Hypertension (High Blood Pressure)

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Hypertension
Heart muscle.jpg

Hypertension
Causes Dietary Factors, Smoking, Stress
See Also Cardiovascular Conditions, Hypotension
Books Books on Cardiovascular Conditions such as Naturopathic Treatment of Blood Pressure and others.
Articles Articles on Cardiovascular Conditions

Blood pressure is a measure of the force of blood against the walls of arteries, veins, and the chambers of the heart as it is pumped through the body.[1] High blood pressure refers to the elevation of systolic and/or diastolic blood pressure. It is the most common of all cardiovascular diseases in industrialized nations and it is a major cause of heart attacks, stroke, and congestive heart failure. Hypertension affects about a third of all North Americans over the age of 20, with increased incidence in black populations. Hypertension is relatively uncommon in cultures untouched by a western lifestyle. [2] Fluctuations in blood pressure are normal. Blood pressure, in a healthy state, will fluctuate throughout the day, by season, based on activity level, and in response to different stressors. When high blood pressure is consistently present it begins to weaken blood vessel walls and makes it easier for harmful substances, such as toxins and cholesterol plaques to deposit and further decrease the diameter of blood vessels.[1] High blood pressure readings are a concern when they remain elevated for an extended period of time. Hypertension can be a serious condition as it can damage the arteries and the heart and can ultimately lead serious complications and death if left untreated.[3]

Contents

Naturopathic Assessment

Article Cortisol Reactivity; A Novel Risk Factor for Hypertension , IHP ; April/May 2013

The assessment of hypertension is commonly based on a person's health history and on a physical exam. There are many causes of high blood pressure that need to be addressed in a thorough assessment, and possible underlying life threatening conditions need to be ruled out by a qualified health care professional.[4]

Causal Factors

The factors that contribute to hypertension are complex and varied. Major modifiable causal factors include lifestyle, stress, and diet.

Lifestyle

Read this article The Role of the ‘Eubiotic’ Diet in Intestinal Dysbiosis and Hypertension, IJNM; 2009 July;Vol4(1)
Check out this book The Anti-Inflammation Diet and Recipe Book: Protect Yourself and Your Family From Heart Disease, Arthritis, Diabetes, Allergies - and More
Check out this book Blood Pressure: A Naturopathic Approach
Check out this book Integrative Medicine and Functional Medicine for Chronic Hypertension
Check out this book Naturopathic Treatment of Blood Pressure


  • A sedentary lifestyle is associated with increased blood pressure. Isometric exercise may temporarily increase blood pressure, so individuals wtih hypertension should seek medical advice regarding static exercise.[8]
  • Smoking increases the risk of high blood pressure as it impairs endothelial function and is associated with increased levels of LDL.[9]
  • Growing up in a family with parents that smoke increases the risk of hypertension later in life.[10]

Social

  • Stressfull situations can cause a temporary increase in blood pressure. Ongoing, unrelenting stress can also contribute to chronic hypertension.[11]
  • Recurring blood pressure elevation caused by emotional distress eventually leads to structural vascular changes and sustained hypertension.[12][13]
  • Emotional distress transiently raises blood pressure in real life.[12][14]
  • Studies indicate that hypertensive individuals report less emotional distress and are more defensive, than normotensive individuals.
  • Hypertension may first appear years or decades after stressful events, which makes the temporal relationship sometimes difficult to ascertain.[12]

Environmental

  • Heavy metal exposure has been linked to increased blood pressure. In particular, increased exposure to mercury, arsenic, lead and cadmium increase the risk of hypertension. [16][8]

External

  • Trauma
  • The onset of hypertension can be triggered by accidents and injuries, both to oneself and to others.[17], [18]

Medical Interventions

  • Prescription Medications
  • Pharmaceutical drugs and some over-the-counter medications are known to cause or aggravate high blood pressure including non-steroidal anti-inflammatories. [19]
  • Oral contraceptives have been shown to moderately increase the risk of hypertension.[20]
  • The administration of diuretics may actually increase the risk of sudden cardiac death due to the depletion of potassium and magnesium.[8]
  • Calcium channel blocking drugs may increase the risk of heart attack, cancer, and have been shown in some populations to increase risk of gastrointestinal hemorrhage.[21][22][23]
  • The use of beta blockers has been shown to cause deficiency in Coenzyme Q10.[24]

Diagnostic Testing

Hypertension.jpg
Article Hypertensive Retinopathy, NDNR, 2011 October


Hypertension is often initially diagnosed during routine physical exam. In oder to confirm a diagnosis of hypertension, three separate readings are required. No other testing is needed to diagnose hypertension, however other tests may be ordered to rule out associated diseases or conditions.[4]


Related Symptoms and Conditions

Conditions associated with hypertension include:[4]

Characteristics

Hypertension is characterized by either a systolic blood pressure above 140 mm Hg or a diastolic blood pressure above 90 mm Hg. Systole occurs when the left ventricle of the heart is contracting to push blood throughout the body, and diastole occurs when the left ventricle is relaxed and the heart fills with more blood. The blood pressure numbers reflect the pressure in the arteries at these different times.

