The Analyst™

Comprehensive diagnosis of your symptoms

Healthy

  Hypertension  
 
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Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | It can lead to... | Recommendations

 

Blood pressure is measured with a blood pressure cuff and recorded as two numbers that represent systolic (peak pressure, shown first) and diastolic (base pressure, shown second). Either or both numbers can be elevated. When the first number is the only one elevated the condition is called Isolated Systolic Hypertension (ISH). Optimal blood pressure is below 120/80mm Hg. When a person has a reading above 140/90, she/he is considered to have high blood pressure. In the past, many physicians relied on diastolic blood pressure to diagnose hypertension. Recent research, however, has found that diastolic blood pressure rises until about age 55 and then declines, while systolic blood pressure increases steadily with age.

Systolic hypertension is a major health threat, especially for older people. For many years we have been taught that diastolic (the bottom number) blood pressure counts more. That may be true for younger people but we now know that, as people get older, systolic blood pressure becomes more important. If you are middle aged or older, systolic blood pressure is a better blood pressure indicator than diastolic of your risk of heart disease and stroke, which are the first- and third-leading causes of death among Americans. High blood pressures can lead to other conditions, such as congestive heart failure, kidney damage, dementia and blindness. While it cannot be cured, systolic hypertension can be treated and its complications prevented.

Many older Americans suffer from ISH, defined as a systolic reading at or above 140mm Hg and diastolic reading under 90mm Hg. In fact, for older Americans, ISH is the most common form of high blood pressure: 65% of all hypertensives older than age 60 have ISH. Unfortunately, many older Americans do not have their blood pressure under control.

Peaks of fluctuating hypertension can be as strong a risk factor for cardiovascular disease as established hypertension.

To find out if you have ISH - or any type of high blood pressure - see your doctor and have your blood pressure checked regularly. Everyone - including children - should have their blood pressure measured every time they see a doctor. Special attention should be paid when there is a family history of hypertension requiring at least annual measurements beginning at age 20.

Untreated or poorly treated hypertension can cause stroke, heart attacks, kidney failure and severe circulatory problems. In most people hypertension occurs without any symptoms whatsoever and there is thus far no identifiable cause for hypertension in most people. They are classified as having "essential" hypertension. About 5% of people have a cause for their elevated blood pressure (such as pre-existing kidney disease) that can be reversed and this places them in the category of "secondary" hypertension.

Recent work possibly explains the cause of 30-40% of essential hypertension. Parathyroid Hypertensive Factor (PHF) is a hormone produced by the parathyroid gland. When elevated, it can cause any increase in blood pressure. PHF levels can be tested, and elevated levels could serve to predict salt sensitivity, and calcium treatment responsiveness. Meridian Valley Laboratory in Seattle, Washington is one lab that performs this test.

Treatment options for ISH are the same as for other types of high blood pressure, in which both systolic and diastolic pressures are high. The key for the treatment of ISH is to bring the blood pressure under control, to less than 140/90.

Diastolic Hypertension is when the lower number is sustained at pressures greater than 90mm Hg. Hypertension, otherwise known as chronic high blood pressure, can be treated in a number of natural ways.

Dietary salt (NaCl) restriction, dietary potassium supplementation, weight reduction, fructose reduction, physical exercise, selected nutrients, meditation and other therapies (e.g., biofeedback) have all been found to be effective.

Late in the first decade of the 21st century, it was discovered that fructose-induced hypertension in the early stages, was not salt sensitive. However, after kidney damage occurred from the chronic over consumption of fructose, salt sensitivity developed. So, salt sensitivity, and the importance of salt reduction, may only be a factor after kidney damage has taken place. Dietary fructose reduction in either case is important.

You should try to achieve normal pressure by a lifestyle and diet change, such as weight loss, reducing salt intake, reducing fructose intake, exercising and supplementation as a first attempt in an effort to avoid medications. No one, however, has to put his or her health at risk from uncontrolled hypertension; but treatment for hypertension must begin early to prevent organ damage - whatever the patient's age.

