September 2011 Newsletter PDF Print E-mail

 

Report of the Month

Hypertension

Hypertension has always puzzled me, and I guess still does, despite all the reading and research I have done on the subject.

Until the sphygmomanometer was developed hypertension was never a medical diagnosis; it then suddenly became a disease to be treated quite aggressively at times, when clearly it is really just a symptom.

While there are a few known causes, the majority of people with high blood pressure have what is called essential hypertension in which the underlying cause is unknown. Nevertheless good research work over the last 20 years clearly points to a number of pathophysiological factors which contribute to the hypertension. I will discuss these factors later in this section, but the overwhelming feeling I have at the end of my probing and reading is that hypertension management has been driven by specialists with personal agendas and pharmaceutical companies pushing their own monetary goals; very little seems to be focused on what is best for the patient.

Evidence-based Medicine is clearly not the criteria used by hypertensive committees in putting together the various management protocols directed at doctors and specialists to manage their cases. A great deal is just the politics of medicine and financial incentive. That is my conclusion, and the deeper I go the more disturbed I become about the way medicine is practised today.

What is clear, however, is the enormous difficulty of doing really good science, which includes good samples of patients of all ages and races, and carrying on the trial for a long enough period to be significant. Hypertensive patients need to take their medication for the rest of their lives, according to standard protocol. Trials which last less than 10 years are not going to be seeing most of the long-term side-effects. It is now recognized, for example, that the long -erm use of diuretics increases the incidence of diabetes, and of course mineral deficiencies.

Despite over 100 antihypertensive drugs that have been approved as being safe and effective, hypertension continues to be a major problem, and is poorly managed. Of special note is the fact that the incidence of cardiovascular disease was already decreasing before the use of antihypertensive drugs became widespread. According to the Journal of the American Medical Association nearly one in three US adults has hypertension. Thirty percent were unaware of their problem, 42% were not being treated, and at the time that their BP was measured, 69% did not have their BP controlled. Side-effects from hypertensive drugs is a major problem that tends to be dismissed by most doctors, but is a major reason for patients not taking the drugs regularly, or even stopping medication. Hypertension causes no symptoms for years, and no one wants to start having symptoms when they start the drug. Impotence, tiredness and headaches are common side effects I see in practice.

Most studies suggest that high blood pressure is a problem, and is the most important risk factor for cardiovascular disease. Good control of blood pressure to a systolic of 140 would reduce strokes by 28-44%, and ischemic heart disease by 20-35%, preventing 21400 strokes and 41400 heart attacks each year in the UK.

He FJ & Macgregor GA Cost of poor blood pressure control in the UK: 62000 unnecessary deaths per year. J Human Hypertension 2003;17:455-457

As people get older, blood pressure tends to go up in most people so that by the age of 70 years, 90% of people have hypertension. Is this a natural consequence of aging like the fall of hormones, and does it require treatment? Hopefully I can answer some of these questions without confusing everyone even more. It would be nice if it was as simple as treating everyone with a blood pressure over 140/90. In fact the whole idea of the polypill is that the lower the blood pressure the better, so that everyone should be taking the polypill even if they don’t have high blood pressure yet, as a preventive measure.

What is the polypill?

Specialists who believe that the lower the blood pressure, the better the long term outcomes, have developed the polypill, which is a combination of a diuretic, beta blocker and aspirin in low doses. The polypill is already in use in some parts of the world and is prescribed as a preventive medicine, as hypertension seems to be a naturally occurring event in almost everyone, and that lowering the BP, according to these specialists, will save lives.

I find the whole concept of the polypill quite scary. It means starting medication at a much younger age, and even at the doses given side-effects still occur. While the dose may be low, it still needs to be high enough to have physiological effects.

Cause of Hypertension

(Not an essential read but interesting nevertheless)

The person with the best credentials for discussing this subject is probably Professor John Laragh. He founded the American Society of Hypertension in 1986 and became its first President. He also established the American Journal of Hypertension. He is the author of over 900 articles and several texts dealing with hypertension and was featured on Time magazine’s cover in 1975 for discovering the role of the rennin-angiotensin-aldosterone system in regulating normal blood pressure. Despite the evidence supporting his research work and the background cause of hypertension, the focus of all management is not on the cause of hypertension but on bringing blood pressure down using 2, 3 or even 4 drugs if necessary. Professor Laragh says this is not evidence-based medicine because it is not addressing the problem but rather the blood pressure, using drugs which are seriously toxic. Any doctor giving more than two drugs is following directives, which are wrongly based; and he says that most hypertensives can be treated with one drug which is used to treat the underlying cause.

