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HYPERTENSION

Updated 7/24/2013   


         Dr. Bernard Presser D.C.

5696 Magnolia Woods Drive

Memphis, TN 38134



 

If you have any questions, please contact us at 901-417-7905

 More articles coming soon.

 


Approximately 50 million adults in the U.S. - 24% of the adult population -- have hypertension or high blood pressure as currently defined. About a quarter of these are under 50 years old.  Only 68% are aware that they have hypertension, 54% are being medically treated, and only 27% have it "under control."

A blood pressure reading of or over 140/90 mmHg is labeled as hypertension.  The most recent guidelines are: (1) High normal: 130-139 / 85-89. (2) Stage 1: 140-159 / 90-99. (3) Stages 2 and 3: 160 or over/ 100 or over.  With no other "risk" factors, lifestyle modification is suggested for all but Stages 2 and 3 when drug therapy is recommended.  It is only with "certain conditions" (such as diabetes, stroke, peripheral arterial disease, heart disease, retinopathy, and nephropathy) that drug therapy is to be the first approach.  Yet, drugs remain the foremost medical treatment.

Despite emphasis on drug treatment, fat-free foods, and salt restriction, the average blood pressure in American adults has risen alarmingly. Compared with data from 1986, the mean systolic and diastolic blood pressure in 1997 was higher by 6.6 mmHg for men and 3.6 mmHg for women.  Although the researchers suggested more drugs should be available to everyone, about 30% of study participants were already taking drugs but were still defined as having high blood pressure. i

DEFINITIONS

Blood pressure (BP) is created by the pumping of the heart.  It is a variable force that moves blood through the circulatory system.  When the heart contracts, blood flows into the arteries, the highest pressure being exerted on the vessel walls is at the end of the contraction.  This is the systolic (top) number (high point during a contraction) in a BP measurement.  When the heart relaxes, blood flows from the veins into the heart and the pressure falls to its lowest level.  This is the diastolic (bottom) number (low point between heart beats).  For years diastolic BP was considered more significant than systolic.  Now it is known that the systolic is far more revealing.  Regardless of patient age, systolic BP "should guide anti-hypertensive treatment."  An intricate and complex system regulates BP which normally fluctuates with any number of factors.

One of the primary regulators of BP is arterioles, small blood vessels that constrict and widen, causing pressure to rise and fall.  If something goes awry - for example, if the arterioles stay constricted - BP stays high.  Most of the time (90% of cases) the cause is unknown and called "essential" or primary hypertension.  Abnormally high and sustained pressure may damage arteries, leading to problems with the heart, brain, kidneys, or thyroid.  Usually there are no symptoms, so it is called "the silent killer."  Hypertension is considered a major risk factor for heart attack and stroke, a contributor to heart and kidney failure.  But BP is "not the only determinant" and the chances of hypertensive persons developing problems in the cardiovascular system or other organs "is markedly influenced by coexisting risk factors..."  As the prevalence of hypertension is worsening despite increased use of drugs, the "urgency and choice of therapy" should be based on other areas including weight control, exercise, reduced alcohol intake, diet, and so on. 

Over the years, hypertension may increase the risk of senile dementia, shrinking the brain.  Elderly people with chronic high BP can lose tissue from parts of the brain involved with memory and language skills.  However, most people in such studies were already taking medication.  Is the problem the blood pressure or the medication or both?  Why didn't the medication protect the people from brain atrophy?

"Preventing high blood pressure isn't like preventing cancer.  It's not something you either have or don't have."  As Johns-Hopkins's Paul Whelton says:  "We draw a line in the sand and say ‘this is hypertension.'  We do it to say that it's the point where the cost and side effects of using a drug are worth it." ii

NORMAL OR AVERAGE?

Hypertension is identified only by measurement of the BP.  But "conventional detection methods are unreliable for three main reasons:" (1) technical inaccuracies (some avoidable), (2) "inherent variability of blood pressure," and (3) the tendency for blood pressure to increase in the presence of a physician or other professional (‘white coat hypertension').  There is no real justification for a rigid separation between what is viewed as high BP and normal BP.  However, "for clinical purposes" a threshold level of pressure "has to be established" above which drug therapy is recommended.  Health risk reduction is supposed to outweigh the adverse effects of treatment.  Yet the level of risk depends on factors other than blood pressure.  Therefore, "there is no reason why the treatment threshold should be the same for everyone."

Many medical school graduates fail to remember the proper technique for taking a BP.  Practicing health professionals probably "need similar monitoring."  A large cuff on the device used to measure pressure (sphygmomanometer) gives lower BP readings than smaller cuffs.  Ambulatory monitoring (readings throughout the normal day by a strapped-on device) yields lower BP readings than the standard way.  BPs rise at increasing distances from the Equator and higher altitudes; are higher in winter than in summer; vary among racial and ethnic groups; are higher with exertion, etc.  The force of blood in its vessels "is continually varying" according to various distances of time after taking food, from exercise, rest, different states of vigor or vivacity, and many other circumstances.  "Doctors play a game of averages when taking blood pressures."  They assume an average person sitting in an average doctor's office has an average BP.