Pulse Pressure
Although current guidelines for the management of high blood pressure (BP) rest almost completely on the measurement of systolic (top) and diastolic (bottom) blood pressure, a new study has found that something known as the "pulse pressure" may actually be a better predictor of heart disease risk. The pulse pressure is the difference between the systolic and diastolic pressures. For example someone with a blood pressure of 120/80 has a pulse pressure of 40.

This study was a meta-analysis combining the results of several studies, including nearly 8,000 elderly patients.
A 10mm Hg increase in pulse pressure was found to increase the risk of major cardiovascular complications and mortality by nearly 20%. The authors contend that this association of pulse pressure to risk of heart disease helps to explain the apparent elevations in risk associated with low diastolic pressure. The authors of the study note that some high blood pressure medications may actually increase the pulse pressure. For example, if someone has an elevated BP of 150/95 (pulse pressure = 55) and medication brings it down to 140/80 (pulse pressure = 60), then according to this study's findings, this person may actually be at GREATER risk of heart disease than before.

Researchers found that a diuretic, or water pill, is more effective in treating high blood pressure and preventing cardiovascular disease than newer, more expensive medications. It was 10 to 20 times less expensive than the other drugs used in the trial. The eight-year study, led by a doctor at Wake Forest University Baptist Medical Center, included 623 clinical sites in North America. There should be less side effects also.
 

 
 

Signs, symptoms & indicators of Hypertension:
 
 
Lab Values - Common  High systolic blood pressure
  High diastolic blood pressure

Symptoms - Head - Nose

  Occasional/frequent nosebleeds
 Recurrent nosebleeds are a sometimes a sign of an underlying disorder, such as hypertension, a bleeding disorder, or a tumor of the nose or sinuses.

Symptoms - Reproductive - Female Cycle

  Hot flashes
 Women who get hot flashes have higher blood pressure than those who don't, according to a new study led by Weill Cornell Medical College.

High blood pressure is a major risk factor for heart disease -- the latter being responsible for half of all deaths among American women 50 and older.

"One-third of the women we studied reported having had hot flashes within the past two weeks. Among these women, systolic blood pressure was significantly higher -- even after adjusting for whether they were pre-menopausal, menopausal or post-menopausal," says Dr. Linda Gerber, the study's senior author, professor of public health and medicine and director of the biostatistics and research methodology core at Weill Cornell Medical College. "Future research will help us better understand the mechanisms underlying this relationship and may help to identify potential interventions that would reduce the impact of hot flashes on blood pressure."

While previous research has linked menopause to high blood pressure, the new Weill Cornell study, published in the March/April, 2007 issue of Menopause: The Journal of the North American Menopause Society, may be the first to link hot flashes to high blood pressure.
 
 

Conditions that suggest Hypertension:
 
 
Aging  Senile Dementia
 Hypertension is a risk factor for reduced circulation in the brain, sometimes called ischemic vascular dementia (IVD).

Circulation

  Poor Cerebral Circulation
  Intermittent Claudication
  Aneurysm / Weakened Arteries
  Cardiomyopathy
 Hypertrophic cardiomyopathy is usually a hereditary disorder, although incidence of this form of cardiomyopathy may also be higher in people with hypertension. [Hypertension 1994;24(5): pp.585-90]

Lab Values - Common

  Recent onset/medium-term/long-term hypertension

Musculo-Skeletal

  Gout / Hyperuricemia
 Gout is strongly associated with obesity, hypertension, hyperlipidemia and diabetes.

Organ Health

  Glomerular Disease
 High blood pressure is the second leading cause of ESRD. Proteinuria in a person with high blood pressure is an indicator of declining kidney function. If the hypertension is not controlled, the person can progress to full renal failure.
 