According to him, hypertension is caused in most patients either by excess rennin or is primary sodium (volume) related. He has the research to back this up after developing a rennin assay.

The full story goes like this:

Rennin is produced in the kidneys, and of itself does not cause hypertension.

Rennin acts enzymatically on a circulating protein called angiotensinogen to release an inactive substance called angiotensin 1. This in turn is converted to angiotensin -11.

It is this substance which is the most powerful vasoconstrictive agent known, and is responsible for all cases of malignant hypertension and probably two thirds of essential hypertension.

Angiotensin -11 also promotes vasoconstriction via a slower and more sustained elevation of blood pressure by stimulating aldosterone secretion to promote body sodium retention and expand blood volume by acting on the kidneys.

With these pathways in mind drug treatment becomes more meaningful, which is  why Prof Laragh can claim to treat most hypertensives with one drug only. His research was largely responsible for the development of many of the drugs used today.

He divided the drug approach into those drugs which affected rennin or angiotensin production, and those which had an influence on sodium retention.

The anti-rennin R type drugs:

Beta blockers which block the kidney beta receptor rennin release.

Angiotensin Converting Enzyme inhibitors (ACE inhibitors) eg captopril, enalopril.             

Angiotensin 11 receptor blocking drugs (ARB drugs)

The above drugs however will not work well in those patients with low rennin hypertension, which responds extremely well to  the natriuretic V type drugs such as the thiazides, spirolactone and calcium channel blockers that reduce body sodium and thus blood volume.

Rennin measurement are not available in most centres, so Professor Laragh suggests a trial of using one of the drugs from the anti-rennin list, and if the result is poor then to use one of the drugs from the volume hypertensive list. Seldom is it necessary to add a second drug, or to combine drugs from the separate categories. He is aghast at the use of more than two drugs to control hypertension and believes this is bad medical practice.

Laragh JH, Sealy JE Relevance of the plasma Renin hormonal control system that regulates blood pressure and sodium balance for treating hypertension and for evaluating ALLHAT . American J of Hypertension 2003;16:407-415

So much for the ALLHAT trial, which is generally regarded as the gold standard of drug trials and upon which most medical guidelines for hypertension are constructed. He is very critical of this study which he considers to be badly designed, and expects many law suites to follow from this trial. The ALLHAT trial was conducted over many years and used many hypertensive centres, comparing the different drug groups to decide which would be superior. The conclusion of this study was that all the drugs gave the same approximate results, and that diuretics were no worse than the other groups. The suggestion was that diuretics should be the first option in all hypertensive patients because they are as effective and cost-effective. The end point of the ALLHAT study was the level of the blood pressure, and the idea was to increase the number of drugs starting with diuretics until the blood pressure was under control. Laragh regards this approach as malpractice as it places no emphasis on the pathophysiology but will lead to patients stopping medication because of side effects.

ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretics: the Antihypertensive and Lipid-lowering Treatment to Prevent heart Attack Trial. JAMA;2002;288:2981-2997

Drug problems

All the drugs have side-effects and clearly the higher the dose for the more serious hypertensions and the longer the treatment, the more side effects one will see.

Diuretics lead to potassium and magnesium depletion, cardiac arrhythmias and a significant increase in diabetes. The diuretic hygroton, for example, produced an over 11% incidence of real and permanent diabetes in less than five years in the ALLHAT trial. This would work out to 22% after 10 years. Surprisingly , the ALLHAT investigators ignored this information and still recommended diuretics as first line medicine even though the average follow up was only 3 years. There was no suggestion, for example, to exclude patients with metabolic syndrome or high fasting blood glucose. They can also deny high-rennin patients protection from fatal cardiovascular complications that anti-rennin medication can give. The ALLHAT trial is supposed to be a good example of evidence-based medicine.

Many of the side-effects of diuretics can be avoided by using spirolactone.

Calcium Channel blockers have also not had a good press with an increased risk of myocardial infarction and even some suggestions of an increased risk of cancer. They also have their own collection of adverse side effects.