There is "ambivalence" about how BP should be measured.  The measurement must be accurate and it must be repeated on separate occasions to give a true picture of a person's regular levels.  In other words, each person is different; "normality has no meaning" when specific numbers are used to indicate disease risk for a vast number of people.  There is a "difference between a normal level and a healthy level of anything."  The degree to which "normal" values differ from "healthy" values changes with many variables.  "The normal level of pressure has no basis in the pathology of heart disease.  It is an arbitrarily defined threshold."  Although elevated BP often accompanies cardiovascular disease and stroke, it is not necessarily the cause.  Many physicians conclude that the introduction of drug therapy should be influenced less by the level of BP and more by the whole picture of risk.  "Somehow, logic and biological precedent make it hard to imagine any sharp and definitive cut-off between normal blood pressure and hypertension."

High BP is not a disease.  It is a compensation, a protective mechanism, a signal from the body that something is amiss and a pressure elevation is needed to offset the deviation.  For example, misalignment in the cervical spine can cause encroachment of blood vessels to the brain.  The heart is signaled to pump harder and faster to assure sufficient blood supply to the brain, elevating BP.  Medication to lower BP sabotages this natural counterbalance mechanism and totally bypasses the cause.  For many people a slightly elevated pressure can be normal as they age and have no relationship to cardiovascular problems.  By lowering the BP, an abnormal situation may be created that can contribute to a stroke or heart attack rather than prevent one.  In a study of 500 elderly men, those on antihypertensive drugs were compared with those taking no drugs.  While those with a diastolic pressure greater than 90 had a heart attack rate that was the same whether they took drugs or not, those with a diastolic pressure less than 90 who took medicine had a rate of heart attack four times greater than the abstainers.  Lowering BP (except in malignant hypertension) may do more harm than good!  Basing treatment sorely on BP is not warranted "because blood pressure alone may give little useful information about individual risk and consequently about potential individual benefit."

Malignant hypertension progresses rapidly, is accompanied by severe vascular damage, and has a serious underlying cause.  Portal hypertension is caused by obstruction of blood flow through the liver.  Pulmonary hypertension has diminished right-heart function and may relate to blood clots in the lungs.  Renal hypertension accompanies kidney disease.  Essential hypertension has no "known" cause.  Actually, all types of hypertension have a cause.  Elevated BP is an effect. iii

DRUG TREATMENT

There was a five- to tenfold increase in the use of anti-hypertensive medication from the 1950s through the 1980s.  Yet the majority of cases of coronary heart disease and stroke occur at lower BP rates.  Is reducing pressure into the low range of normal better than reducing it to the upper edge of normal?  Is it dangerous to reduce BP even lower?  When various reductions in BP are considered, there is "not a huge difference among patients."  The rates for heart attack, stroke, and death are similar.  "With each medication comes the possibility of side effects" and adding drugs "will produce little additional decrease in the risk of cardiovascular events."  The majority of people diagnosed with hypertension (as many as 60%) have "mild" hypertension (systolic 140 to 159 mmHg and/or diastolic 90 to 99 mmHg).  "But doubt remains whether the benefits of treatment to reduce blood pressure outweigh the risks in individuals with levels this low..."

Classic medical management is diuretics, then calcium channel blockers or beta blockers or angiotensin inhibitors and other drug categories, with new ones continuously emerging.  All drugs give the patient "an overblown confidence" that symptoms are being controlled.  "In the meantime, he is flirting with disaster.  Drugs eventually trigger more disease."  People "successfully treated" with drugs on a long-term basis are still more likely to die from heart disease, stroke, or any disease.  Medications are doubly dangerous.

First, they do nothing towards finding the underlying cause and resolving it, so inevitably things get worse.  Second, they all have adverse (unwanted) effects.  For example, calcium channel blockers can cause dizziness, headache, flushing, swelling of feet and ankles, constipation, increased cancer risk by 60%, shrinking and deterioration of the brain, and increase the death rate from heart disease.

Diuretics cause loss of vitally needed magnesium, calcium, potassium, sodium, chloride, zinc, iodine and other minerals in the fluids that leave the body.  Deficiency or imbalance of any of these minerals can contribute to hypertension in the first place.  BP may thus worsen, and the physician will prescribe more medication with more side effects (unwanted effects).  Diuretics are taken by 20% of people over age 65 and, in that age group, diuretics have more adverse effects than any other prescription drug.  Some large studies have shown increased death rate from mineral wasting.  Common side effects are fatigue, numb or weak muscles, cramps, diarrhea, rash, nausea, vomiting, irregular menstrual periods, and impotence.