 

Risk factors for Hypertension:
 
 
Circulation  Atherosclerosis

Diet

  Salt Sensitivity

Environment / Toxicity

  Heavy Metal Toxicity
 In some individuals with hypertension, high levels of heavy metals were found. When treated for these heavy metals with chelation therapy, the hypertension improved or resolved.

Hormones

  Hypopituitarism / Empty Sella Syndrome
  Cushing's Syndrome / Hypercortisolism
  Elevated Insulin Levels
 Up to 50% of patients with hypertension are estimated to have insulin resistance.

Lab Values - Cells

  Having low CD8 count
 Significantly less CD8+ T cells (p = 0.02) [and more CD25hi+ and FoxP3+CD4+ T cells] were found in the peripheral blood of patients with Idiopathic Pulmonary Arterial Hypertension (IPAH) compared with controls (p = 0.009 and p < 0.001, respectively).

Lab Values - Common

Counter-indicators:
  Having/having very low diastolic BP or having normal diastolic BP
  Having very/having low systolic BP or haivng normal systolic BP

Metabolic

  Acute, Intermittent Porphoria
  Nephrotic Syndrome (NS)
 Hypertension can be both a cause and the result of NS. This hypertension must be treated aggressively to prevent further damage to the kidneys.

Personal Background

  African ethnicity
 New research shows that higher levels of uric acid are strongly associated with high blood pressure in blacks, suggesting that a simple blood test could predict risk and that treatments to lower uric acid may be a novel way to reduce hypertension-related complications in this population.

Uric acid levels are influenced by dietary factors, such as high levels of protein, and by the breakdown of the body's cells. Most uric acid is eliminated in urine. However, if excess uric acid is being produced or if the kidneys cannot remove enough of it, levels build up in the blood.

Very high levels of uric acid cause gout, but recent animal and human studies suggest that modest elevations of uric acid are one cause of hypertension. Currently, studies are under way to evaluate whether lowering uric acid prevents hypertension.

"If these studies show that lowering uric acid is an effective treatment, our research suggests that it may be especially appropriate for blacks," said Mellen.

Uric acid can be lowered by medications such as allopurinol and newer agents under development. [Hypertension Nov 7, 2006]

Supplements and Medications

  Prednisone use
 A side-effect of treatment with prednisone can be hypertension.

Symptoms - Food - Intake

Counter-indicators:
  Eating sizable chocolate portions
 Foods rich in cocoa appear to reduce blood pressure but drinking tea may not, according to an analysis of previously published research in the April 9, 2007 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Current guidelines advise individuals with hypertension (high blood pressure) to eat more fruits and vegetables, according to background information in the article. Compounds known as polyphenols or flavonoids in fruits and vegetables are thought to contribute to their beneficial effects on blood pressure and cardiovascular risk. "Tea and cocoa products account for the major proportion of total polyphenol intake in Western countries," the authors write. "However, cocoa and tea are currently not implemented in cardioprotective or anti-hypertensive dietary advice, although both have been associated with lower incidences of cardiovascular events."

Dirk Taubert, M.D., Ph.D., and colleagues at the University Hospital of Cologne, Germany, conducted a meta-analysis of 10 previously published trials, five of cocoa's effects on blood pressure and five involving tea. All results were published between 1966 and 2006, involved at least 10 adults and lasted a minimum of seven days. The studies were either randomized trials, in which some participants were randomly assigned to cocoa or tea groups and some to control groups, or used a crossover design, in which participants' blood pressure was assessed before and after consuming cocoa products or tea.

The five cocoa studies involved 173 participants, including 87 assigned to consume cocoa and 86 controls, 34 percent of whom had hypertension (high blood pressure). They were followed for a median (middle) duration of two weeks. Four of the five trials reported a reduction in both systolic (the top number, when the heart contracts) and diastolic (the bottom number, when the heart relaxes) blood pressure. Compared with those who were not consuming cocoa, systolic blood pressure was an average of 4.7 millimeters of mercury lower and diastolic blood pressure was an average of 2.8 millimeters of mercury lower.

