by Tori Hudson, N.D.
Hypertension is the most common chronic disease in older women and a significant risk factor for stroke, heart attack, congestive heart disease, and kidney disease. Beginning at age 50, hypertension is more common in women than in men and even more so in black women. Heart disease and stroke remain the first and third leading causes of death, respectively, in the United States. The most recent national recommendations define incipient hypertension at readings of 140/90mm Hg. Blood pressure readings fairly consistently above these require treatment. Isolated systolic hypertension (systolic BP of 160mm Hg ore greater) or combined hypertension (systolic BP of 160 or greater and diastolic BP 90 or greater) is directly related to increased death.
Hypertension is divided into two main categories: essential or primary hypertension and secondary hypertension. Over 90% of all diagnosed hypertension is essential, meaning that the underlying mechanism is unknown. In the remaining 6-8%, hypertension is secondary to another disease.
Several factors can either exacerbate high blood pressure or contribute to complications and more serious consequences from the hypertension. These include: Black racial background, males, postmenopausal women, earlier age of onset, diastolic pressure consistently >115, smoking, diabetes mellitus, high cholesterol levels, obesity, cardiac enlargement, compromised blood flow to the heart and congestive heart failure.
Individuals with a normal diastolic pressure , but elevated systolic pressure >158 have a two fold increase in their cardiovascular death rates when compared to individuals with normal systolic pressure. The benefit in the reduction in stroke mortality is especially significant in women age 50 and older: one-half of the benefit among white women and nearly two-thirds of the benefit among African American women can be attributed to a fall in blood pressure.
The goal of prevention and management of hypertension is to reduce disability and death by the least intrusive method possible. These goals may be reached with lifestyle modification, herbal and nutritional antihypertensives, or pharmacologic intervention.
Lifestyle changes have the potential to prevent hypertension, lower blood pressure, and reduce other cardiovascular risk factors. Even if lifestyle changes alone are not satisfactory in controlling hypertension, these changes, along with nutritional supplementation and botanical therapies may be able to adequately treat the situation, or just lifestyle changes may reduce the number and dosage of antihypertensive medications needed. Lifestyle modifications for prevention and management of hypertension include:
- Lose weight if overweight. ( Weight reduction of as little as 10 pounds reduces blood pressure in a significant number of individuals who are overweight with hypertension.)
- Limit alcohol intake to no more than .5 oz ethanol or 12 oz beer or 5 oz wine or 1 oz 100 proof whiskey per day. (These amounts of alcohol do not raise blood pressure and may even be associated with a lower risk for coronary heart disease. However, there are many good health reasons to consider avoiding alcohol altogether. )
- Increase aerobic activity (30-40 minutes 4 or more times per week. ( Sedentary individuals with normal blood pressure have a 20 to 50 percent increased risk of acquiring hypertension. )
- Reduce sodium to no more than 2.4 grams of sodium or 6 grams of sodium chloride per day
- Maintain adequate intake of dietary potassium. (High levels of potassium intake in the diet may protect against hypertension and even help to control or improve hypertension.
- Maintain adequate intake of dietary calcium and magnesium. Low dietary calcium intake has been associated with an increased incidence of hypertension in most epidemiologic studies. Increasing the calcium intake my lower blood pressure in some individuals with hypertension, but the therapeutic effect of calcium supplementation is only minimal. Evidence suggests an association between lower dietary magnesium intake and higher blood pressure.
- Stop smoking. Cigarette smoking is a significant risk factor for cardiovascular disease. Blood pressure rises with every cigarette smoked. Risk of cardiovascular disease returns to normal after having quit smoking for 2 years.
- Reduce intake of saturated fats in the diet and high cholesterol foods. Although altering ones intake of fats dos not seem to have much effect on hypertension, abnormal cholesterol ratios are a major independent risk factor for coronary artery disease.
- Reduce caffeine; caffeine may raise blood pressure; however, no direct relationship between caffeine intake and hypertension has been found in most diet surveys.3
- Mental/emotional stress can acutely raise blood pressure and if prolonged, can contribute to chronic high blood pressure. Relaxation therapies and biofeedback have been studied with mixed results, some showing mild, others significant decreases in systolic and diastolic blood pressure.
- Exercise regularly. Blood pressure can be lowered with moderately intense physical activity, and 30-45 minutes most days of the week. Regular aerobic physical activity can reduce the risk for cardiovascular disease and mortality. Even sedentary individuals with a normal blood pressure have a 20 to 50 percent increased risk of developing hypertension.
Calcium Most population studies have indicated that individuals with hypertension consume less dietary calcium than individuals with a normal blood pressure. An increased calcium intake may lower blood pressure in some patients with hypertension, but the overall effect is considered modest. Several clinical studies have demonstrated that calcium supplementation does have the ability to lower blood pressure.
Magnesium At least 10 independent clinical studies show that patients with hypertension exhibit serum and/or tissue hypomagnesemia. On the average, patients with long-term hypertension have at least a 15 percent deficit in total magnesium. Pregnant women with labor-induced hypertension have decreased blood levels of magnesium. Magnesium also improves cardiac performance by enhancing blood flow in the coronary arteries, prevents oxidation of lipoproteins and subsequent atherosclerosis. Therapeutic doses of magnesium range from 400 mg to 1200 mg per day.
Potassium In addition to increasing the potassium foods in our diet, several studies now show that potassium supplementation can reduce blood pressure. It has been shown that potassium supplementation of 2.5 grams per day can lower the systolic blood pressure an average of 12 points and diastolic blood pressure an average of 16 points. Potassium supplementation may be even more beneficial in people over age 65 who often do not respond well to anti-hypertensive drugs.