Beta blockers have many side effects including fatigue, a heart rate that is too slow, cold hands and feet, faintness, worsening of blood lipids (cholesterol, triglycerides, etc.), loss of libido, impotence, and more.  In fact, "it is impossible to have normal sexual function if you are taking any kind of blood pressure medication."  Further, beta blockers seriously compromise the function of the heart.  Angiotensin II blockers and ACE inhibitors still lack any reliable evidence of safety and effectiveness.  A dry, hacking cough, dizziness, weakness, insomnia, diarrhea, loss of taste, and vomiting are among the side effects.  ACE inhibitors are often ineffective alone, requiring the addition of a diuretic or other drug.

Elderly people taking calcium-channel blockers or loop diuretics have indications of decreased blood supply to the brain and perform worse in mental examinations.  Although high BP is considered a risk factor for dementias in the elderly, studies suggest that "dementia cannot be prevented simply by lowering of blood pressure."  Diuretics and beta blockers are still recommended as first-line treatment for hypertension, but newer drugs such as ACE inhibitors and calcium channel blockers are becoming more popular and account for 55% of anti-hypertensive prescriptions in the U.S.  Sadly, the "success" of the newer drugs "is more the result of effective marketing by pharmaceutical companies than any scientific demonstration of their superiority."  Further, none of the drugs works well in everyone and "predicting individual responses is very difficult."

The truth is that many blood pressure medications represent more of a threat to health than high BP, especially if the pressure is only slightly elevated.  Apparently, anti-hypertensive drugs can cause the very disasters they are supposed to prevent.  But medication should not be stopped suddenly.  Withdrawal must be gradual.  Sudden withdrawal from a powerful drug can cause serious problems.  Although doctors tend to advise staying on BP medication indefinitely, patients can and do get off the pills with impunity and without raising their BP, even older adults who have been taking medications for years.  This is especially possible if regular exercise, weight control, nutritional support, stress reduction, and other imperatives are followed.  Studies show that "no matter how old you are or how long you've used blood pressure drugs, if you have the gumption to stop using medication it may be worth a try." iv

SALT

The assumption that salt causes high blood pressure and edema is extremely controversial.  Some people benefit from removing salt from their diets, others can worsen their condition.  The salt used in conventional medical research is not the natural salt used for millennia, but the same highly refined salt in the shakers on most peoples' tables.  This salt is not even close to being a whole food; it has been processed, stripped of nutrients (leaving only sodium and chloride), contains anti-caking chemicals, potassium iodide, sugar, and other additives.  Whole, natural, unprocessed salt (with 60 or more trace minerals that are easily assimilated) can actually aid the body to regulate fluid, assist the function of the thyroid, adrenals, and other glands and restore pH balance.  The out-of-balance, chemically-refined salt is "hidden" in processed, canned, packaged, and frozen foods - from chips to soy sauce - so what is sprinkled on food in cooking or at the table is only a small fraction of what is actually ingested.  About 75% of sodium comes from processed foods that are already nutritionally depleted.  Biochemical imbalances are created along with a craving for more in an effort to capture the needed balance.  People eating a processed diet get far more refined salt than the sodium needs of their bodies, particularly since they do not obtain the needed minerals and other nutrients to balance the sodium chloride intake.

A small portion of the population (15% to 17%) have "sodium sensitivity."  Processed salt creates reactions that increase the risk for edema and other difficulties.  The kidneys either cannot properly filter or excessively reabsorb the sodium.  Obesity, overweight, insulin sensitivity, and other signs of inadequate nutrition (hunger or starvation for needed natural food factors) are linked to sodium sensitivity.  Thus the magnitude of the sodium/BP relationship might vary with body weight or other deficiency conditions.  If the diet is high in calcium, magnesium, potassium, and other minerals, sodium does not increase BP.  Actually, people who consume plenty of these minerals from whole foods and include sodium in their diets have lower blood pressures than people whose mineral levels are lower than the recommended daily allowances.  Therefore, dietary factors, working directly on their own and/or indirectly through individual needs, "may alter BP favorably or unfavorably."  Discriminating between what the body needs (whole, natural, unaltered foods) and what it does not need (refined, processed, chemicalized, altered non-foods) is the key.

Data linking sodium intake and BP in the general population "are weak."  At least two large studies have shown an increased risk of heart attack as well as all-cause and cardiovascular disease mortality in people who have restricted their sodium intake.  Other studies show that a salt-restricted diet can increase risk of stroke and heart disease.  Contrary to what is thought, no studies have ever proven that salt causes hypertension.  Skirting direct admission, medics say research "suggests" an association between sodium and heart attacks, but there is definitely no cause-and-effect correlation.  Clinicians need to "re-evaluate the simple notion that severe dietary sodium restriction is always beneficial for people with hypertension."  Lowering salt intake does not lower hypertension for most people.  Unlike weight loss, lowering dietary sodium intake "is not an effective long-term measure to prevent hypertension even among a population at high risk to develop this condition."  A meta-analysis showed there are often significant decreases in BP without a reduction in dietary sodium intake.  Re-analysis of 58 studies carried out over a 30- year period until 1997 led to the conclusion that, overall, there is no support for a general recommendation to reduce sodium intake.