The effects are comparable to those achieved with blood pressure-lowering medications, the authors note. "At the population level, a reduction of 4 to 5 millimeters of mercury in systolic blood pressure and 2 to 3 millimeters of mercury in diastolic blood pressure would be expected to substantially reduce the risk of stroke (by about 20 percent), coronary heart disease (by 10 percent) and all-cause mortality (by 8 percent)," they write.

Of the 343 individuals in the five tea studies, 171 drank tea and 172 served as controls, for a median duration of four weeks. Drinking tea was not associated with a reduction in blood pressure in any of the trials.

Tea and cocoa are both rich in polyphenols, but while black and green tea contain more compounds known as flavan-3-ols, cocoa contains more of another type of polyphenol, procyanids. "This suggests that the different plant phenols must be differentiated with respect to their blood pressure-lowering potential and thus cardiovascular disease prevention, supposing that the tea phenols are less active than cocoa phenols," the authors write.

Uro-Genital

  Eclampsia / Preeclampsia
 
 

Hypertension suggests the following may be present:
 
 
Hormones  Elevated Insulin Levels
 Up to 50% of patients with hypertension are estimated to have insulin resistance.

  Cushing's Syndrome / Hypercortisolism

Metabolic

  Acute, Intermittent Porphoria
  Nephrotic Syndrome (NS)
 Hypertension can be both a cause and the result of NS. This hypertension must be treated aggressively to prevent further damage to the kidneys.

Musculo-Skeletal

  Gout / Hyperuricemia
 Gout is strongly associated with obesity, hypertension, hyperlipidemia and diabetes.

Organ Health

  Increased Risk of Diabetes ll
 Statistical analyses showed that the relationship between blood pressure and the onset of type 2 diabetes was similar among women who were normal weight, overweight or obese. There was a three-fold increase in risk from the lowest to the highest BP category within all three weight categories. This analysis showed that the association between blood pressure and diabetes was not explained by weight alone.

Women who had an increase in BP during the study also had an increased risk of developing diabetes. Those whose BP rose but who remained within the range of normal BP had an increased risk of 26% compared to women who had stable or decreasing BP. Women who progressed to hypertension had a 64% increased risk. [European Heart Journal Oct 2007]

Risks

Counter-indicators:
  Increased Risk of Hypertension

Uro-Genital

  Eclampsia / Preeclampsia
 
 

Hypertension can lead to:
 
 
Aging  Senile Dementia
 Hypertension is a risk factor for reduced circulation in the brain, sometimes called ischemic vascular dementia (IVD).

Circulation

  Increased Risk of Stroke
  Aneurysm / Weakened Arteries

Nutrients

Counter-indicators:
  Salt Intake Requirement
 People who are salt-sensitive experience an exaggerated blood pressure elevation when they are given a salt load. (There is no standard way to test for salt-sensitivity, and such tests are currently done only in a research setting.) While salt-sensitivity is felt to be a risk factor for developing hypertension, many salt-sensitive people are, in fact, not hypertensive at all. The Indiana study suggests that, while hypertension is a major cause of cardiovascular disease, it’s not the hypertension that causes early death in salt-sensitive people – it’s the salt-sensitivity itself. That is, in these individuals, high dietary salt causes cardiovascular disease even if their blood pressures remain normal.

How does salt cause cardiovascular disease without increasing the blood pressure? Dr. Aviv from the University of Medicine and Dentistry of New Jersey thinks he has the answer – salt increases the reactivity of platelets, the tiny blood elements that help the blood to clot. Thus, he says, high dietary sodium might lead to cardiovascular events like stroke, heart attack, and kidney disease directly, even in the absence of hypertension.