Thompson PL The Calcium channel blocker controversy in 1997. Aust NZ J Med;1997;27: 330

Fitzpatrick AL et al Use of calcium channel blockers and breast carcinoma risk in postmenopausal women. Cancer.1997;80(8):1438-1447

Beta-blockers are no longer recommended as first-line therapy for hypertension. They appear to be less effective in reducing the incidence of stroke, myocardial infarction and death compared to all other hypertensive drugs taken together, but also when compared to placebo or no treatment. There is also a trend towards worse outcomes than the other anti-hypertensives.

Wiysonge CS et al Beta-blockers for hypertension. Cochrane Database Syst Rev 2007.Jan 24;(1):CD002003

Besides the efficacy of the drugs there is also the question of adverse effects, which  is often the reason for so many ‘healthy’ people who don’t have any symptoms from their high blood pressure stopping their medication, which now produces symptoms.

Personal Conclusions

I think the work of Dr John Laragh  needs serious study by medical doctors because it would certainly cut down on their use of multiple drugs and help them to identify the two types of hypertension; nevertheless I really don’t think this is the only way to go or that the problem of hypertension is so simple.

In my previous newsletter I identified atherosclerosis as the primary underlying pathology of heart disease and that this was a poor lifestyle problem. In the next section I will show also that life style changes can reverse hypertension. Clearly atherosclerosis is another factor causing or aggravating blood pressure as one gets older. Atherosclerosis is an endothelial disease and will influence the secretion of nitric oxide from the endothelial cells and cause increasing stiffness of the arterial system. NO is an essential vasodilator substance. Atherosclerosis plus hypertension contribute to worsening each other.

Arterial stiffness may also be worsened by a deficiency of vitamin C required for collagen production, and copper which is a co-factor for elastin production.

Regarding the question of when to treat blood pressure, Dr Port pointed out that the 18 year Framington Blood pressure study jumped to a number of conclusion based on a distortion of the facts. These distortions arose because they used computer smoothing of the results, which then showed a linear increase in the risk of heart disease and death as the blood pressure increased. From this Linear Model was derived the idea that the lower the blood pressure the better; but if one examines the original raw data from the Framington study there was in fact no linear increase of deaths. Dr Port produced a Non-linear model which took into account age and gender, and showed that mortality increased steadily with blood pressure that exceeds a threshold based on sex and age. The threshold blood pressure formula is 110+2/3 age for a man aged 45-74 and 104+5/6 age for a woman 45-74.

One arrives at the following figures

Age                 Male BP threshold                      Female BP threshold

45                                 139                                           142 mmHg

50                                 143                                           146    “

55                                 147                                           150    “

60                                 150                                           154    “

65                                 153                                           158    “

70                                 157                                           162    “

According to the above chart, a blood pressure of 147mmHg in a 60 year old man does not require treatment with drugs. Although Dr Port’s work was funded by the National Heart, Lung and Blood Institute, they rejected his findings and clearly preferred the Linear model showing an increasing death rate with any rise in Blood pressure.

So whether you accept the work of Dr Port and make 160 the cut-off point, or believe that any BP above 120 or above 140 requires treatment, is a matter of choice. Integrative doctors should consider alternative approaches detailed below for people with blood pressure readings between 140 to 160, and may opt for some drug medication to start with if the person has a BP greater than 160. Nevertheless even in these cases , using Rewolfia(snake root) may be enough to bring BP below 160 while you and the patient get on with the work of correcting lifestyle and adding other supplements.

Port S et al  Systolic blood pressure and mortality. Lancet 2000;355(9199):175-180

Port S et al There is a non-linear relationship between mortality and blood pressure. European Heart Journal 2000;21:1635-1638

Franklin MD et al Hemodynamic patterns of Age-related changes in blood pressure. The Framingham Heart Study. Circulation 1997;96:308-315

One of the major factors in trying to assess efficacy and relevance of  drug approaches for the treatment of hypertension is that very often doctors don’t distinguish between relative risk and absolute risk when discussing the results.  In general, when specialists talk about a 40% reduction this is usually relative risk but gives the impression of a major drug effect when in real terms (absolute risk reduction) the effect is not major, and may help a person decide to take a chance on lifestyle changes rather than take the drug which does not really confer a major advantage.