Lifestyle modifications - such as increasing exercise, consuming a diet rich in fresh fruits and vegetables and other nutrient-dense foods, losing weight, quitting tobacco, moderating alcohol and caffeine consumption, participating in some form of stress management, etc. - "are likely of greater importance for blood pressure control in the population at large than a single focus on the restriction of salt intake." v

CAUSES

Essential hypertension is usually a result of lifestyle choices.  This means it can often be managed with lifestyle changes which approach the cause(s), not just treat the symptom.  It is "possible to use natural remedies to reduce or eliminate the need for medication in the management of hypertension."  Hypertension is a chicken and egg question.  Which comes first, deterioration of blood vessels and/or heart tissue or the elevated blood pressure?

The cardiovascular system may be likened to a pump (heart) and an array of pipes (arteries) though, in reality, it is far more complex.  In any pump and pipe system, pressure will increase under three conditions: (1) An increase in the volume of fluid. (2) A narrowing of the diameter in the pipes. (3) More forceful pumping action.  Relating these to hypertension:

(1) BP increases as the volume of blood increases.  This is often a result of biochemical imbalances at the cellular level.  For example, a deficit of potassium, calcium, magnesium, water-soluble vitamins (B complex, C complex), a number of trace minerals, phytonutrients, fiber, and other nutrients can affect blood volume.  Inadequate water intake causes the body to hold onto whatever it has by retaining sodium.  Blood flow to less essential areas is decreased so there is more water and increased blood volume for more important, life-sustaining functions.  The result is increased BP.

(2) Arteries and other blood vessels can be narrowed by tightening, constriction, or spasm of the muscles lining the arterial walls, or by atherosclerosis (compensative plaque buildup due to weakening of these walls).  Nutrients that support proper vasodilation or relaxation and opening of the blood vessel "pipes" can help lower BP.  Food factors to support the strength, integrity, and elasticity of those walls usually are required.  Diet, exercise and stress reduction can literally reduce blockages in the arteries.  The kidneys secrete the enzyme renin into the bloodstream which triggers reactions that create angiotensin, a powerful blood vessel constrictor which also affects the kidneys by causing retention of sodium and water.  Renin is generally released by the kidneys when BP drops much too low (as after the loss of large amounts of blood) or when blood flow to the kidneys is insufficient (as in altered prostaglandin production or heart failure).  By nutritionally supporting heart health, prostaglandin production, and abnormal renin levels, the BP, fluid retention, and even clogging of the arteries may be controlled.

(3) Increased impetus in the pumping action of the heart also raises blood pressure.  This can occur by signals from hormones such as epinephrine or norepinephrine brought on by metabolic imbalances or constant stress.  Blood vessel encroachment, stress, a need for more force to get more blood to a suffering area, various nutrient deficiencies, and other factors may necessitate increased pumping action.

Studies reveal that impaired blood vessel dilation or a reduced number of capillaries precede hypertension.  Dysfunction in the endothelial tissues lining blood vessel walls or lack of elasticity (increased rigidity) of arterial walls are other discoveries.  Kidney function is altered in hypertension, but still unresolved is the question of whether the kidney function changes are a consequence of hypertension or the primary basis of the problem.  Many lines of evidence indicate that kidney function is altered before the development of the high BP.

Weight loss is one of the most effective strategies in reducing BP for obese people.  With every extra pound of weight a person gains, there is a corresponding increase in blood volume (increase in fluid to be pumped), and the heart must work that much harder (more forceful) to pump more blood through a more extensive circulatory system.  A 10- to 20- pound weight gain during adulthood can add to the risk of high BP, but a comparable weight loss can help reverse this risk.  About half the cases of hypertension may be related to long-term weight gain since age 18.  "Among obese individuals, even a modest weight loss of 5 to 10 percent can significantly reduce blood pressure."  People who are just slightly overweight are more likely to have hypertension than people who maintain their normal weight.  Weight loss reduces the number of and doses of medication required to reach target BPs in stage 2 and 3 hypertensive patients.

Caffeine raises BP.  An equivalent of 2 to 3 cups of coffee raises systolic BP significantly for at least three hours after ingestion.  Habitual coffee drinkers receiving a daily dose of 500 mg of caffeine experience significantly higher workday BP and heart rate.  "Caffeine may be the most popular drug in the world, and its side effects are not inconsequential."  Cessation of caffeinated coffee can result in dramatic reductions in systolic and diastolic BP.  Alcohol consumption may be another important modulator - there is often a linear relationship between alcohol intake and BP.  The hypertensive effect is more pronounced in frequent drinkers and in women (who break down alcohol slower than men).  Reduction or cessation of alcohol intake results in decline in BP.

