Malinow, 1990) In the past 20+ years, research has shown that elevated homocysteine, or hyperhomocysteinaemia, is linked to atherosclerosis, pregnancies complicated by neural tube defects, early pregnancy loss and venous thrombosis. (Bakker, 1997)
The risk of vascular disease is 30 times greater in people with high homocysteine levels. (Ross, 1997) Although it is projected that 5% of the general population has moderately elevated homocysteine (Bakker, 1997), hyperhomocysteinaemia has particularly affected postmenopausal women, the elderly and individuals with folate, vitamin B6, and vitamin B12 deficiencies. (Stabler, 1997; Gupta, 1997; Malinow, 1990)
The Missing Link
Questions began as numerous patients became afflicted with cardiovascular disease even though they lacked the "normal" risk factors, such as high cholesterol, diabetes mellitus, obesity and hypertension. Enter the Homocysteine Theory. In a 1990 study of 194 consecutive autopsies performed on atherosclerosis victims, researchers concluded that approximately two-thirds of the patients developed severe atherosclerosis without evidence of elevated serum cholesterol, diabetes or hypertension. Their explanation was elevated homocysteine. (McCully, 1990) Another observation was made in Ireland, where mortality rates for coronary heart disease in men is about three times higher than in France. While conventional risk factors did not account for the difference, plasma levels of homocysteine were significantly higher in the Irish than the French. (Manilow, 1996) When homocysteine is elevated, arteriosclerotic lesions can form which can cause intimal injury, calcium deposition and elastin degeneration within the arterial wall. (McCully, 1990) It has been suggested that supplementation of folic acid could prevent approximately 13,500-50,000 deaths caused by coronary artery disease annually. (Boushey, 1995)
The Role of Folate
Low levels of folate have been found to be inversely correlated with homocysteine. Data shows that high plasma homocysteine levels and low plasma folate and vitamin B12 levels are associated with a higher prevalence of coronary artery disease, especially in older men and women. (Aronow & Ahn, 1997) Numerous publications support the importance of folate in lowering homocysteine levels. The folate dependent enzyme, methylenetetrahydrofolate reductase (MTHFR), is a crucial enzyme for the remethylation of homocysteine to methionine. (Bostom et al., 1996) In a 1996 study, folic acid supplementation (on patients with chronic renal failure) lowered plasma homocysteine levels significantly. (Chauveau et al., 1996) In a meta-analysis of 27 studies relating homocysteine to arteriosclerotic vascular disease and 11 studies of folic acid and homocysteine published in JAMA, 1995, researchers concluded that higher folic acid intake reduces homocysteine levels and "promises to prevent arteriosclerotic vascular disease". (Boushey, 1995) In order for folic acid to be effective, however, levels of vitamin B 12 (cobalamin) must be normal. Often, patients with a Bl2 deficiency have elevated homocysteine levels as well as methylmalonic acid levels. This is especially prevalent in the elderly. (Stabler et al., 1997) It is believed that vitamin B 12 can correct methionine synthase abnormalities, which is theorized to be a major metabolic pathway that converts homocysteine to methionine. (Mills et al., 1996) A paper published by the National Institutes of Health in 1996 discusses the critical part vitamin B12 plays along with folic acid in regulating the homocysteine levels in periconceptual mothers, thereby preventing neural tube defects. (Mills et al., 1996)
Vitamin B6 (pyridoxine) also works to lower homocysteine like vitamin B12 and folic acid. Pyridoxine is necessary for homocysteine to convert to cysteine through the transsulfuration pathway. A 1996 study concluded that patients deficient in vitamin B6 can not convert homocysteine to cysteine causing levels to escalate. Therefore, vitamin B6 deficiency is an independent risk factor associated with vascular disease. (Ubbink, 1996)
One of the newest focuses of treatment for homocystinuria is trimethylglycine (TMG), also called Betaine (not MCI). TMG is considered a "methylation enhancing compound" which helps homocysteine convert to methionine. In a 1993 study on patients with elevated homocysteine, the therapy with TMG in addition to pyridoxine, folate and cobalamin supplementation significantly reduced homocysteine plasma levels with no side effects during the two years in which treatment was monitored. Interestingly, on the cases where combined folate, pyridoxine and cobalamin did not dramatically lower homocysteine, adding TMG had significant effects. (Monatero et al., 1993) Along with lowering homocysteine, TMG is said to lower VLDL's increase muscle mass and decrease fat content. (Franker, 1997) Research is ongoing and the results on this beneficial nutrient may be revolutionary in homocysteine maintenance.