Conclusion of Conventional studies

It seems that the ALLHAT trial still dominates most recommendations to medical doctors regarding hypertensive management i.e. all antihypertensives have more or less the same outcomes in BP control, and that diuretics should perhaps be the first drug used, and then other drugs from different family of antihypertensives built up on that until BP is satisfactory. Satisfactory is a BP 140/90, or preferably even lower, especially for certain high risk populations such as those with diabetes, cardiovascular disease or renal disease The lower the better, but there is evidence that BP lowering has a J curve to it which means that there is no reduction in morbidity and mortality below a certain BP which may in fact be 140/90.

“More trials are needed, but at present there is no evidence to support aiming for a blood pressure target lower than 140/90mmHg in any hypertensive.”

Increasing drug usage, and increased adverse drug effects could negate any potential benefit associated with any achieved lower blood pressure, and according to the authors could even increase the number of adverse cardiovascular events if blood pressure gets too low.

Arguedas JA et al Treatment blood pressure targets for hypertension. Cochrane Database of Systemic Reviews 2009;Issue 3:CD004349

The work of Dr John Laragh is amazingly disregarded in favour of a haphazard use of drugs without any attention to underlining pathophysiology. In addition, the interesting data of Port suggesting that a BP reading up to 160 may even be normal depending on the age of the person, has also been dismissed. Pointing out that the Framington blood pressure study was not in fact linear makes absolute sense to me. I am always suspicious of those perfect graphs, and according to Port these are in fact computer generated to improve the way the results look. Living systems are much too complex and unique to ever produce such linear models.

Even more surprising in this whole scenario is the low status given to lifestyle approaches. They are often mentioned, but most studies very quickly move onto drug approaches and treatment.  In general that is the approach of the average medical doctor i.e. make a diagnosis of hypertension and move straight into drug therapy.

I am left in the end disappointed and even disillusioned with most of the specialist committees appointed to provide guidelines to doctors. In trying to guide they fail to point out the unique nature of each person with hypertension, that taking drugs for 10 or 20 years for mild or moderate hypertension may not in fact reduce morbidity and mortality, and that drugs are potentially dangerous so lifestyle approaches should be much more aggressively promoted.

Management options

An Integrative Approach

Integrative doctors recognize that hypertension is a symptom and not a disease. Nevertheless if this hypertension is present for years on end, then it can contribute to ill health, especially if there is endothelial dysfunction in the form of atherosclerosis. Atherosclerosis plus hypertension are a serious combination as they lead eventually to various cardiovascular complication such myocardial infarction, strokes, kidney disease etc. Atherosclerosis which causes a decrease in vascular flexibility can aggravate hypertension and probably accounts for the fact that hypertension increases with age.

Hypertension is a symptom, and atherosclerosis is the disease of the arterial vascular system. So what is the underlying cause? In my previous article on heart disease I mentioned the research work showing that lifestyle changes can reverse arteriosclerosis, and also mentioned that heart disease was unknown 100 years ago suggesting that lifestyle, especially food choices, may be responsible for this disease of the arteries. White coat syndrome supports the idea that stress has a major part to play in hypertension as well.

In my approach to all ill health I think of the ‘3 phases’ of the movement towards disease.

The first phase has to do with identifying causes.

The second phase is the dysfunction that arises as result of the causes.

The third phase is the ‘disease’ that is the end point of dysfunction going on for many years.

So, in the management of hypertension the first phase approach is to assess life style: food choices, exercise, stress management, toxins.

Dean Ornish is probably the best example of an Integrative doctor specializing in the use of mainly lifestyle changes to heal and reverse heart disease. Research by Dr Ornish at the non-profit Preventive Medicine Research Institute and the University of California shows that changing what you eat and how you live may actually alter, for the better, how your genes are expressed. He has shown that many people with coronary heart disease, diabetes, high blood pressure, elevated cholesterol levels and other chronic conditions are able to reduce or even discontinue their medication when they make the diet and lifestyle changes recommended. Angiographic studies reveal a reversal of coronary artery narrowing. He believes that changing lifestyle and diet can prevent and reverse a large proportion of cardiovascular ill health and disease. He knows it works in hundreds and hundreds of patients that come to his centre.