There is a correlation between lead intake or bone or intracellular lead levels and hypertension.  Lead concentration is much higher in persons with elevated BP.  Environmental lead exposure in industrialized societies is suspected and, for some, the use of diuretics may be involved since these drugs can affect kidney function, bone metabolism, and the kidney clearance of lead.  Cadmium toxicity can cause BP to climb.  Pollutants containing cadmium permeate the air, water, and foods.   Cadmium is high in paints, solder, auto exhaust, and cigarette smoke.  Gradual buildup can cause - among other things - high BP.  Smoking contributes to hypertension through inhaled cadmium, by constriction of blood vessels, and by depletion of vitamin C complex from the body.  Non-aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen increase the risk of developing high BP.  BP can also rise when women take estrogen in drug form (oral contraceptives or hormone replacement therapy).  Chemical or environmental sensitivities can contribute to hypertension.  Sensitivities to natural gas, gasoline fumes, chlorine, air pollution, auto exhaust, soft plastics, cleaning chemicals (Lysol, phenol), perfumes, formaldehyde, pesticides, tobacco smoke, or other chemical exposures may be involved.

Sleep-disordered breathing (repeated episodes of apnea and hypopnea during sleep) may be associated with hypertension.  Mental and emotional factors can be involved.  For example, there is a two-fold increased risk of hypertension among people with an extreme anger expression style.  Individuals reporting problems in their marriage are more likely to have elevated BP.  High stress is associated with high BP.  Stress is an individual's perception of threat and differs tremendously among people.  Social support, including friends or a loved pet, can have a calming and stabilizing influence on BP and heart rate.

Low birth-weight increases risk of hypertension.  Individuals weighing less than 5.5 pounds at birth have 39% to 43% higher risk of high BP as adults.  "Disproportionate retardation of fetal growth results in increased blood pressure and increased risk of cardiovascular mortality."

Impaired blood sugar metabolism affects an upward shift in BP.  Consumption of refined sugars and artificial sweeteners no doubt play a huge role.  Researchers report they are able to raise BP at will in their laboratories by providing refined sugar to both experimental animals and human volunteers.  Refined carbohydrates (sugars) are associated with BP elevations, while complex carbohydrates (starches, vegetables) and soluble fibers (guar, psyllium, oats, etc.) are associated with BP reductions.  Refined sugars boost levels of renin and catecholamines that can up BP and trigger spastic reactions in blood vessels.  Insulin, which rises markedly in the presence of refined sugars, causes the body to retain sodium instead of excreting it.  For every gram of refined sugar eaten, three grams of water is needed for transport, storage and metabolism; this increases fluid volume.  Caffeine, theophylline (in tea), and vanillic acid (oxidized from vanilla) in foods taken with refined sugars enhance adrenaline production.  Refined sugar eaten with salt releases insulin and adrenaline; both cause sodium retention.

In still undeveloped countries, the high BP rate is as little as 7%.  In the U.S., it is around 26%.  People in developed countries smoke more, drink more, and eat more fatty, salty, fast foods.  Perhaps a diagnosis of "fast-food hypertension" is needed.  Food sensitivities can affect BP - most common are chocolate, corn, peanuts, nuts, pork, coffee, milk (pasteurized), and wheat.  Continuous licorice consumption has been linked to BP increases.  However, a daily intake of over 100 grams (about 20 tablespoons) is usually needed to raise BP markedly.

Excess animal fats augment BP, while polyunsaturated fats - particularly omega-3 fatty acids - may help lower pressure.  Commercially raised animals carry more fat than nature intended, are deficient in omega-3s, and the fat is contaminated with pesticide, hormone, and drug residues.  Unnatural toxic fats can affect BP.  Commercially-grown grains, legumes, and vegetables are also deficient in omega-3s and other needed nutrients.  Altered fats - refined, hydrogenated, overheated (as in fried foods) - create reactions that can elevate blood pressure.  A "fast-food" diet provides altered fats, refined sugars, refined starches, and refined salt.  A perfect prescription for hypertension! vi

NUTRIENTS

Diet has the potential to "obviate or reduce the need for anti-hypertensive medication" in many people.  "By far," says Dr. Sherry Rogers, "the most common causes of hypertension are undiagnosed nutrient deficiencies."  Not only what an individual is not getting in the diet, but also what he or she is getting has important ramifications.  Processed foods, trans fatty acids and other altered fats, pasteurized milk products, refined sugars, refined grains, chemical food additives, artificial sweeteners, overcooked foods or foods heated to very high temperatures can all cause imbalances, deficits, and toxic by-products.  Most can indirectly contribute to spastic reactions in blood vessels, stress the heart and kidneys and vessel walls, and more.  Pesticide, drug, and hormone residues also upset the biochemistry.

The most important method of preventing and treating hypertension is a healthy diet.  Some studies show that a high complex carbohydrate, low-fat diet is helpful.  An equal number of studies show that a diet adequate in protein and fat yet relatively low in carbohydrates is balancing.  Both approaches seem to work.  The answer is twofold: (1) The diet must be tailored to the individual, their tendencies and current needs.  (2) Foods must be whole, unaltered, and natural.

