Hypertension & Wise Therapy

Hypertension & Wise Therapy

Hypertension, or High Blood Pressure (HBP), is a common disease in modern cultures, more common in men than women, and in African Americans over Caucasians. Hypertension means ‘too much tension,’ and of course, stress plays a role in this factor/disease that causes many other problems in the cardiovascular system as well as in the kidneys and brain. It is also called the “silent killer” because typically people are not aware they have high blood pressure unless they have it checked, and it does take its toll over time. So, check yours out at the local pharmacy, your doctor’s office, or from a company nurse, or friend who has a blood pressure cuff. Check it both when you are relaxed and also when you are under stress, as in just out of heavy traffic or right after work. The normal numbers should be below 130/80, and ideally between 110/70 and 120/80. The old level for labeling HBP was 140/90 as borderline, yet that is now considered hypertension because even those numbers have been shown to be problematic over the long-term.

General Hypertension Guidelines

• Normal BP (less than 120/80)
• Prehypertension (125-139/84-89, or more strictly over120/80)
• Borderline or Early (130-160/90-94)
• Mild (140-160/95-104), or Stage 1 at 140-159/90-99
• Moderate 140-180/105-114), or Stage 2 more than 159/99
• Severe (160+/115+)

The Life Extension Institute has reported that government guidelines state that blood pressure should be considered normal only if it is at or below 119/79.4. Those with blood pressures of 120/80 up to 140/90 are now considered ‘prehypertensive’ and are encouraged to take immediate measures to decrease their blood pressure, such as daily exercise, decreasing salt in their diet, and consuming no more than two alcoholic drinks a day. Also, it is wise to limit caffeine, which clearly raises blood pressure.

NOTE: Healthy BP may vary a bit with age, as it may be fine to be a bit higher in our elder years. Many seniors I see are being over-treated with meds and have some lightheadedness, fatigue, and poor memory from low blood perfusion. They often benefit from lessening their medications under their doctor’s supervision. And it is best to have each patient monitor their BP regularly and see if there I any association between their readings and any symptoms.

What do the BP numbers mean? The higher one is called systolic and is the number that occurs when your heart pumps blood, so it is the higher pressure. The lower number is termed diastolic, and is the reading with the heart at rest, or between pumps. Elevation of the diastolic pressure appears to offer greater concern for health problems. Overall, it’s important to maintain normal pressures to protect your health. There are many natural ways with lifestyle and natural therapies to keep a healthy pressure, yet I would say as a practicing physician, that getting results, and in this case a normal blood pressure, is the goal. If it can be done more naturally, then all the better. Yet, if people cannot change their habits/lifestyles, they may need to take medication. Let’s look at more factors and therapies in relation to hypertension.

LIFESTYLE & NATUROPATHIC Treatments

The main areas of concern, at least that we have some control over, are diet, smoking, cholesterol levels, stress, exercise, and weight. Dietary matters include following a low-fat diet (aligning with the bulleted chart below), minimizing salt intake, and really becoming more of a vegetarian, possibly including some animal proteins primarily from some fish or poultry, occasional eggs, and low- or non-fat milk products if desired. Create a balanced diet and exercise program that will allow appropriate weight reduction and the maintenance of your optimum weight.

Exercise guidelines involve a balance between stretching and flexibility, strength and toning exercises, and aerobic/endurance training. Choose exercises that you can enjoy, make time to do them, get your friends or family involved with you, and set reasonable goals at first. Be sure to check with your doctor if you have not been doing any strenuous workouts in a while, and consider having a treadmill/stress test to monitor your blood pressure and heart function while you exercise. Yet clearly, people with high blood pressure or those who are pre-hypertensive can lower their blood pressure by losing weight and increasing physical activity (by doing aerobic activity for at least 30 minutes every day).

Learn some stress reduction techniques to help with relaxation of your body, mind, and your blood vessels. Do whatever it takes to stop smoking; dietary changes and regular exercise will help with motivation. Programs using hypnotherapy, acupuncture, and/or nutritional cleansing practices may all be helpful. And monitor your cholesterol levels to see how low they will go with your natural program for lowering blood pressure.