Risks

  Increased Risk of Alzheimer's / Dementia
 A study in Journal of Neuroimaging (July 2007) suggests that cognitively normal adults exhibiting atrophy of their temporal lobe or damage to blood vessels in the brain are more likely to develop Alzheimer's disease. Older adults showing signs of both conditions were seven-times more likely to develop Alzheimer's than their peers.

"Alzheimer's disease, a highly debilitating and ultimately fatal neurological disease, is already associated with other risk factors such as poor cognitive scores, education or health conditions," says study author Caterina Rosano. "This study, because it focused on healthy, cognitively normal adults, shows that there other risk factors we need to consider."

MRI images of participants' brains were examined to identify poor brain circulation, damaged blood vessels and/or atrophy of the medial temporal lobe. Subjects showing any one or a combination of these symptoms were more likely to develop Alzheimer's in the following years.

"Similarly to heart disease, brain blood vessel damage is more likely to occur in patients with high blood pressure, high cholesterol or diabetes," says Rosano. "Since we know that prevention of these conditions can lower risk of heart attack and stroke, it is likely that it would also lower the risk of developing Alzheimer's."
 
 

Recommendations for Hypertension:
 
 
Amino Acid / Protein  Theanine (L-Theanine)
 High blood pressure is a feature of stress that can be lowered by lowering the stress. The simple act of drinking a cup of tea (which contains theanine) can lower blood pressure by forcing a person to slow down and relax.

Animal-based

  Fish Byproducts
 Vasotensin is the proprietary name of a product from Metagenics. It supports healthy vascular function for optimal blood flow and healthy blood pressure levels by supplying bioactive peptides from bonito fish. It helps prevent the formation of angiotensin II a potent vasoconstrictor through their interaction of bonito peptides with angiotensin converting enzyme.

Fast-acting formula that provides a clinically effective dose in just 2 tablets twice daily. No rebound effect observed in human clinical trials when supplementation is discontinued. Excellent safety profile no adverse effects associated with bonito peptides have been reported.

May be used as a complement to other heart support programs including prescription drugs.

  Fish Oil / Krill
 In a review of 36 clinical studies, just under 4gm of fish oil per day was associated with modest reductions in both systolic and diastolic pressure, especially if subjects were older and had hypertension. [Journal of Hypertens 2002;20(8): pp.1493-1499]

Botanical

  Grape Seed Extract / Resveratrol
 A study published in the October 2006 journal of Clinical and Applied Thrombosis/Hemostasis shows Pycnogenol® (pic-noj-en-all), an antioxidant plant extract from the bark of the French maritime pine tree reduced edema, a typical side-effect of antihypertensive medications, by 36 percent in patients taking these medications.

According to Dr. Gianni Belcaro, lead researcher of the study, more than 35 percent of patients taking antihypertensive medications are believed to suffer from edema as a side-effect. This happens because the antihypertensive medications cause blood vessels to dilate, which allows easier blood flow and thus lowers blood pressure. However, as a side-effect this causes blood to pool in the vessels of the lower legs. In result they stretch and liquid seeps into tissue causing swelling (edema). Hypertension is a serious risk factor for developing severe cardiovascular incidents some time in the future and thus the necessity for treatment justifies the development of edema as a side-effect.

Antihypertensive medications reduce pressure by inhibiting constriction of blood vessels. "The larger the blood vessel diameter, the easier blood will flow with less pressure," said Dr. Belcaro. "In order to avoid blood pooling in the lower legs and feet (edema), blood vessel diameters must adjust when a person changes positions from laying down to standing up. Results of this study show Pycnogenol to improve blood circulation, avoiding blood pools and reducing edema."

  Ginkgo Biloba
 One effect of Ginkgo extract is that of promoting vasodilation and blood flow.