Vegetarian-type diets often aid hypertension and CVD.  Other studies show that people who eat more protein (including meats, seafood, eggs and dairy products) have lower BP.  Historically, protein was thought to raise BP.  This is not true of all people.  Some are metabolic carnivores and need the addition of meat.  Vegetables, whole grains, legumes, seeds, nuts, and other unaltered foods - when live or raw (such as sprouted) - work wonders for some people whereas others may need their grains, legumes, and vegetables lightly cooked.  High fiber foods can effectively lower BP, particularly when uncooked.  Naturally fermented milk results in a decrease in systolic and diastolic BP.  Each person has unique needs.

Although individual nutrients in foods have been studied and often found to be significant in their benefits, it "has become evident that certain complex dietary patterns have a blood pressure-lowering effect and may help protect against the development of hypertension."  People are supposed to eat foods, not single nutrients.  Whole foods are complexes of macronutrients, vitamins, minerals, fiber, phytochemicals, and other factors that in combination can lower BP.  Scientists have deduced that nutrients such as calcium or magnesium in foods play a role. But when people are given calcium or magnesium supplements - isolated, inorganic minerals - BP barely budges.  Supplementing the diet with various single nutrients sometimes lowers BP but results are always "ambiguous."  Scratching their heads, scientists admit it "may be a combination of nutrients" that does the trick.

The landmark DASH (Dietary Approaches to Stop Hypertension) study determined that foods can lower high BP as well as the most powerful prescription drugs.  This large study found that eating an abundance of fresh vegetables, fruits, and low-fat dairy products, reducing saturated and total fat, and maintaining salt intake about the same as consumed by most Americans, BP is brought down as quickly and as significantly as medications.  Though the benefits were attributed to the mineral content and other specific nutrients, overall emphasis was totally supportive of whole foods rather than single nutrients for optimal BP control.  Diet provides a strategy to treat and possibly prevent chronic medical problems "whose control continues to elude us."

Consistently, fruits and vegetables rate high in their ability to balance BP.  Fresh whole eggplant, guava fruit, potatoes, apples, apricots, bananas, strawberries, oranges and grapefruit, avocados, carrots, broccoli, peas, green leafy vegetables (all good sources of minerals, phytochemicals, vitamins) and others have therapeutic values.  James Duke, Ph.D., explains that fava beans, celery, tomatoes, and onions contain several compounds with BP-lowering activity.  As little as one clove of garlic (raw is more beneficial than cooked) a day can reduce hypertension.  A 62- year old Chinese immigrant treated his hypertension with an ancient Asian remedy: he ate two stalks of celery every day for a week.  He was able to lower his BP from 158/96 to 118/82.  His medical student son and a pharmacologist were curious about how celery would bring such relief.  Their research indicated that compounds in the vegetable helped the inner walls of blood vessels to relax.

In people with normal BP and normal cholesterol levels, who ate high fat meals - containing refined or otherwise altered fats and fats from animals raised commercially - had a dramatic loss of blood vessel relaxation.  The vessels constricted, raising BP.  However, this "bad" induced spasm effect on blood vessels is countered when vitamin C complex and vitamin E complex are taken before the meals.  "That means that there is a factor above and beyond the timely process of cholesterol build-up that makes us more prone to hypertension, heart attack or stroke every time fat is eaten."  E-series prostaglandins are low in many patients with high BP.  Obtaining natural unaltered, "clean" fatty acids in the diet seems to normalize these prostaglandins.  But this good effect stops when aspirin is taken; hypertensives who take daily aspirin are "doing exactly the wrong thing."vii

SPECIFICS

Raised uric acid concentrations in the blood are commonly found in hypertensive people.  This may reflect a decrease in blood flow to the kidneys and/or it may reflect a systemic deficiency of minerals.  "Whether hypertension is genetic or environmental in origin, control of dietary mineral intake has a place in its management and prevention."  If the intakes of calcium, magnesium, potassium, and other minerals and nutrients (in food forms) are increased in the diet "the percentage of Americans with moderately severe hypertension would be decreased by nearly half..."

So-called "food products" such as snacks, sweets, and soft drinks have supplanted nutrient-rich foods such as fruits, vegetables, whole grains, unpasteurized milk, and total proteins (such as raw nuts, seeds, etc.).  This suboptimal nutrient intake is "far more likely to contribute to the prevalence of hypertension than salt..."

Calcium, magnesium, and potassium are known to lower BP if needed.  Foods with high mineral content have been noted for their beneficial influences on BP levels.  Calcium, when deficient, is consistently and independently associated with high BP among those not previously diagnosed as hypertensives.  People who consume at least 1,000 milligrams (mg) of calcium per day in their food lowered their risk of hypertension by about 12%.  Hypertensives who consume between 1,600 mg and 2,000 mg of calcium in their diets may lower their BP by 11% or 12%.  However, alcohol interferes with absorption of calcium and could block the BP-lowering benefits.  Preeclampsia, a type of high blood pressure that can develop during pregnancy, may be prevented with calcium supplements.  Supplementation may also prevent salt-sensitive individuals from developing hypertension.  Over 80 studies have reported lower BP after "dietary calcium enrichment".  In a meta-analysis of 23 studies of about 39,000 people, a consistent inverse association was found between dietary calcium intake and BP.

