Hypertension and 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 HBP which, when untreated, can cause many other problems in the cardiovascular systems 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. 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)
• Pre-hypertension (125 –139/84– 89, or more strictly over 120/80)
• Borderline or Early (130 –140/90 –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 and 99
• Severe (160+/115+)

What do these 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 infringement. 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 or to treat early HBP, yet I would say as a practicing physician, that getting results, and in this case a normal blood pressure, is the goal. Of course, it’s better if it can be done more naturally. 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
The main areas of concern, at least over which we have some control, are diet, smoking, cholesterol levels, stress, exercise, and weight. Dietary matters include following a low-fat diet (aligning with the chart below), minimizing the salt intake, and really becoming more of a vegetarian, including some animal proteins primarily from some fish, 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. Often, people with high blood pressure or those who are pre-hypertensive can lower their blood pressure by losing weight and increasing physical activity (especially 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 percent 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 red meats like burgers and lunch meats, 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 (less than 2.4 grams/day) to balance out your exercise and sweating
• Follow 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.

HERBAL AND 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 I use 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 anti-hypertensive 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. The other is called APC and is a mixture of Western and Chinese herbs. They both work quite well.

Nutritional approaches and detoxification can really be helpful at clearing 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, if 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 not 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.

Some other ideas for support come from Drs. Jonathan Wright and Alan Gaby, 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 15 mg/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 87.4 mm to 83.4 mm Hg after eight weeks in patients with untreated hypertension (single-blind trial).

HOMEOPATHIC
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 BP, 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, 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, is all helpful. 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 (the 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 antihypertensives, 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), 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 antihypertensive 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fs further listing of the different Western blood pressure drugs, their actions, efficacy, and side effects. 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.

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. The bottom line is to get the results needed to keep blood pressure normal, close to 130/80. I use my approach in medical therapy, and that's "Lifestyle first, Natural Therapies next, and Drugs last."

REFERENCES

1. http://www.nlm.nih.gov/medlineplus/ (click on Drugs & Supplements link on the left)
2. 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 know more about natural treatment for HBP, the following info on herbs/supplements may also be helpful. http://www.lef.org/protocols/heart_circulatory/high_blood_pressure_01.htm

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