Overview: Hypertension

• Hypertension is the most important risk factor for cardiovascular morbidity and mortality in industrialized countries.

• At least 65 million U.S. residents have blood pressures (BPs) that place them at significantly higher risk of coronary artery disease, heart failure, renal failure, thoracic and abdominal aneurysms, myocardial infarction, and stroke.

• Hypertension is also associated with cognitive dysfunction, erectile dysfunction, and loss of vision. The higher the pressure is, the greater is the risk of complications.

Important Points to Consider

• Prehypertension is a condition characterized by systolic blood pressure of 120 to 139 mm Hg and diastolic blood pressure of 80 to 89 mm Hg.

• A reduction of systolic blood pressure of 5 mm Hg is associated with a 7% reduction in all-cause mortality.

• Consider recommending one fourth of a standard- sized dark chocolate bar consisting of 70% cocoa daily

• Omega-3 fatty acids may be particularly useful in patients with the metabolic syndrome because of the effect of these fatty acids on improving insulin sensitivity and on reducing blood pressure and triglycerides.

• Statin drugs and some beta blockers (propranolol) can reduce the endogenous production of CoQ10 by as much as 40%

• Herbs to Avoid in the Treatment of Hypertension: Herbs that require close monitoring in the treatment of patients with hypertension include licorice, ephedra, and Panax ginseng.

• These have the capacity to raise blood pressure significantly.

Prevention Prescription

Michael Pollan advises this: “Eat food. Not too much. Mostly plants.” These three guidelines will minimize intake of unhealthy fats including hydrogenated vegetable oils, limit intake of unhealthy sugars including high-fructose corn syrup, and significantly increase soluble fiber intake.

• Exercise at least 30 minutes a day at least 4 days per week.

• Limit alcohol consumption.

• Do not smoke.

• Breathe: incorporate mind-body practices into your daily routine.

Therapeutic Review

Dietary

• Follow the DASH diet eating plan with its emphasis on foods rich in potassium, magnesium, and calcium.

• Reduce dietary sodium to less than 2.4 g per day (1 teaspoon).

• Limit alcohol to two drinks or less per day for men and one drink or less per day for women.

• Consider 10 to 30 g per day of 70% cacao dark chocolate (one fourth of a regular-sized chocolate bar).

Exercise

• Aim for 30 minutes a day of aerobic exercise.

Weight Loss

• Aim for a weight loss of at least 10 lb (4.5 kg) if overweight.Mind-Body Therapy

  
  

Supplements

• Maintain serum 25-(OH) vitamin D level greater than 40 ng/mL.

• Ensure 1000 mg a day of eicosapentaenoic acid and docosahexaenoic acid by fish or krill oil.

• Consider coenzyme Q10 to achieve a serum level higher than 2.0 mcg/mL.

• Consider magnesium at 6 mg/kg.

• Ashwagandha 250 mg

Botanicals

• Consider a trial of garlic at 350 mg (4000 mcg allicin) twice daily.

• Consider the tonifying effect of hawthorn at 750 to 1500 mg per day.

Mind-Body Therapy

• Attempt to practice any of these approaches for approximately 20 minutes daily:

  • Practices to stimulate the relaxation response

  • Biofeedback

  • Transcendental meditation

  • Yoga

  • Qi gong

  • Tai chi

Pharmaceuticals

• Follow the seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines, which emphasize thiazide diuretics as first-line agents.

• Stage 1 hypertension (140 to 159/90 to 99 mm Hg):

  • Start with single-drug treatment (diuretic, angiotensin-converting enzyme inhibitor [ACEI], angiotensin receptor blocker [ARB], or calcium channel blocker).

• Stage 2 hypertension (higher than 160/100 mm Hg):

  • Use two-drug regimen (diuretic, ACE or ARB, beta blocker, calcium channel blocker).

Other Therapies

• Consider Ayurvedic assessment for dietary and other means of balancing one’s dosha (constitutional state).

• Consider traditional East Asian medicine, including acupuncture, for balancing one’s constitutional state.

• Note: With use of all therapies, including pharmaceuticals, an organized system of regular follow-up and review with self-monitoring and appointment reminders appears to be an effective adjunct for blood pressure control.

Key Web Sources

• Risk Assessment Tool for Estimating 10-year Risk of Developing Hard Coronary Heart Disease (Myocardial Infarction and Coronary Death): http://hp2010.nhlbihin.net/atpiii/calculator. asp?usertype=prof.

• Your Guide to Lowering High Blood Pressure: Healthy Eating: http://www.nhlbi.nih.gov/hbp/prevent/h_eating/h_eating.htm.

• The DASH Diet Eating Plan. http://dashdiet.org/default.asp.

• Heart Decision calculator. https://www.heartdecision.org/index/tool#.

• The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8): http://www.nhlbi.nih.gov/guidelines/hypertension/jnc8/index.htm.