Heart arteries.jpg
  • The physiology of hypertension is complex, involving hormonal, vascular, inflammatory, and structural influences. Primary hypertension can be partially attributed to vascular remodeling which is a consequence of decreasing blood vessel diamater, deposition of cellular matrix, and decreased smooth muscle motility.[26]
  • Hypertension is associated with chronic inflammation. Hypertensive individuals tend to have high circulating levels of TNF, IL-6 and other acute phase inflammatory proteins.[27] Rise in blood pressure causes inflammation of endothelium which in turn causes further rise in blood pressure - a vicious cycle. [26].
  • Oxidative stress is a contributing factor.[28]


Classification of blood pressure for adults age 18 and older.[8]

Category Systolic (mmHg) Diastolic (mmHg)
Optimal <120 <80
Normal <130 <85
High-normal (Borderline) 130-139 85 to 89
Hypertension
Stage 1 140-159 90 to 99
Stage 2 160 to 179 100 to 109
Stage 3 >180 >110

Common Symptoms

  • For many people, hypertension does not produce any symptoms unless it is prolonged or severe. For others hypertensive incidents are associated with the following symptoms:[2]

Naturopathic Treatment

The goal of naturopathic treatment is to support and work in tandem with the healing power of the body and to address the causal factors of disease with individual treatment strategies. High blood pressure is typically considered a chronic disease and the therapeutic objectives involve addressing underlying and associated condtions, balancing fluids and electrolytes and relaxing cardiac and vascular muscle. Prevention of hypertension is much easier than cure.[29] It is always advisable to work with a naturopathic doctor before engaging in any treatment plan.

Bloodpressurecuff.jpg


Home Care

If high blood pressue is a concern or suspected, it is beneficial to monitor blood pressure on a daily or weekly basis. Blood pressure needs to be monitored by a naturopathic doctor or trained health professional whenever there are any changes to medication or treatment regimen.[5]

Lifestyle

Lifestyle factors include: Many of the lifestyle factors to prevent and treat hypertension are identical to strategies to prevent and treat Atherosclerosis[5]

  • Dietary
  • Achieving and maintaining a healthy body weight by combining exercise with a reduced caloric intake is a primary treatment for hypertension.[31][32]
  • Swimming is often beneficial as it has been shown to put less stress on the heart.[35]
  • Just as stress can increase blood pressure, relaxation techniques like meditation[5] and biofeedback can lower it.[12]

Naturopathic Therapies

The prescribing of naturopathic therapies requires the guidance of a naturopathic doctor as it depends on a number of factors including the causal factors, a person's age, prescription medications, other conditions and symptoms and overall health. It is always advisable to work with a naturopathic doctor prior to taking any natural therapies. Naturopathic Therapies for hypertension include:

Article Botanical Interventions for Hypertension and Hypercholesterolemia, NMJ, [1], 2012 March
Read this article Aged Garlic Extract Lowers Blood Pressure [2]
Astragalus ("Astragalus membranaceus"), Oat straw (Avena sativa), Dandelion ("Taraxacum offinale"), Garlic ("Allium sativum"), Hawthorn ("Crataegus oxyacantha"), Mistletoe ("Viscum album), Valerian ("Valeriana officinalis"), Yarrow ("Achillea millefolium"), Rauwolfia (Rauwolfia erpentina), Skullcap (Scutellaria laterfolia), Siberian ginseng (Eleuthrococcus senticosis), Small leafed lime (Tilia cordata), Periwinkle (Vinca major/minor), Evening Primrose (Oenothera biennis), Olive (Olea europaea).
Aurum, Belladonna, Crataegus, Lachesis, Strontium carb, Veratrum viride, Viscum album.
  • From the four pattern perspective hypertension is typically identified as one of the following: Yin-deficient and Yang deficient, Yin-deficient with Yang-excess, Hot Liver, Yin deficiency of Liver and Kidney. The treatment approach is based on the specific pattern that has been assessed.
  • Other differentials to consider for constitutional treatment include: phlegm heat, damp heat, wind phlegm, Qi and Blood stagnation, Liver Yang rising and Liver fire.[44].
Article Acupuncture for Essential Hypertension, NDNR, 2011 October
  • Acupuncture has been shown to successfully treat essential hypertension[45] and is used to significantly reduce diastolic hypertension.[46]
  • Accupuncture points commonly used to treat hypertension are selected based on diagnosis and commonly include: GB20, GB34, GV20, LI4, LI11, SP6, ST36, LR2, Taiyang, TW17, Anmian, KD3, PC6, ST40, CV4,CV6, LR3, UB18, ST9, ST36, LI11.[44]
  • Hydrotherapy strategies such as Neutral bath are often used to treat hypertension[47], Constitutional treatment[47],

References

Reviewed by Iva Lloyd, BScH, RPE, ND [3]