DIETARY FACTORS FOR HYPERTENSION

* Reduce the fats in your diet to 25% or less, and consume primarily good oils from nuts and seeds and avocado, avoiding dairy fats and hydrogenated oils (trans fats). Also, obtain your essential fats from fresh olive, canola, or flaxseed oils preferably

* Avoid or eat very little animal meats, especially fatty (and often salty) red meats like burgers and lunchmeats, such as bologna, salami, bacon, and sausages, which are also very salty

* Focus more on fish and skinless poultry

* Avoid fried foods

* Use only low- or non-fat dairy products

* Generally eat a more vegetarian diet

* Eat plenty of fresh fruits, vegetables, and whole grain products

* Reduce caffeine (raises blood pressure) and alcohol beverages

* Limit your salt intake to balance out your exercise and sweating

You may also see common dietary modifications to be helpful:

First, initiate the DASH (Dietary Approaches to Stop Hypertension) eating plan, which increases dietary potassium, fiber, and calcium intake through a diet rich in fruits, vegetables, low- or non-fat dairy products, whole grains, and foods with reduced saturated fat and reduced total fat content. The DASH plan is also rich in magnesium (from green vegetables, nuts, and seeds), a crucial mineral that may help promote optimal blood pressure levels.

Also, limit alcohol consumption to no more than two drinks a day for men and no more than one drink a day for women. Red wine may have the best cardiovascular protection. Furthermore, reduce salt intake to no more than 2.4 grams (g) of sodium or 6 g of sodium chloride each day. Use sea salt or salts with other minerals. We do need more when we exercise and sweat, plus some people are more sensitive to sodium and their blood pressures than others.

HERBAL & NATURAL TREATMENTS

Both Western and Chinese herbs and herbal products can be advantageous to the basic support and reduction of blood pressure. Any herbs that help to relax the body, reduce the blood fats (often by supporting liver metabolic functions), and strengthen the kidneys as well as help get rid of excess water may be useful in the treatment of hypertension.

In Chinese medicine, the overall treatment is oriented to subduing the rising Yang energies and nourishing the Yin. More specifically, we are trying to calm the heart fires and strengthen the kidney chi (energy). This can be done in part through the needling of certain acupuncture points as relevant to the individual case. Also, the person must attempt to reduce tension and excessive activity levels, and try to take a more relaxed “let it flow” attitude toward life. Regarding Chinese herbal treatment, the goals include cooling the heart by reducing the fires, strengthening the kidneys, and relaxing the liver, much like the goal of shifting energies with needles.

In my office we have several herbal combination formulas that work quite well. One is called Carditone and is a mixture of Ayurvedic herbs that contains Rauwolfia serpentina, a source of reserpine, an alkaloid widely used for antihypertensive and sedative effects, Arjuna and rose powder to support heart function, Tribulus terrestris for renal support, and Indian coral powder as a good source of calcium and magnesium. Another is called Seven Flowers and is a mixture of Western and Chinese herbs. They both work quite well.

Nutritional approaches and Detoxification can really be helpful at reducing hypertension problems. Over the years, I have had many people with HBP and who were on prescription medications join my Detox Groups. Typically then, as they change their diets and begin to lose water pressure and weight, their blood pressures go down. Then they need to begin to lower their medicine dosages. I often have them half their dosages first. Then, it they continue to make positive changes and keep their pressures down, they can go off of them eventually and support themselves more naturally. Thus, the goal is to improve the health condition so that prescriptions are less needed, and not to just get off medicines. The problem for which the medicines were required needs to be addressed. For people who are not my patients, I suggest that they work with their own physicians.

Other nutrients are also important. Magnesium is the key here as it is often deficient and it helps to relax the blood vessels. Typically I provide some calcium/magnesium formula in a one-to-one ration and then additional magnesium, at least twice daily, often after lunch and at bed. Potassium is also important and especially to balance out excess sodium. And potassium has cardio-protective effects, especially on electrical conductivity (as does magnesium). The preferred source for potassium is through the intake of fruits (dried apricots, avocados, dates, dried figs, raisins, and bananas), vegetables (beet greens, Jerusalem artichokes, winter squash, spinach, carrot juice, potatoes), and legumes (white beans, lima beans, lentils, kidney beans, pinto beans). The B-complex vitamins are also important to support many functions and balance stress and blood pressure.

Here’s a few other ideas for support taken from Drs. Jonathon Wright and Alan Gaby presentation based on the research:

CoQ10: 60-200 mg/day may produce substantial reductions in both systolic and diastolic blood pressure after 1-4 months treatment.

EFAs (Essential Fatty Acids) Fish oil or sunflower oil has lowered blood pressure in some studies.

Vitamin C, 500-1000 mg/day may reduce systolic blood pressure in elderly.

Tomato extract (Lyc-O-Mato) providing 15mg/day of lycopene plus other carotenoids decreased mean systolic blood pressure from 144.0 mm Hg to 134.0 mm Hg and diastolic blood pressure from 87.4mm to 83.4 mm Hg after 8 weeks in patients with untreated hypertension (single-blind trial).

Also, Dr. Wright observed in his clinic the following:

Most of the folks he worked with who have been diagnosed with essential hypertension have tested positive for insulin resistance, heavy metal toxicity, or both, and most of them have had less than “tropical” blood levels of vitamin D. He advocates doing these tests (insulin, metal, Vitamin D level).