Calcium may properly balance electrolytes, aid calcium-regulating hormones, and assist the nervous system.  Calcium supplements help lower BP in some hypertensives though results are mixed.  Some studies report significant decreases in BP while others report only small reductions or no effects at all.  The reasons may be related to the need for other nutrients associated with calcium absorption and utilization.  Vitamin D deficiency, increased concentrations of parathyroid hormone, essential fatty acid deficits, an imbalance of other minerals - all may play a part.  Another reason may relate to the use of supplements; isolated, inorganic sources of calcium will not have the nutritional benefits of food or food complexes.  Indeed, the greatest improvements are noted when mineral-rich foods are added to the diet.

Various studies show that when bodily magnesium levels decrease and intake is low, reversible hypertension results.  About 50% of magnesium-depleted patients have hypertension and BP returns to normal with supplementation.  Yet its beneficial effect "cannot be isolated from those of potassium and calcium."  Just as Nature never produces foods containing one mineral or other nutrient, the effects of dietary nutrients on the body do not occur independently but rather within a complex interplay which supersedes the effects of a single element such as magnesium, calcium, or potassium.  Nutrients are interdependent, interworking complex components of foods, and their physiologic actions are expressed within harmonious integrated pathways in the body.  Magnesium is required for numerous enzyme functions, relaxation of muscles in blood vessel walls, and for cell-membrane permeability to calcium, sodium, and other nutrients.  It may also help to balance adrenal activity.  Magnesium has a significant effect on high BP, reducing both systolic and diastolic levels in hypertensives.

Low potassium intake may contribute to the development of high BP.  Increased potassium intake is recommended to prevent and treat hypertension, particularly for those unwilling to reduce their intake of salt.  There has been "consistent evidence" that increasing dietary potassium can significantly lower BP in salt-sensitive people.  Severe potassium restriction within a short time promotes salt-sensitivity in people with normal BP.  A meta-analysis of 33 randomized controlled trials indicate that this mineral is associated with a notable reduction in both systolic and diastolic BP.  Yet the responses to potassium supplements have been "variable;" again the downfall of using a single, non-food nutrient.  Research points to the ratio of sodium to potassium as contributing far more to hypertension than sodium intake itself.  Potassium together with sodium and other nutrients keep all muscles, including the heart, contracting and relaxing properly.  Potassium helps prevent fluid retention and plays a regulatory role in calcium balance.  In fact, calcium, magnesium, potassium, and sodium in balanced food form - foremost among a multitude of other nutrients - are all essential to BP equilibrium.  Studies confirm the need to "avoid diuretic-induced potassium depletion".

Selenium-based compounds have exhibited anti-hypertensive activities in animals and humans.  As the trace mineral activator of the vitamin E complex, selenium works with the rest of the E components (especially "E2") in relaxing and supporting the integrity of blood vessel walls.  Low vitamin E complex levels have been associated with higher BP in women with preeclampsia.

A number of studies have shown an inverse relationship between BP and vitamin C complex intake, including flavonoids and rutin.  Individuals with the highest levels of vitamin C complex in their blood have the lowest BPs, even in those with normal pressures.  Use of ascorbic acid (so-called "vitamin C," a synthetic, isolated fraction) has elicited some pressure-lowering effects, though small and often lasting a short time (such as 20 minutes).  Huge doses are sometimes suggested for extended periods, but this can create biochemical imbalances, worse than deficiencies.  Some researchers have observed that real nutritional benefits may not come from ascorbic acid, "but from other compounds in high vitamin C foods."  Vitamin C complex contains components important to blood vessel wall strength, integrity, and elasticity as well as support to heart and kidney health, mineral balance, and more.  High ascorbic acid supplementation may result in depletion of these factors, making a bad situation worse.  The synergistic effects of vitamin C complex, vitamin E complex, and carotene complexes have led to research into various combinations.

Studies have demonstrated a clear benefit to people taking coenzyme Q10 (ubiquinone).  In one study, after an average of 4.4 months, 51% of the patients were able to discontinue their hypertension medications.  Other studies show substantial reductions for systolic and diastolic pressures in groups taking CoQ10.  A deficiency of CoQ10 is found in 39% of patients with hypertension.  CoQ10 is only one of many coenzyme Qs.  Food sources containing all these coenzymes along with their natural coworkers are always best.  Vitamin B complex is associated with balancing BP.  Support to heart muscle function, blood vessel wall relaxation, and other neurological factors - including handling of stress - is no doubt why it is so helpful.  Zinc has also been associated with favorable BP responses.