Aronow, W.S. & Ahn, C., "Association between plasma homocysteine and coronary artery disease in older persons." American Journal of Cardiology 80:9 (November 1, 1997): 1216-8.
Bakker, R.C., Brandjes, D.P., "Hyperhomocysteinaemia and associated disease." Pharm World Science 19:3 (June 1997): 126-32.
Bostom, A.G., et al., "Folate status is the major determinant of fasting total plasma homocysteine levels in maintenance dialysis patients" Atherosclerosis 123:1 -2 (June 1996): 193-202.
Boushey, C.J., et al., "A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes [see comments]" JAMA 274:13 (October4, 1995): 1049-57.
Chauveau, P., et al., "Long term folic acid but not pyridoxine supplementation lowers elevated plasma homocysteine level in chronic renal failure" Mineral and Electrolyte Metabolism 22:1-3 (1996): 106-9.
Frankel, Paul, Ph.D., TMG Breakthrough Specialty Laboratories (1997).
Gupta, A. ~ Robinson, K., "Hyperhomocysteinaemia and end stage renal disease" Journal of Nephrology 10:2 (March-April 1997) 77-84.
Koehler, K.M., et al., "Vitamin supplementation and other variables affecting serum homocysteine and methylmalonic acid concentrations in elderly men and women" Journal of American College of Nutrition 15:4 (August 1996): 364-76.
Malinow, M.R., M.D., "Hyperhomocysteinemia: A Common and Easily Reversible Risk Factor For Occlusive Atherosclerosis" Circulation 81(1990): 2004-6.
Manilow, M., et al., "Plasma homocysteine levels and graded risk for myocardial infarction: findings in two populations at contrasting risk for coronary heart disease" Atherosclerosis 126: 1 (September 27, 1996): 27-34.
McCully, Kilmer, S.D., "Atherosclerosis, Serum Cholesterol and the Homocysteine Theory: A Study of 194 Consecutive Autopsies" The American Journal of the Medial Sciences 299:4 (April 1990): 217-221.
Mills, J.L., et al., Journal of Nutrition "Homocysteine and neural tube defects" 126:3 (Marchl996) : 756S-760S.
Monatero Brens, C., et al., "Homocystinuria: effectiveness of the treatment with pyridoxine, folic acid, and betaine" An Esp Pediatr 39: 1 (July 1993): 37-41.
Ross, Gary, M.D., "Deadly Amino is Factor in Health Problems" Journal of Longevity Research 3:8 (1997): 16-17.
Stabler, S.P.; Allen, R.H.; Lindenbaum, J., "Vitamin B-12 deficiency in the elderly: current dilemmas." American Journal of Clinical Nutrition 66:4 (October 1997): 741-9.
Ubbink, J.B., "The role of vitamins in the pathogenesis and treatment of hyperhomocysteinaemia." Journal of Inherit Metabolic Disorders 10:2 (June 1997): 316-25.
Ubbink, et al., "The effect of a subnormal vitamin B-6 status on homocysteine metabolism [see comments]" Journal of Clinical Investigation 98:1 (July 1, 1996): 177-84.
Michael T. Murray, N.D.
Hawthorn species (Crataegus Oxyacantha, C. Monogyna, and C. Pentagyna) are spiny trees or shrubs native to Europe. Hawthorn may reach a height of 30 feet, but is often grown as a hedge plant. Its common name, Hawthorn, is actually a corruption of "Hedgehorn", as it was used in Germany to divide plots of land. The fruits and blossoms are used medicinally.
Hawthorn leaves, berries, and blossoms contain many biologically active flavonoid compounds, particularly anthocyanidins and proanthocyanidins. High performance liquid chromatography have demonstrated that extracts of the flowers are particularly rich in flavonoids (quercetin, quercetin-3-galactoside, vitexin, etc.) and proanthocyanidins.
In addition to flavonoids, hawthorn extracts also contain: cardiotonic amines (phenylethylamine, o-methoxyphenylethylamine, tyramine, isobutylamine); choline and acetylcholine; purine derivatives (adenosine, adenine, guanine, and caffeic acid), amygdalin, pectins, triterpene acids (ursolic, oleonolic, and crategolic acids).
History and Folk Use
Aortic GAGs flowers and berries have been utilized primarily as heart tonics and mild diuretics in organic and functional heart disorders including congestive heart failure, angina, and HIGH BLOOD PRESSURE. They were also utilized for their astringent qualities for the relief of the discomfort of sore throats.