HOMEOPATHIC REMEDIES

The homeopathic treatment of hypertension is somewhat difficult to address because homeopathy doesn’t really treat diseases or symptoms specifically, but is oriented more to the whole person. To come up with a certain “remedy,” all the symptoms and life patterns must be incorporated, such as specific likes and dislikes, sleep patterns, emotional and mental attributes and difficulties, etc. Even so, you likely can find some homeopathic hypertension remedies at your natural foods store.

WESTERN/PHARMACEUTICALS

Clearly, it seems important to long-term health to maintain the blood pressure at least within the high normal range of 110-135/70-85 for reasons mentioned in the previous discussion. This requires regular checking of it, ideally by patients themselves, because most often symptoms of hypertension are minimal until the blood pressure reaches higher levels or unless the individual is very attuned to the inner experience, which often he or she is not with the hypertensive, stressed, and overactive personality. Like many health issues, the more information we have, the better and more individualized the therapy can be.

Thus, multiple readings, upon arising, when stressed, relaxed, or after exercise, are helpful to be able to manage the right treatment. Early warning signs of high blood pressure may include an increased inner tension and inability to relax, mild tension headaches especially in the back of the head (occiput), or increased pressure around the eyes.

The key Western approach to lowering the blood pressure is the use of medications manufactured by pharmaceutical companies and tested for their effectiveness and side effects. Increased pressure can come from too much volume and thus pressure in the blood vessels, and vessels that are too stiff as they lose their elasticity. The medications include diuretics and anti-hypertensives, such beta blocking agents, calcium channel blockers, and vasodilators.

The earliest treatment may be the use of diuretic drugs, which increase the flow of urine and reduce the volume (pressure) of circulating blood. There are a great variety of Diuretics—thiazides, such as hydrochlorothiazide (HCTZ); potassium-sparing diuretics, such as aldactone; and loop diuretics, including furosemide and ethacrynic acid, which work at another area of the kidneys. However, recent research is suggesting that we be less focused on diuretic drugs.

Many more physicians have turned to the ACE inhibitors, including Vasotec, Prinivil, and Zestril (lisinopril), and others use beta blockers or the calcium channel blockers as their first line of treatment. Beta blocking agents include such drugs as Inderal (propanolol), metoprolol, Tenormin (atenolol), and Corguard (nadolol). These agents work by blocking the beta-adrenergic receptor sites at the blood vessels, which respond to adrenaline and cause vasoconstriction, a tightening of the blood vessels leading to increased blood pressure. The calcium channel blockers include Cardizem (diltiazem), Isoptin or Calan (verapamil), Plendil (felodipine), and DynaCirc (isradipine). These agents work by altering the calcium ion exchange across the arterial and heart smooth muscle cells, which apparently allow the blood vessels to relax.

Other types of anti-hypertensive medicines include vasodilators, like Apresoline, alpha-adrenergic blocking agents, such as Minipress.

However, a relatively new class of drugs as mentioned above are now much more commonly used and the preferred medications by many doctors; these are the ACE inhibitors, including Vasotec, Prinivil, and Zestril (lisinopril). Experienced physicians have found that the effectiveness of particular drugs are influenced by race, gender, age, and associated medical problems.

For those who wish to go a bit deeper, here’s further listing of the different Western blood pressure drugs, their actions, efficacy, and side effects. Adapted form the list on www.familydoctor.org The following sites have good information as adapted for this next section.

A good site to check on any drug side effects and purpose:

http://www.nlm.nih.gov/medlineplus/

The American Heart Association also has useful information

http://americanheart.org/presenter.jhtml

Descriptions and Names of the Various Types of Blood Pressure-Lowering Drugs:

1) Diuretics (water pills) are used to treat high blood pressure and fluid retention caused by various conditions, including heart disease. It causes the kidneys to get rid of unneeded water and salt from the body into the urine (and potassium and magnesium, two very important minerals to lower blood pressure and protect the heart). Some examples of diuretics include amiloride (brand name: Midamor), bumetanide (brand name: Bumex), chlorthalidone (brand name: Thalitone), furosemide (brand name: Lasix), hydrochlorothiazide (brand name: Esidrix) and indapamide (brand name: Lozol). Your doctor may also prescribe a combination of diuretics, such as hydrochlorothiazide combined with triamterene (brand names: Dyazide, Maxzide) or other medications.

2) Beta-blockers make the heart beat slower and blocks the vessel tightness so that blood passes through your blood vessels with less force. They decrease the heart rate and cardiac output, which lowers blood pressure, and don’t allow your heart rate to rise as much with exercise. Some examples of beta-blockers include atenolol (brand name: Tenormin), carvedilol (brand name: Coreg), metoprolol (brand names: Lopressor, Toprol XL), nadolol (brand name: Corgard), propranolol (brand name: Inderal) and timolol (brand name: Blocadren).