Ornish D et al Can lifestyle changes reverse coronary heart disease. Lancet.1990;336(8708):129-33

Ornish D et al Intensive lifestyle changes for reversal of coronary heart disease. JAMA.1998;280(23):2001-7

Ornish D Avoiding revascularization with lifestyle changes: The Multicenter Lifestyle Demonstration Project. Amer J Cardiol. 1998;82(103):72T-76T

Not surprising to most of us are the results of the INTERHEART study which followed almost 30 000 men and women in 52 countries and 6 continents. The study found that nine factors related to nutrition and lifestyle accounted for almost 95% of the risk of a heart attack in men and women in almost every geographic region, and in every racial and ethnic group worldwide. These factors were smoking, cholesterol levels, hypertension, diabetes, obesity, diet, physical activity, alcohol consumption and psychosocial issues such as stress and depression.

The point of the study is that cardiovascular disease, which is the number one killer today, is almost completely preventable by changing diet and lifestyle. I don’t have a strong feeling that the medical profession is really intent on changing lifestyle based on the rapidity with which the prescription pad is whipped out, or patients referred for surgery.

The DASH diet is perhaps the best known research diet developed by Professor Sacks to specifically deal with hypertension. A number of studies have supported his assertion that a diet rich in fruit, vegetables, nuts  and low in meat, fat, dairy, alcohol, salt and sugar can lower blood pressure. Adding physical activity and stress management just adds to the benefits of the diet and lowers the blood pressure even more.

Appel LJ et al A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group.NEJM 1997;336(16):1117-24. The combination diet reduced systolic pressure by 11.4 and diastolic pressure by 5.5

Kolasa KM Dietary Approaches to Stop Hypertension(DASH) in clinical practice: a primary care experience. Clin Cardiol 1999;22(7):16-22.  Patients with high blood pressure dropped their systolic by 11mmHg and diastolic by 6mmHg. The reduction occurred within 2 weeks of starting the plan .

Suter PM et al Nutritional factors in the control of blood pressure and hypertension. Nutr Clin Care 2002;5(1):9-19

Ascherio A et al A prospective study of nutritional factors and hypertension among US men. Circulation.1992;86(5):1474-84

Melby CL et al Blood pressure and blood lipids among vegetarian, semivegetarian, and nonvegetarian African Americans. Am J Clin Nutr 1994;59:103-9 Study showed that amongst  vegetarians only 16% had hypertension while the semivegetarians had 35.7% and nonvegetarians 31.1% high blood pressure. The vegetarians also had significantly lower lipid factors. The study suggests that a vegetarian diet lowers the risk factors for cardiovascular disease in African-Americans.

Fleet JC DASH without the dash(of salt) can lower blood pressure. Nutr Rev 2001;59(9):291-3   The original DASH diet did not include reducing salt but this has now been added to the DASH diet producing better outcomes.

Svetkey LP et al Effects of dietary patterns on blood pressure: subgroup analysis of the Dietary Approaches to stop hypertension(DASH) randomized trial. Arch Intern Med 1999;159(3):285-93 Conclusion: The DASH combination diet may be an effective strategy for preventing and treating hypertension in a broad cross section of the population at highest risk for blood pressure-related cardiovascular disease.

The above is only a small part of the literature on diet and blood pressure. The DASH diet with the added reduction in salt for those who are salt sensitive, together with exercise, weight reduction, decreased alcohol and stopping smoking will not only decrease blood pressure, but also decrease many of the other risk factors for cardiovascular disease. Many people will also be able to come off their antihypertensive drugs with their considerable side effects accumulating over the years.

According to Ornish, a single exercise session for example can lower the blood pressure by 5 to 7mm/Hg  which may persist for as long as 22 hours. However, the blood pressure benefits of exercise are reduced after only one or two weeks of returning to the couch, so regular exercise in important to sustain the reduction in blood pressure. Clearly if the blood pressure is very high (over 160 to 170) then specialist advice is recommended.

For more information on the DASH diet please go to conditions and treatment or click here dash diet

Nutritional Supplements for hypertension

A number of supplements can be added to the lifestyle recommendations when appropriate and necessary:

1. Rewolfia tincture or tablets (Tibb’s Pressure Eeze Forte includes Rewolfia plus other Tibb herbs): Rewolfia works as well as any drug to control blood pressure and is usually the best way of  getting the patient off some of the drugs. It has a sedative effect on the sympathetic nervous system and this results in a lowering of the blood pressure. When I was a student this was the main medication for lowering blood pressure. It has side-effects such as stuffy nose, depression, fatigue and generally should not be used by non-professionals.