  1. 1.0 1.1 Leviton Richard High Blood Pressure, Lower It Naturally Alternative Medicine Digest;16:pp42-47.
  2. 2.0 2.1 2.2 Hoffmann David (1992) Therapeutic herbalism: A correspondence course in phytotherapy
  3. 3.0 3.1 3.2 Pizzorno Joseph, Murray Michael, Joiner-Bey Herb (2003) The Clinician's Handbook of Natural Medicine, Churchill Livingstone
  4. 4.0 4.1 4.2 El-Hashemy Shehab(2007)Naturopathic Standards of Primary Care. CCNM Press Inc.:pg78-86
  5. 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 Smith Fraser, Winterstein James (2008) An Introduction to Principles & Practices of Naturopathic Medicine CCNM Press Inc., Toronto:pg128-131
  6. Murray Michael, Pizzorno Joseph.(1998) Encyclopedia of Natural Medicine 2nd edition. Three Rivers Press, New York:pg524-535
  7. Duarte CG (1978) Magnesium metabolism in potassium-depleted rats Am J Physiol Renal Physiol;234:466-471.
  8. 8.0 8.1 8.2 8.3 Murray MT, Pizzorno JE (2006) Pizzorno Textbook of Natural Medicine 3rd ed Chap 176 Hypertension Elsevier.
  9. Heitzer Thomas, Ylä-Herttuala Seppo, Luoma Jukka, Kurz Sabine, Münzel Thomas, Just Hanjörg, Olschewski Manfred, Drexler Helmut (1996) Cigarette Smoking Potentiates Endothelial Dysfunction of Forearm Resistance Vessels in Patients With Hypercholesterolemia. Role of Oxidized LDL Circulation;93:1346-1353.
  10. Simonetti Giacomo, Schwertz Rainer, Klett Martin, Hoffmann Georg, Shaefer Franz, Wühl Elke (2011) Determinants of Blood Pressure in Preschool Children, The Role of Parental Smoking Circulation;123:292-298.
  11. Mann Samuel (Mar 2000) The Mind/Body Link in Essential Hypertension: Time for a new paradigm Alternative Therapies;6(2):39-45.
  12. 12.0 12.1 12.2 12.3 Mann Samuel J (Mar 2000) The Mind/Body Link in Essential Hypertension: Time for a new paradigm Alternative Therapies;6(2):39-44.
  13. Weder AB, Julius S (1985) Behavior, blood pressure variability and hypertension. Psychosaom Med;47:406-414.
  14. James GD, Yee LS, Harshfield GA, Blank SC, Pickering TG (1986) The influence of happiness, anger and anxiety on the blood pressure of borderline hypertensives: a preliminary report. Psychosom Med;48:502-508.
  15. Holick M (2004) Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. American Society for Clinical Nutrition;362-371.
  16. Telisman S, Jurasovic J, Pizent A, Cvitkovic P (2001) Blood pressure in relation to biomarkers of lead, cadmium, copper, zinc, and selenium in men without occupational exposure to metals Environ Res: 87:57-68
  17. Pietrzak RH, et al (2012) Physical health conditions associatied with posttraumatic stress disorder in US older adults: results from wave 2 of the National Epidemiologic Survery on Alcohol and Related Conditions J Am Geriatr Soc 60(2)296-303
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  20. Chasan-Taber Lisa, Willett Walter, Manson JoAnn, Spiegelman Donna, Hunter David, Curhan Gary, Colditz Graham, Stampfer Meir (1996) Prospective Study of Oral Contraceptives and Hypertension Among Women in the United States Circulation;94:483-489.
  21. White SR, Hedge MW (2007) Shannon: Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose 4th ed Chap 13 Gastrointestinal Toxicology Saunders
  22. Psaty B.M., Smith N.L., Siscovick D.S., et al (1997) Health outcomes associated with antihypertensive therapies used as first-line agents. A systematic review and meta-analysis. JAMA; 277:739-745
  23. Furberg C.D., Psaty B.M., Meyer J.V. (1995) Nifedipine: Dose-related increase in mortality in patients with coronary heart disease Circulation ; 92:1326-1331
  24. Ronzio RA (2006) Pizzorno Textbook of Natural Medicine 3rd ed Chap 109 Naturally Occurring Antioxidants Elsevier.
  25. Lotufo PA, Chae CU, Ajani UA, Hennekens CH, Manson JE (Jan 2000) Male pattern baldness and coronary heart disease: the Physicians' Health Study. Arch Intern Med.;160(2):165-71. PMID: 10647754.
  26. 26.0 26.1 Blumenfeld JD, Liu F, Laragh JH (2011) Taal: Brenner and Rector's The Kidney 9th ed Chap 46 Primary and Secondary Hypertension Saunders
  27. Pruijm M et al (2012) Inflammatory markers and blood pressure: sex differences and the effect of fat mass in the CoLaus Study J Hum Hypertens doi: 10.1038/jhh.2012.12 (Epub ahead of print)
  28. Dhalla Naranjan S, Temsah Rana M, Netticadan Thomas (2000) Role of oxidative stress in cardiovascular disease Journal of hypertension;18(6):655-668.
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  36. Lu Henry (1986) Chinese System of Food Cures, prevention and remedies Sterling Publishing Co. New York.
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