  Chlorella / Algae Products
 Fifty-five subjects with fibromyalgia, 33 with hypertension, and 9 with ulcerative colitis consumed 10gm of pure chlorella in tablet form and 100mL of a liquid containing an extract of chlorella each day for 2 or 3 months. Daily dietary supplementation with chlorella was seen to reduce high blood pressure, lower serum cholesterol levels, accelerate wound healing and enhance immune functions. Researchers concluded that the potential of chlorella to relieve symptoms, improve quality of life, and normalize body functions in patients with fibromyalgia, hypertension, or ulcerative colitis suggests that larger, more comprehensive clinical trials of chlorella are warranted. [Altern Ther Health Med. 2001 May-Jun; 7(3): pp.79-91. Review]

  Pomegranate
 In an Israeli study, systolic blood pressure was reduced by 21% after one year of pomegranate juice consumption. This effect is believed to be related to the particularly potent antioxidant properties of pomegranate polyphenols. [Clin Nutr. 2004 Jun;23(3):pp. 423-33]

A similar study at the same research facility examined consumption of pomegranate juice to ascertain its effectiveness in lowering blood pressure. Researchers studied the effect on hypertensive patients of daily consumption of 50 ml of pomegranate juice. After two weeks, a 5% reduction in systolic blood pressure was noted, along with a 36% decrease in serum angiotensin converting enzyme (ACE) activity. Reduc-tion in serum ACE activity has previously been shown to attenuate atherosclerosis, independent of its effects on blood pressure. The study authors concluded, “Pomegranate juice can offer wide protection against cardiovascular diseases, which could be related to its inhibitory effect on oxidative stress and on serum ACE activity.” [Atherosclerosis. 2001 Sep;158(1):pp. 195-8]

  Rhodiola rosea
  Garlic
 One study found that aged garlic extract at 7.2gm per day reduced total and LDL cholesterol, as well as systolic and diastolic blood pressure.

  Noni
  Mistletoe (Viscum album)
 Mistletoe is known to relieve pain from headaches caused by high blood pressure. Mistletoe reduces the heart rate, and at the same time strengthens the capillary walls. Its cardiotonic action is thought to be due to the lignans, while the hypotensive action is believed to be due to a choline derivative related to acetylcholine. Choline derivatives bring about parasympathetic stimulation and vasodilatation.

  Stephania tetrandra

Diet

  Fructose Avoidance/reduction
 A diet high in fructose can increase uric acid levels, but allopurinol may help lower the resulting high blood pressure, researchers say.

Men who took the drug to mitigate the effects of a high-fructose diet did not experience the increase in blood pressure observed among men on the same diet who did not take the drug, Richard Johnson, MD, of the University of Colorado, and colleagues said at the American Heart Association's High Blood Pressure Research Conference in Chicago.

"These results support the idea that fructose, such as present in table sugar and high-fructose corn syrup, could have a role in the epidemic of obesity and metabolic syndrome," Johnson said. "Further, they suggest that [the two sweeteners] could have a role in high blood pressure, and that this might be mediated by uric acid."

Eating a lot of fructose -- typically from sugary drinks sweetened with high-fructose corn syrup -- has previously been associated with increased levels of uric acid.

"It has been known for a long time that fructose can raise uric acid levels, and in the last few years epidemiological studies have also confirmed that those with the highest fructose intake have higher uric acid levels," Johnson said.

"Reducing sugar intake was an old treatment for gout as well, and was even espoused by Sir William Osler," the renowned physician widely credited with advancing modern medicine.

Robert Lustig, MD, of the University of California San Francisco, was a co-author on a paper in the Journal of Pediatrics published last summer (2008) that found evidence of this link in adolescents. The more sugary beverages the teens consumed, the greater their serum uric acid levels and, hence, their systolic blood pressure.

"The fact that this paper addresses this mechanism in humans rather than just rats is extremely important," Lustig said.

But he cautioned that uric acid is likely not the only cause of the metabolic syndrome.

"I absolutely think that uric acid is the main driver of hypertension" with regard to fructose consumption, Lustig said. "But it may not be the driver of the visceral adiposity, the dyslipidemia," and other components of the metabolic syndrome.