The pharmacology of hawthorn extracts center on the flavonoid components. In particular, the proanthocyanidins in hawthorn are largely responsible for its cardiovascular activities.
Synergism with Vitamin C - Hawthorn flavonoids have very strong "vitamin P" activity. Included in their effects are an ability to increase intracellular vitamin C levels, stabilize vitamin C (by protecting it from destruction or oxidation), and decrease capillary permeability and fragility.
Collagen Stabilizing Action - Hawthorn's flavonoid components possess significant collagen stabilizing actions. Anthocyanidins, proanthocyanidins, and other flavonoids are remarkable in their ability to prevent collagen destruction. They affect collagen metabolism in many ways, including: 1) the unique ability to actually crosslink collagen fibers, resulting in reinforcement of the natural crosslinking of collagen that forms the collagen matrix of connective tissue (ground substance, cartilage, tendons, etc.), 2) the prevention of free radical damage, due to its potent free radical scavenging action, 3) the inhibition of enzymatic cleavage by enzymes secreted by white blood cells during inflammation, 4) the prevention of the release and synthesis of compounds that promote inflammation such as certain prostaglandins, serine proteases, histamine, and leukotrienes.
Cardiovascular Effects - Hawthorn extracts are clinically effective in reducing blood pressure, angina attacks, and serum cholesterol levels, and in preventing the deposition of cholesterol in arterial walls. The beneficial pharmacological effects of hawthorn in the treatment of these conditions appears to be a result of the following actions: 1) improvement of the blood supply to the heart by dilating the coronary vessels, 2) improvement of the metabolic processes in the heart which results in an increase in the force of contraction of the heart muscle and elimination of some types of rhythm disturbances, 3) inhibition of angiotensin converting enzyme (ACE). Hawthorn's ability to dilate coronary blood vessels, the vessels supplying the heart with vital oxygen and nutrients, has been repeatedly demonstrated in experimental studies. This effect appears to be due to relaxation of the smooth muscle components of the vessel. Various flavonoid compounds in hawthorn have been shown to inhibit constritction of vessels by a variety of substances.
Most recently procyanadins have been shown to inhibit angeotensin converting enzyme (ACE) similar to that of captopril, a synthetic ACE inhibitor widely used in the treatment of high blood pressure. ACE is responsible for converting angiotensin I to angiotensin II which is a potent constrictor of blood vessels. The proanthocyanidins that appear to have the highest activity are proanthocyanadins found in relatively high concentrations in hawthorn berries, flowers, and their extracts.
Improvement in energy production within the heart has been demonstrated in humans and animals to whom hawthorn extracts have been administered. This improvement is a result not only of increased blood and oxygen supply to the myocardium, but also a result of flavonoid-enzyme interactions. In particular, hawthorn extracts and various flavonoid compounds in hawthorn have been shown to inhibit several key enzymes within the myocardium (ex. cyclic AMP-phosphodiesterase). This net result is an increase in the force of contraction. This is particularly beneficial in cases of congestive heart failure.
A recent study has shed additional light on how hawthorn extracts enhance heart function. A hawthorn extract standardized for proanthocyanadin content (3.3%) was studied utilizing an experimental model to determine the effects of a substance on heart function during ischemia. Although effectiveness in this model was less than beta blockers and calcium channel blockers, two classes of drugs often used in treating angina, there are a couple of distinctions to be made. Foremost, the mechanism by which the drugs work in this model is by improving coronary blood flow and actually reducing the need for oxygen by the heart by reducing its mechanical function. In contrast, hawthorn actually improves the mechanical function of the heart without increasing coronary blood flow.
Evidence that hawthorn improves energy metabolism and the utilization of oxygen by the heart was demonstrated by a decrease in accumulated lactic acid. Without oxygen, the heart muscle will shift to the breakdown of sugar for energy, but this can only go so far without oxygen. As a result, pyruvic acid is shunted to lactic acid. Recovery of heart function is inversely related to the level of lactic acid in the heart. The beneficial effects of hawthorn in angina appear to be related more to its ability to improve oxygen utilization, as noted by its ability to reduce heart tissue lactic acid levels, rather than an ability to dilate coronary vessels. In fact, in this most recent study, hawthorn did not improve coronary blood flow.
