Naturopathic approach to hypertension

Townsend Letter for Doctors and Patients, June, 2002 by Dr. Farhang Khosh, Dr. Mehdi Khosh

High blood pressure (hypertension) is one of the leading causes of disability or death due to stroke, heart attack, heart failure and kidney failure. It's also the most common chronic illness Americans face. Yearly expenses related directly or indirectly to the treatment and detection of hypertension in the United States are approximately $10 billion, excluding the enormous yearly financial burden of $259 billion and the social burden from heart disease and stroke, which remain the first and third leading causes of death, respectively, in the United States. Despite the importance of these observations, blood pressure is poorly controlled in the United States. (1) An estimated 50 million American adults (25% of all adults) have high blood pressure, but only 68% are aware of their condition, and only 27% have it under control. (2) Each year, 2 million new cases of hypertension are diagnosed. (3) The risk of hypertension increases with increasing age in both men and women. (4) Until age 55 more men than women h ave hypertension, after that it is the other way around. African Americans have significantly more risk of developing high blood pressure, than Caucasians and Mexican-Americans.

There are two types of high blood pressure: essential (primary) hypertension, and secondary hypertension. Essential hypertension is when the physician cannot identify a specific cause. This is the most common type of hypertension, which accounts for 90% of all cases of high blood pressure. Genes play a major role in essential hypertension. In secondary hypertension, the cause can be identified and usually is treatable or reversible.

To describe blood pressure, two numbers are used; systolic (upper number) and diastolic (lower number). Optimal blood pressure is less than 120/80 mm Hg. (5) The systolic pressure measures the force that blood exerts on the artery walls as the heart contracts to pump out the blood. The diastolic pressure measures the force when heart relaxes to allow the blood flow into the heart.

Conventional Guidelines for Drug Therapy consists of the following (6):

1. Diuretics, which cause the body to excrete water and salt

2. ACE inhibitors, which reduce the production of angiotensin, a chemical that causes arteries to constrict. So, the end result with ACE inhibitors is vasodilation

3. Beta-blockers, which block the effects of adrenaline; therefore, heart pumps easily, and vasodilates (widening blood vessels)

4. Vasodilators

5. Calcium-channel blockers, which help decrease the contractions of the heart and vasodilate.

Beta-blockers, diuretics, or both are usually the first line of treatment for most physicians. (7)

Holistic Approach to Hypertension

Diet

Low in saturated fat, high in complex-carbohydrates; increase whole grains (whole grains are almost complete meals within themselves, containing fiber, protein, complex and simple carbohydrates, fats, vitamins such as B-family and E, and many minerals like calcium, magnesium, potassium, iron, copper, and manganese which are essential for health), fruits, vegetables, nuts, seeds, legumes, fish, soy products; food rich in potassium, calcium and magnesium (carrots, spinach, celery, alfalfa, mushrooms, lima beans, potatoes, avocados, broccoli, and most fruits); salt restriction; fiber is very important in blood pressure and to reduce cholesterol and prevent atherosclerosis (hardening of arteries). A diet rich in garlic and onion is as important as any other supplements.

To determine the impact of dietary patterns on the control of hypertension researchers studied the subgroup of 133 participants with systolic blood pressure (BP) of 140 to 159 mm Hg and/or diastolic BP of 90 to 95 mm Hg enrolled in the Dietary Approaches to Stop Hypertension (DASH) study. Participants were fed a control diet for a 3-week period and were then randomized to receive for 8 weeks either the control diet; a diet rich in fruits and vegetables, but otherwise similar to control; or a combination diet rich in fruits, vegetables, and low-fat dairy products, including whole grains, fish, poultry, and nuts, and reduced in fats, red meats, sweets, and sugar-containing beverages. Sodium intake and body weight were held constant throughout the study. The combination diet significantly reduced systolic BP and diastolic BP. The fruits-and-vegetables diet also significantly reduced systolic and diastolic. The combination diet produced significantly greater BP effects than the fruits-and-vegetables diet. Blood pressure changes were evident within 2 weeks of starting the intervention feeding. After the 8-week intervention period, 70% of participants eating the combination diet had a normal BP (systolic BP < 140 and diastolic BP < 90 mm Hg) compared with 45% on the fruits-and-vegetables diet and 23% on the control diet. In patients with hypertension, the DASH combination diet effectively lowers BP and may be useful in achieving control of Stage 1 hypertension. (8)

Life-style Changes

Weight loss -- The United States is in the midst of an epidemic of obesity involving more than one-third of the adult population. (9) Weight gain is very high risk in determination of hypertension. It is very critical to lose weight in a slow fashion to control hypertension. Rapid weight loss is not advised. Many studies have shown those overweight-hypertensive patients can reduce their medication with weight loss.