Hypertension – Managing Blood Pressure Holistically

Hypertension – a definition

Normal is < 120/80
Pre hypertension is 120-139/80-89

Why do we care?
The risk of cardiovascular disease beginning at 115/75 mmHg doubles with each
increment of 20/10 mmHg.
The time frame is generally not urgent, however (see above guidelines)

Why do we get it? – The Rules of Tacks
Hypertension is a piece of Syndrome X – the syndrome involving truncal obesity (waist > 40 inches for men, 35 inches for women), blood sugar issues and insulin resistance (glucose greater than 110 fasting), high cholesterol (HDL < 50 in women, < 40 in men), etc., and is related to the SAD (Standard American Diet), sedentary lifestyle, etc. Thus, many of the interventions that reduce insulin resistance and increase antioxidants are likely to be of benefit (Think cinnamon, acacia fiber, fish oil, increased fruits and veggies – especially greens)
Sleep apnea increases the risk – Annals of Internal Medicine 1994 | 120 Issue 5 | Pages 382-388
Increased work stress and other acute stress

Some other “secondary” causes:
Antiinflammatory medications, decongestants, appetite suppressants (incl ephedra, bitter orange), licorice, birth control pills, some antidepressants
Kidney disease or renovascular disease (narrowing of arteries to the kidneys)
Hormonal problems – adrenals, thyroid, rarely others

Approaches to Treatment
Diet – DASH diet – diet rich in fruits, vegetables, and low-fat dairy foods and with reduced saturated and total fat lowered blood pressure in hypertensive patients by 11.5/5.5 mm Hg G Appel et al N Engl J Med. 1997 Apr 17;336(16):1117-24; see www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
Lower sodium to 1500 mg in addition for best results – drops by another 3 mm Hg.

Consumption of 60 g/day dry weight of oatmeal or 40 g/day oat bran have also been shown in clinical trials to reduce blood pressure. Functional foods and cardiovascular disease. Curr Atheroscler Rep. 2000;2:467-475.
Consuming 3.3 g/day wakame (Undaria pinnatifida), a seaweed, also reduces BP. J Jpn Soc Clin Nutr. 1998;20:92.
Sesame oil was effective in hypertensive diabetics compared to palm oil or groundnut oils. J Med Food. 2006;9(3):408-412

Exercise More vigorous exercise is more beneficial, but “Start low, go slow” if this is a big change, 30 to 60 minutes 3-4 days per week drops it by 7/6 mm Hg.

Limit alcohol
Lose weight
Relaxation practices

Calcium/Magnesium/Potassium – particularly for those on diuretics

Fish oil: Annals internal medicine 1995 | 123 (12) | Pages 911-918 Fish oil 4 grams per day lowered systolic blood pressure by 3.8 mm Hg more than control (P = 0.04)

Coenzyme Q10:
12 week study of 60 mg bid showed drop of 17.8 +/- 7.3 mm Hg in systolic blood pressure

The herbs:

Hawthorn: Clinical trials have been mixed, but I have had great results with the extract from Pure Encapsulations, which combines flower, leaf and berry, 2 caps twice a day Phytotherapy Research. 16: 2002:48-54. Mills and Bone say the leaves have more hypotensive effect than the berries.

Olive leaf:
One study found 4 Tblsp per day of olive oil allowed people to decrease their blood pressure medicine by half.
Olive leaf extract. :J Pharm Belg. 1996 Mar-Apr;51(2):69-71 Small study in humans using 1600 mg per day of an aqueous extract found lowering of blood pressure. Triterpenoids are beta blockers.

Grape seed extract
Study at UC Davis using 150 – 300 mg per day.
The average drop in systolic pressure was 12 mm. The average drop in diastolic pressure was 8 mm. We use the New Chapter Blood Pressure Take Care.