Coenzyme Q10 CoQ10 deficiency is present in almost 40 percent of patients with high blood pressure. In several studies, CoQ10 has been able to lower blood pressure in hypertensive patients after four to twelve weeks. Typical reductions are in the range of 10 percent for both systolic and diastolic blood pressure. These reductions can be seen with doses of 50 mg three times per day.
Essential fatty acids The daily consumption of fish oils can lower blood pressure in people with hypertension. A groups of researchers at the Johns Hopkins Medical School evaluated the results of 17 clinical trials using fish oil supplementation. They found that the consumption of 3 grams or more per day of fish oil led to reductions in blood pressure of individuals with hypertension. 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 greater at higher blood pressures, and no significant effects were noted in people with normal blood pressure. Fish oil supplements usually provide 180 mg of eicosapentanoic acid (EPA) and 120 mg of docosahexanoic acid (DHA) in one capsule, although higher potency supplements are now available. The fish-oil supplements used in most studies have generally been 4 capsules three times per day, providing approximately 4 grams of fish oil.
Garlic (Allium sativum) Garlic mildly lowers blood pressure in women with hypertension. Studies have shown that garlic can lower systolic pressure by 20-30 mm Hg and the diastolic pressure by 10-20 mm Hg. The majority of studies utilizing a garlic powder tablet provide from 600 to 900 mg of garlic. Capsules that contain 5,000 mcg of allicin are generally considered more potent.
Hawthorne (Crataegus oxyacantha) Hawthorne preparations have been effective in lowering blood pressure and in improving heart function. Although its blood pressure lowering effects should be considered mild, hawthorn is a valuable heart medicine. It can prevent and treat atherosclerosis, lower cholesterol, prevent the oxidation of LDL, improve the blood supply to the heart by dilating the coronary arteries, increasing the force of contraction of the heart muscle and regulating cardiac rhythm.
Mistletoe (Viscum Album) Mistletoe has its historical roots in traditional herbal medicine and is used frequently in this country by herbalists and Naturopathic Physicians to regulate blood pressure. The mechanism underlying the anti-hypertensive action of mistletoe is not well understood, yet it is one of the more potent herbal anti-hypertensives we have. It is often used along with crataegus. Mistletoe is a potentially toxic herb and should be used with caution and with a knowledge of its safety dosage schedule respective to whether its being delivered as a dry powdered herb in a capsule or in tincture. Clinical trials are lacking in the use of mistletoe as an antihypertensive.
Indian snakeroot (Rauwolfia serpentina) Indian snakeroot contains a mixture of alkaloids, including reserpine. The reserpine extract in particular has been used, even within conventional medicine, to lower blood pressure. Reserpine has a sedative effect on the sympathetic nervous system, and this then results in lowering the blood pressure. Rauwolfia is associated with several side effects including stuffy nose, depressive mood, fatigue, slowed reaction times and impotence.
Dandelion leaf (Taraxacum officinale) The leaves of dandelion have a diuretic effect. In one animal study, dandelion leaf exerted a diuretic activity comparable to that of Lasix. The dose used was 8 milliliters of the aqueous fluid extract of the leaf per kilogram body weight.
Numerous other herbs are used in traditional herbal medicine to bring about either a diuretic effect, a calming effect as in the use of nervines, aids to circulation and heart tonics. Some of these herbs include dandelion leaf, lily of the valley and parsely as diuretics. Heart tonics such as motherwort and night-blooming cactus are frequently used along with hypotensive and diuretic herbs in a combination formula. Herbs such as hawthorn, ginger and cayenne are aids to circulation and herbs such as valerian, chamomile, hops, lemon balm and passion flower help to have a calming effect, enabling individuals to respond to stress better.
Lifestyle and herbal/nutritional treatments are a reasonable first line of intervention for mild to moderate high blood reassure. Blood pressures in this range can usually respond to these natural interventions generally without pharmaceutical intervention. Blood pressure must be monitored, and a lack of response within two months, or blood pressures fitting the definition of stage III hypertension should be treated with pharmaceuticals, with natural therapies and lifestyle as an adjunct.
- Appel L, Moore T, Obarzancek E, et al., for the DASH Collaborative Research Group. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med 1997;336:1117-1124.
- Cappuccio F, Elliott P, Allender P, et al. Epidemiologic association between dietary calcium intake and blood pressure: a meta-analysis of published data. Am J Epidemiol 1995;142:935-945.
- Stamler J, Caggiula A, Grandits G. Chapter 12. Relation of body mass and alcohol, nutrient, fiber, and caffeine intakes to blood pressure in the special intervention and usual care groups in the multiple Risk Factor Intervention Trial. Am J Clin Nutr 1997;65(suppl):338S-365S.
- Resnick L, Sealey J, Laragh J. Short and long-term oral calcium alters blood pressure in essential hypertension. Fed Proc. 1083;42:300.
- Altura B, Altura B. Magnesium in cardiovascular biology. Scientific American, Science and Medicine 1995; May/June:28-37.
- Patki P, et al. Efficacy of potassium and magnesium in essential hypertension: a double-blind, placebo-controlled, crossover study. Br J Med 1990; 301:521-523.
- Digiesi V, et al. Mechanism of action of coenzyme Q10 in essential hypertension. Curr Ther. 1992;51:668-672.
- Appel L, et al. Does supplementation of diet with fish oil reduce blood pressure? Arch Int Med 1993;153:1429-1438.
- Silagy C, Neil A. A meta-analysis of the effect of garlic on blood pressure. J Hyper 1994;12:463-468.
- Petkov V. Plants with hypotensive, antiatheromatous and coronarodilating action. Am J Chin Med. 1979; 7:197-236
- Racz-Kotilla E, Racz G, Solomon A. The action of Taraxacum officinale extracts on the body weight and diuresis of laboratory animals. Planta Medica. 1974;26:212-217.