Hawthorn berries and hawthorn extracts are useful as food supplements in conditions affecting collagen structures, such as arthritis, periodontal disease, atherosclerosis, and inflammation. The clinical use of hawthorn revolves around its cardiovascular effects. Its use in atherosclerosis, hypertension, congestive heart failure, and arrythmias is discussed below:
Atherosclerosis - Hawthorn extract, like other extracts containing proanthocyanidins (such as grape seed and pine bark extract), are very effective in the prevention and treatment of atherosclerosis. Increasing the intake of flavonoid compounds by taking hawthorn extracts has numerous health promoting effects, including reducing cholesterol levels, decreasing the size of existing atherosclerotic plaques, and preventing the oxidation of LDL-cholesterol.
High Blood Pressure - Hawthorn exerts a mild blood pressure-lowering effect which has been domonstrated in many experimental and clinical studies. Its action in lowering blood pressure is quite unique, in that it does so through a number of diverse pharmacological effects. Specifically, it dilates the coronary vessels, inhibits ACE, increases the functional capacity of the heart, and possesses mild diuretic activity.
Hawthorn's effects generally require prolonged administration, and in many instances it may take up to two weeks before adequate tissue concentrations are achieved.
Congestive Heart Failure - Hawthorn has a long history of use in the treatment of congestive heart failure (CHF), particularly in combination with digitalis or other herbs containing cardiac glycosides. It potentiates the effects of cardiac glycosides.
Because of this enhancing effect, lower doses of cardiac glycosides can be used. In addition, magnesium has also been shown to augment digitalis action. For mild to moderate cases of CHF, hawthorn extract used alone may be sufficient, but for moderate to severe CHF, it should be used in combination with other cardiac glycosides as prescribed by a healthcare professional.
Hawthorn preparations are very effective in early stages of congestive heart failure and minor arrythmias for which digitalis is not yet indicated. This has repeatedly demonstrated in double-blind studies. In the most recent study, 30 patients with congestive heart failure were assessed in the randomized double-blind study. Treatment consisted of a hawthorn extract standardized to contain 15 mg procyanidin oligomers per 80 mg capsule. Treatment duration was 8 weeks, and the substance was administered at a dose of one capsule taken twice a day. The group receiving the hawthorn extract showed a statistically significant advantage over the placebo in terms of changes in heart function as determined by standard testing procedures. Systolic and diastolic blood pressure was also mildly reduced. Like all other studies with hawthorn extract, on adverse reactions occurred.
Rarely will I use hawthorn extract on its own. In most instances, I will use a formulation containing hawthorn extract, magnesium, and khella among several other supportive compounds. These compounds, especially magnesium, appear to work synergistically with hawthorn extract. The beneficial effects of magnesium to the heart and vascular system are well known.
The dosage depends of the type of preparation and source material. Standardized extracts, similar to those used in Europe and Asia as prescription medications, are available commercially in the US and are the preferred forms to use for clinical purposes. For the hawthorn extract standardized to contain 1.8% vitexin-4'-rhamnoside is 150 to 250 mg three times daily.
Hawthorn has been shown to have low toxicity. In rats, the typical acute LD50 of the tincture is about 25 ml/kg for oral administration; toxicity for chronic administration is found at about 5 ml/kg. Similar results, adjusted for concentration, are found with other forms of hawthorn.
Celery seed is one of the lesser-known herbs in Western herbal medicine. However, it has been used for thousands of years in other parts of the world for a variety of reasons. During ancient times, Ayurvedic physicians (vaidyas) used celery seed to treat people with colds, flu, water retention, poor digestion, various types of arthritis, and certain ailments of the liver and spleen.
Today, celery seed is used primarily as a diuretic to promote the excretion of urine. The diuretic action combined with the presence of anti-bacterial compounds in celery seed also make it useful in treating urinary tract infections. Laboratory studies have found that compounds in celery seed and its essential oil may also help reduce muscle spasms, calm the nerves, and reduce inflammation. In fact, some experts claim that celery seed alleviates the pain associated with certain inflammatory health conditions such as arthritis and gout.
In addition, a few animal studies suggest that celery seed extracts may have activity to help lower blood pressure (A compound in celery, 3-n-butyl phthalid has been shown to reduce blood pressure.)
and cholesterol as well as protect the liver from damaging agents such as acetominophen (also called paracetamol; an over the counter medication for pain and headache that can cause liver damage if taken in large quantities.)
None of these claims, however, have not been studied in people to date or backed by rigorous scientific studies. So, further research is needed to determine the safety and effectiveness of celery seed for the conditions described.