3) Angiotensin-converting enzyme inhibitors (ACE inhibitors) expand blood vessels and decrease resistance. This allows blood to flow more easily and makes the heart’s work easier or more efficiently. They prevent the body from creating angiotensin, a hormone in the blood that causes vessels to tighten and raises blood pressure.. Some examples of ACE inhibitors include benazepril (brand name: Lotensin), enalapril (brand name: Vasotec), lisinopril (brand names: Prinivil, Zestril), quinapril (brand name: Accupril), and ramipril (brand name: Altace).

4) Angiotensin-2 receptor blockers (ARBs) do not lower the angiotensin level like ACE inhibitors, but block angiotensin from tightening the heart and blood vessels so blood can flow more smoothly. Some examples of ARBs include candesartan (brand name: Atacand), irbesartan (brand name: Avapro), losartan (brand name: Cozaar), olmesartan (brand name: Benicar), telmisartan (brand name: Micardis) and valsartan (brand name: Diovan).

5) Calcium channel blockers (CCBs) block calcium from entering the cells and keep the blood vessels from narrowing or constricting. They lower blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. Some examples of CCBs include amlodipine (brand name: Norvasc), diltiazem (brand names: Cardizem, Cartia, Dilacor, Tiazac), felodipine (brand name: Plendil), nicardipine (brand name: Cardene), nifedipine (brand names: Adalat, Procardia) and verapamil (some brand names: Calan, Covera, Isoptin, Verelan).

6) Alpha-blockers help relax blood vessels by reducing nerve impulses. This allows your blood to pass through more easily. Some examples of alpha-blockers include doxazosin (brand name: Cardura), prazosin (brand name: Minipress) and terazosin (brand name: Hytrin).

7) Central Alpha Agonists It works by decreasing your heart rate and relaxing the blood vessels so that blood can flow more easily through the body. They affect the brain and central nervous system to reduce the nerve impulses that can cause your blood vessels to narrow. Some examples of centrally acting drugs include clonidine (brand name: Catapres) and methyldopa.

8) Direct vasodilators relax the muscles in the blood vessel walls. This causes the blood vessels to widen. Some examples of vasodilators include hydralazine (brand name: Apresoline) and minoxidil (brand name: Loniten).

Some common side effects of blood pressure-lowering drugs include: muscle weakness, dizziness, cramps, thirst, stomach pain, upset stomach, vomiting, diarrhea, loss of appetite, headache, hair loss, confusion, thirst, blurry vision, constipation, restlessness, sore throat with fever, unusual bleeding or bruising, severe skin rash with peeling skin, difficulty breathing or swallowing, loss of hearing, rapid excess weight loss. Of course, they do not occur often, yet they do occur often enough to cause people to commonly stop their meds because they feel worse on them than off them. This is why it’s so important to do an integrated approach to work to lower BP naturally, which is often possible, and has many other side benefits (the author’s special note).

SUMMARY REVIEW

The key concern with the pharmaceutical approach is that almost all of the medications have a high degree of noncompliance because they all cause side effects–people most often don’t feel as good on them as when they go off or “forget” to take them. The diuretics cause potassium and magnesium loss and the many symptoms related to their deficiencies, such as fatigue. The beta-blockers also cause fatigue, depression—known as the “beta-blocker blues”—and occasionally can cause impotence in men. The blood vessel dilators have a wide range of side effects that reduce general functioning and vitality, while the “calcium-channel blockers” are fairly well tolerated, however, do have some incidence of constipation, headache, nausea, dizziness, edema, and fatigue. The newer ACE inhibitors have also become more popular because they seem to be better tolerated by patients.

In review, there clearly is a place for the medical/drug treatment of hypertension; it just should not be the primary focus. Lifestyle management is most useful and can remedy the problem and/or delay it for many years, again emphasizing the importance of a good diet, regular exercise program, and weight and stress reduction if indicated. Herbs and nutrients also can be helpful within the natural program. However, if these measures do not work to maintain a normal blood pressure, medication should be added.


REFERENCES

1) http://www.nlm.nih.gov/medlineplus/ (click on Drugs & Supplements link on the left)

2) The second link works for me:

http://americanheart.org/presenter.jhtml?identifier=159

Yes, the whole list of BP meds came from both the americanheart.org and also from this site: http://familydoctor.org/online/famdocen/home/seniors/seniors-meds/797.html

If you would like to add more to your article on HP,

the following info on herbs/supplements may also be helfpul.

http://www.lef.org/protocols/heart_circulatory/high_blood_pressure_01.htm