Lower BPs occur in persons who obtain more omega-3 fatty acids in their diets.  Over 60 double-blind studies have demonstrated that supplements - either with fish oil or flaxseed oil - are very effective in lowering BP.  One study found that for every absolute 1% increase in body alpha-linolenic acid (omega-3) content, there was a decrease in systolic, diastolic, and mean BP of 5 mm Hg.  Other studies confirm the BP-lowering effects of the polyunsaturated family of fatty acids (linoleic acid, gamma-linolenic acid, arachidonic acid, dihomogamma-linolenic acid) as well as the omega-3s. Borage oil, black currant seed oil, and evening primrose oil are sources of gamma-linolenic acid that can lower pressures.  Olive oil, a member of the monounsaturated family, also lowers BP and renders BP-lowering medications less necessary.  The exact mechanisms of the action of fatty acids "remain unidentified" though they may be "mediated through changes in prostaglandin metabolism."  It seems that most any unaltered fatty acid is healthful.  Trying to pinpoint "the" chemical compound in food is grasping at the wind.

Various herbs have been used for many years to aid elevated BP.  Foremost is garlic which can normalize blood pressure when about a clove a day is consumed.  The evergreen leaves of Olea europaea (olive tree) have been used since the turn of the century.  Hawthorn berries can dilate blood vessels and increase stress tolerance.  Kava-kava is helpful for its relaxing effects.  Alfalfa, kudzu, celery, onion, tomato, broccoli, carrot, purslane, saffron, valerian, rauwolfia, periwinkle, mistletoe, kelp, and others have been successfully utilized.

Whole, natural, unprocessed foods balance BP, "but attempts to identify dietary components responsible have been unsuccessful."  It is the whole food package with its intrinsic nutrient combination that works. viii

STRESS

Stresses and anxiety contribute to hypertension.  Job strain by itself may contribute, particularly in people who hold a "high-strain"  job such as air-traffic controllers or drivers of city buses, though BP at work is generally higher than at home.  However, the amount of stress or strain in anything is determined by the perception of the individual.  Nevertheless, a job that demands careful attention to details but allows the worker little latitude for decision-making and offers little personal satisfaction is known to take its toll on health.  A sense of control is very important.

People who develop hypertension have greater anxiety than those whose pressures remain normal.  Anger and anger suppression as well as symptoms of depression are noted as precursors to hypertension.  BP surges are related to serious stresses such as sudden death of a loved one, myocardial infarction or other serious illness.  The higher the stress, the higher the BP.  Patients report significantly higher levels of psychological distress, significantly lower levels of vocational and social role-functioning and vitality, and more adverse views of their physical and mental health.

Cognitive therapy, relaxation training, meditation, and biofeedback have been utilized in health promotion for hypertension.  Cognitive-behavioral therapy including weekly group sessions that emphasize relaxation, stress management, and ways to reduce hostility and defensiveness help patients lower BP and cut medication use.  Strong religious belief is associated with lower BP levels.  Optimal health is a function of all aspects of wellness, including spiritual well-being.  People who pray, attend a religious service once a week, or study the Bible daily are 40% less likely to have high blood pressure than those who do not.  Of the personal and social aspects of religion, the social part seems to be most helpful.  Patients regularly practicing transcendental meditation show greater BP reductions than those using progressive muscular relaxation or a "usual care" program.  Meditators have significantly greater survival rates than randomized controls.

Shallow breathing or holding the breath triggers a biochemical cascade of events that raises BP.  Eastern cultures place great significance on proper breathing techniques that lower heart rate, BP, and cardiac output, increase blood oxygen levels, promote clearer thinking, and relieve stress.  The benefits of proper diaphragmatic breathing are multiple.  Any number of reflective, spiritual, or relaxing practices can be beneficial and enlightening.  Any method is good that improves intuitive understanding of the relationship between humans and their environment. ix

EXERCISE

It has long been known that regular exercise can help control elevated BP.  Exercise alone may aid some people reduce their medication.  One study concluded that exercise may work just as effectively as drugs in lowering high blood pressure.  Both aerobic activities and weight training are worthwhile.  Stretching, T'ai Chi, and yoga are also excellent and are very calming.  The key is regularity.  Getting fit is imperative - there is a significant drop in death rates of hypertensives with higher fitness.  So even if BP does not drop significantly, being fit helps to compensate for the increased cardiac burden, perhaps by lowering blood vessel resistance and/or lowering stress hormone levels. x

CONCLUSION

There are many therapeutic avenues open to the person with high BP.  First the cause should be determined if possible.  Then lifestyle changes should be made including weight loss, diet, supplementation, exercise, and psychosocial support.  Hypertension is not a "disease" in itself.  It is a signal from the body that something else is taking place that results in the reaction or compensation of elevating BP.  Forcing the BP down with drugs does not solve the underlying problem.  Other options can thus be explored, allowing patients to realize their own level of control and touch their body's innate wisdom.

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Originally published as an issue of Nutrition News and Views, reproduced with permission by the author, Judith A. DeCava, CNC, LNC.