2. Potassium chloride tablets are recommended by Dr J Wright.

Some clinical trials suggest that increasing dietary potassium by approximately 2100mg (54mmol) per day can reduce systolic blood pressure by 4-8mmHg in hypertensive individuals and 2mmHg in normotensive individuals. Potassium-rich whole foods, such as bananas, kiwi fruit, avocado, potatoes (with skin), nuts and yoghurt can be used instead.

National Heart Foundation of Australia. Summary of evidence statement on the relationships between dietary electrolytes and cardiovascular disease. October 2006

Krishna GG, Kapoor SC Potassium depletion exacerbates Essential Hypertension. www.annals.org/contents/115/2/77.abstract  In this study when potassium intake was low, systolic blood pressure increased by 7mmHg and diastolic blood pressure by 6mmHg. Potassium depletion was associated with a decrease in sodium excretion which may have contributed to the increase in blood pressure.

Pakti P et al Efficacy of potassium and magnesium in essential hypertension. A double blind, placebo-controlled , cross over study. BMJ 1990;301:521-523

3. Vasotensin : 1-2 tablets twice per day. Highly recommended by Dr Sherry Rogers. Vasotensin isolated specific, active peptides from the Bonita fish identified by Japanese researchers to lower BP (See product of the month). Dr Rogers says it take about 2 months to see results. Start with 2 tablets twice a day.

4. Circutrol BP contains vitamin K, Grapeseed extract and Wild Blueberry extract.

Vitamin K improves the elasticity of the blood vessels.

Grape seed extract contains high concentrations of polyphenols, potent antioxidants that naturally increase the dilation of blood vessels and decrease blood pressure. The polyphenols may also help to improve impaired endothelial function.

5. Magnesium (500mg/day) and Arginine (3-5gms/day) are other products recommended. Both of these nutrients increase the Nitric oxide (NO) secreted by the endothelium of the arteries. NO causes vasodilation of the arteries. The ability of endothelial cells to produce nitric acid falls with age and may account for the increasing blood pressure as people get older.

Magnesium is also a natural calcium channel blocker. Keep in mind that magnesium deficiency is a major problem and may be present in 30 to 75% of the population. Also it is a difficult mineral to assess and it is an intracellular mineral and serum levels are not an indication of intracellular levels. Deficiencies are also especially common in the elderly.

Hypertension develops in rats who become deficient in magnesium. Intravenous infusion of magnesium will lower the blood pressure in women with pre-eclampsia . Blood pressure resistant to conventional drugs will often respond when magnesium is added. All these studies point to the importance of magnesium in blood pressure management.

Combining a low-salt diet together with magnesium will give the best results.

Dose: Try magnesium (330mg elemental magnesium) 2 to 4 times per day for 2 to 3 months or 400 to 1200mg/d.

Adding potassium supplementation 50mg/day  may add substantially to the outcome.  

Dyckner T et al Effect of magnesium on blood pressure. BMJ 1983;286(6381):1847-1849

Itoh K et al The effects of high oral magnesium supplementation on blood pressure, serum lipids and related variables in apparently healthy Japanese subjects. British J Nutrition.1997;78(5):737-750

Sanjuliani AF et al Effects of magnesium on blood pressure and intracellular ion levels of Brazilian hypertensive patients. Int J Cardiol.1996;56(2):177-183

6. Coenzyme Q10 is deficient in almost 40% of persons with hypertension. In several studies Coenzyme Q10 was able to lower blood pressure in hypertensive patients after 4 to 12 weeks. 50mg 2-3x/ per day.

Digiesi V et al Mechanism of action of coenzyme Q10 in essential hypertension.Curr Therapy 1992;51:668-672

7. Vitamin D: The conclusion from two recent studies were as follows-

“Lower vitamin D status seems to be associated with increase risk for hypertension and cardiovascular disease, but we do not yet know whether vitamin D supplements will affect clinical outcomes.”