Preliminary animal studies have also found that celery seed helps prevent the formation of cancerous tumors in mice. In a study that included large numbers of people with and without colorectal cancer, researchers found that people who consumed a diet rich in lutein (from celery, spinach, broccoli, lettuce, tomatoes, oranges, carrots, and greens) were significantly less likely to develop colorectal cancer. It is not clear, however, whether celery alone played an important role in the prevention of this disease and how the information about these whole foods relates to the extracts and isolates of celery seed.
The celery plant is slender and stands about two to three feet tall. It has three to five segmented leaves, and flowers with small white petals. Celery seeds, which are found in the flowers, are very small, tan to dark brown, and have a strong, pleasant smell.
What's It Made Of?
Celery seeds contain several substances including volatile oils, flavonoids, coumarins, and linoleic acid.
Fresh or dried seeds
Capsules filled with celery seed oil
Celery seed extract, in which the active ingredients of celery seed have been extracted by alcohol or glycerin
How to Take It
There are no known scientific reports on the pediatric use of celery seed. Therefore, it is not currently recommended for medicinal purposes in children.
Celery seed oil capsules or tablets: One to two capsules or tablets three times a day, as directed by your health care provider.
Celery seed extract: 1/4 to 1/2 tsp three times a day, or as directed by your health care provider. (Always take with plenty of juice or with water at mealtime, unless instructed otherwise.)
Whole celery seeds: Prepare a tea by pouring boiling water over one teaspoon (1 to 3 g) of freshly crushed seeds. Let it steep for 10 to 20 minutes before drinking. Drink three times a day.
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain active substances that can trigger side effects and that can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a practitioner knowledgeable in the field of botanical medicine.
Pregnant women should not use celery seed because it may uterine bleeding and cause muscle contractions in the uterus.
People with active kidney inflammation should also avoid this herb.
Although uncommon, allergic reactions (even anaphylaxis) to celery seed may develop in people who handle or ingest celery. In fact, some individuals who are allergic to birch pollen may also be allergic to celery seed.
Active compounds in celery stems and seeds can cause the skin to become highly sensitive to UV rays (called photodermatitis). For this reason, people taking celery seed should use sunscreen or sunblock lotions to protect their skin from the sun.
Celery seeds should not be taken from a garden packet. Most seeds sold for these purposes have been treated with chemicals and should not be taken internally.
There are no known scientific reports of interactions between celery seed and conventional medications. However, given that celery seed is an herb with diuretic effects, people taking prescription diuretics (such as furosemide or hydrochlorothiazide) should not take this herb without first consulting a healthcare provider.
Similarly, celery contains properties that may thin the blood, thus making it somewhat of a concern to take with blood thinning medications such as warfarin or aspirin. If you take warfarin in particular you should not use celery seed without first consulting your healthcare provider.
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Because hypertension has no warning signs, it is called the "silent killer." When hypertension is not detected and treated, it can cause:
The heart to get larger leading to heart failure
Small blisters to form in the brain’s blood vessels, which may cause a stroke.
Blood vessels in the kidney to narrow, which may cause kidney failure
Arteries throughout the body to harden faster, especially those in the heart, brain, and kidneys, which can cause a heart attack, stroke, or kidney failure
In fact, hypertension plays a role in about 700,000 deaths a year from stroke, and heart and kidney disease. Hypertension, brought on by uncontrolled high blood pressure, costs Americans billions of dollars each year. It’s easier and wiser to treat your high blood pressure right from the start.
According to the American Heart Association, about 1 in 4 American adults - nearly 50 million people - has high blood pressure. More than 30 percent don't know it.
Hypertension - Testing For It
You probably found out about your hypertension during a visit to a clinic or doctor. Maybe you went to a doctor for a physical exam, unaware of what hypertension even is. The doctor asked for your medical history and did some simple tests, such as urine and blood tests. And, your blood pressure was measured. Having your pressure taken to determine if you have hypertension is easy. The doctor uses a device called a "sphygmomanometer." Here's how it works: A blood pressure cuff is placed around an arm and inflated with air until blood circulation in the artery is temporarily stopped. A valve is opened and some of the air is slowly let out from the cuff, which allows the blood flow to start again. Using a stethoscope, the doctor listens to the blood flow in an artery at the inner elbow. The first sound heard is the heart as it pumps. This is the systolic pressure, the maximum pressure in the artery produced as the heart contracts and the blood begins to flow. More air is slowly released from the cuff. When the beating sound is no longer heard, the heart is at rest. The lowest pressure that remains within the artery when the heart is at rest is the diastolic pressure.