Tomato Extract (Lyc-O-Mato)
Lowered by 12/5.5 by 6 weeks. Markers of lipid peroxidation also dropped. Engelhard Y, Gazer B, Paran E. Natural antioxidants from tomato extract reduce blood pressure in patients with grade-1 hypertension: a double-blind, placebo-controlled pilot study. Am Heart J. Jan 2006;151:100.e1-100.e6.

Garlic:
In human trials, effects on blood pressure are small and inconsistent, although aged garlic extract is effective in rats. J Hypertens. 1994 Apr;12(4):463-8.
On the other hand, garlic also addresses multiple other cardiovascular risk factors. Prolongation of life span in hypertensive rats by dietary interventions. Effects of garlic and linseed oil. 1: Basic Res Cardiol. 1997 Aug;92(4):223-32. (A comment on secondary endpoints)
Mills and Bone recommend Garlic powder (allicin-releasing preparations)

Stevia:
Stevioside 250 mg tid After 3 months, the systolic and diastolic blood pressure of the stevioside group decreased significantly (13.4/14.4, P < 0.05), and the effect persisted during the whole year Clinical Therapeutics 25:2797 2003

Kudzu (Pueraria lobata).
Chinese studies suggest that kudzu helps normalize blood pressure. Animal studies are available showing vascular relaxation, antioxidant capacity, and lowering of lipids, but human trial data is not in English. Other effects include decrease in alcohol consumption and craving.

Cordyceps and other mushrooms (Maitake, reishi) Triterpenoids have ACEI activity.
Reishi was added to captopril or nimodipine, at 55 mg three times a day, with “significant” drop in blood pressure compared to placebo. Microcirculatory Approach to Asian Traditional Medicine 1996:131-138.

Pomegranate juice: A three-year study during which 19 volunteers were given 50 ml (1.33 ounces) pomegranate (Punica granatum) juice per day resulted in a significant mean decrease of 12 mm Hg in systolic blood pressure after one month (P < 0.05) and a 21 mm Hg decrease in after one year compared to baseline (P < 0.01). Also reduced intimal thickness in the carotid and LDL oxidation. Clin Nutr. Jun 2004;23(3):423-433

Rauwolfia (Rauvolfia serpentaria), aka Indian snake root – the herb from which reserpine was isolated. Depletes catecholamines. Should be standardized to reserpine content.
Must be used very cautiously. Can cause severe depression, even suicide in excessive doses/vulnerable people. Also note drug interactions – should not be combined with St. John’s wort, beta blockers, antidepressants, 5HTP, decongestants.
HerbPharm’s tincture contains 0.1 mg reserpine per 4 drops. Loading dose is 4 drops, 2-3x per day for 1 week, then 4 drops per day. A maximum of 5 drops twice a day is recommeneded to acoid serious side effects. Long half-life means dose will not be immediately effective, and will not wear off immediately after it is stopped.

Hibiscus. Hibiscus sabdariffa. One clinical trial found a cup of tea daily lowered blood pressure 11% in 12 days. : J Ethnopharmacol. 1999 Jun;65(3):231-6. Later trial of a standardized extract was as effective as captopril in lowering blood pressure. Phytomed. 2004;11:375-382, and almost as effective as lisinopril Planta Med. 2007;73:6-12.

Forskohlii: (Plectranthus barbatus a.k.a. Coleus forskohlii) 540 mg/day recommended dose of a
10% forskolin standardized extract – may produce loose stools. Note antiplatelet activity.

Chocolate Cocoa reduces blood pressure and insulin resistance and improves endothelium-dependent vasodilation in hypertensives. 12/8.5 mmHg drop with dark chocolate Hypertension. 2005;46:398-405

Other herbs used:
Valeriana,
Viburnum opulus (cramp bark),
Achillea millefolium (yarrow) – esp for elevated DBP,
Taraxacum officionale – dandelion leaves, esp for elevated SBP in elderly
Tilia spp. (lime flowers)
Viscum album – mistletoe – note toxicity concerns
Connie Basch, M.D. April 2007