Pittas AG et al Systematic review: Vitamin D and cardiometabolic outcomes. Ann Int Med 2010;152(5): 307-14

“To date, evidence from prospective observational studies and randomized controlled trials suggests that vitamin D supplementation at moderate to high doses may have beneficial effects on reducing the risk for cardiovascular disease.”

Wang L et al systemic review: Vitamin D and calcium supplementation in prevention of cardiovascular events. Ann Intern Med 2010;152(5):315-23

Vitamin D in high doses(2000IU) may positively affect arterial stiffness.

Dong Y et al A 16 week randomized clinical trial of 2000 IU daily vitamin D3 supplementation in black youth: 25-hydroxyvitamin D, adiposity, and arterial stiffness. Endocrine Care 2010; 95(10):4584

Meta-analyses of randomized controlled trials showed that vitamin D supplementation reduces systolic blood pressure by 2-6mmHg

Pilz S , Tomaschitz A Role of vitamin D in arterial hypertension. Expert Rev Cardiovasc Ther 2010;8(11):1599-608

The anti-hypertensive-effect properties of vitamin D include renoprotective effects, suppression of the rennin-angiotensin-aldosterone system, direct effects on vascular cells, and effects on calcium metabolism.

Pilz S et al Vitamin D status and arterial hypertension: a systematic review.

8.Vitamin K: helps remove calcification from arteries making them more flexible and elastic.

9. Garlic and vitamin E help thin blood, keeping it more fluid.

10. Craetagus has mild blood pressure lowering affects. Nature’s ACE inhibitor.

It is nevertheless a good remedy to use as it has a powerful action on supporting heart function and treating atherosclerosis.

Other Approaches:

1. Chelation: A case report in Townsend’s Letter for doctors reported that chelation was the only answer to a patient’s extremely resistant hypertension. I do know that lead can cause hypertension (decreases endothelial ability to make NO) and perhaps this was his problem. Remember Detoxamin suppositories which are a good substitute for Intravenous chelation.

A number of Integrative doctors recommend chelation to remove heavy metals but particularly lead as a cause of hypertension.

2.Infrared Sauna

3.Resperate.  see www.resperate.com

Tip of the month

Osgood-Schlatter’s disease, which is a painful swelling of the bony area just below the knees occurring in the pre-teens and teens, can usually be resolved by taking selenium 200mcg plus 400IU of the mixed tocopherol form of vitamin E. The low energy laser is also helpful.

Case report

65 year old male with a long history of hypertension treated with various drugs over the years. At present on a diuretic and calcium channel blocker. Blood pressure averages to 150/ 95. Wants to come off drugs.

Management: Stopped the calcium channel blocker over 10 days. Started Rewolfia tincture 10 drops/day to replace the drug.  Discussed diet as he was a heavy meat eater, lots of grains and refined carbs. Diet: More fish, cut out bread and refined carbs plus sugar, more vegetables and fruit. To start slowly in the gym and discussion on stress management.

The following supplements added: Coenzyme Q10 (NanoQ10 from Solgar), Vasotensin 2 tablets twice per day, Circutrol 1/day, Garlic 3/day.

Over the next few months the diuretic was also stopped. His blood pressure is now on average 145/90. We are both happy with the result and will see which of the remedies can be reduced to decrease cost.

Product of the Month

Vasotensin

Japanese researchers have identified a patented process to isolate specific, active peptides from the Bonita fish which demonstrates blood pressure lowering effects in animals and human models. The nine identified, specific active peptides in dried Bonita fish include a pentapeptide that on its own only slightly inhibits angiotensin-converting enzyme (ACE). When however the ACE interacts with the pentapeptide it is converted into a tripeptide that has powerful inhibitory effects against ACE which makes it a relatively strong, natural ACE. 

Three human clinical trials on patients with borderline or mild hypertension have shown significant decrease in BP. No serious adverse effects were reported.

Late night musing

Well, that’s been a long report and I must apologize for that; nevertheless it has given me a lot of satisfaction trying to sort out what is really going on here. I am not sure that I have all the answers and certainly each person is unique and will want different parts of the programme touched on in the report. Hopefully each practitioner can gain something by reading through all the information and recognize that despite the specialist committees providing various guidelines in the management of hypertension, these are really only a very general guide which keeps changing over the years, and is should never limit the doctor in approaching each person in a creative way.