Still, Johnson and colleagues wanted to know whether allopurinol, which is primarily used to treat gout, could combat the blood-pressure-increasing effects of a high-fructose diet.

So they evaluated 74 adult men who were put on a diet that included 200 grams of fructose a day, on top of their regular diet (typically, people in the U.S. consume about 50 to 70 grams of fructose per day).

Half of the men were randomized to allopurinol.

After two weeks, those who weren't on the drug had a 6 mm Hg-increase in systolic blood pressure and a 3 mm Hg-increase in diastolic pressure (P<0.004 and P<0.007, respectively).

On the other hand, those on allopurinol had no increase in diastolic pressure and a nonsignificant 1 mm Hg-increase in systolic pressure, Johnson said.

The drug also lowered serum uric acid levels compared with controls (P<0.0001).

In addition, markers of the metabolic syndrome increased among men eating lots of fructose but not taking allopurinol. Incidence of the disease jumped from 19% at baseline to 44% after two weeks, Johnson said.

For this group, mean fasting triglycerides increased by about 55 mg/dL while HDL cholesterol fell by about 2.5 mg/dL (P<0.002 and P<0.001, respectively).

Fasting insulin and HOMA scores (which quantify insulin resistance and beta-cell function) increased, but plasma glucose didn't change, the researchers said.

For those on allopurinol, Johnson said there was a lowering of LDL cholesterol compared with controls. But there was no reduction in HOMA scores or triglyceride levels.

"I think there's more to it than just uric acid," Lustig said. "Uric acid is responsible for hypertension, but dyslipidemia is due to other effects in the liver on lipid pathways. There are other ways fructose induces these problems."

Fructose is one of the sweetest naturally occurring sugars and is frequently found in fruits, some vegetables, honey, and some other plants. What makes it different from other sugars is how the body treats it.

Lustig noted that fructose can only be metabolized by the liver, unlike glucose, which can be used by all organs of the body.

In the liver, fructose is phosphorylated, which depletes phosphate levels in the liver and increases uric acid production, he added.

"The liver is under greater substrate pressure with fructose than with glucose, which means you'll gen[erate] more uric acid for the same number of calories," Lustig said.

Once in the bloodstream, uric acid inhibits endothelial nitric oxide synthase (eNOS), thus reducing the production of the nitric oxide essential for keeping the vessels flexible. In turn, that leads to high blood pressure, Lustig said.

Either way, Johnson added, the take-home message is that "we should probably reduce our intake of added sugars, and that the benefits may be greater than simple weight loss."

  Raw Food Diet
 In a study of 32 patients whose diets were changed to include 62% of calories from raw foods, their mean diastolic pressure reduction was 17mm Hg. This study was conducted over a period of 6 months. Of these patients, 28 were also overweight. [South Med J 1985 Jul;78(7): pp.841-4]

  Increased Fruit/Vegetable Consumption
 Fruit and vegetable consumption (minimum of five portions daily) was associated with modest reductions of systolic and diastolic blood pressures in a controlled study of 690 healthy people ages 25-64. [Lancet May 28, 2002]

  Soy Isoflavones (genistein, daidzein)
 Soy milk consumption (about 2 cups twice per day) reduced systolic and diastolic blood pressure in a double-blind study of 40 men and women with mild to moderate hypertension, when compared to cow's milk. [J Nutr 2002;132(7): pp.1900-1902] The average systolic blood pressure was reduced 18.4mm Hg, diastolic 15.9mm Hg and mean blood pressure 16.7mm Hg.

The mechanism of action may be independent of isoflavone content, as another study showed no blood pressure lowering benefits with the use of isoflavones alone.

  Therapeutic Fasting
 Fasting is a way to correct high blood pressure without drugs. Fasting will normalize blood pressure in the vast majority of cases; the blood pressure will remain low after the fast if a person follows a health-supporting diet and lifestyle.

  High/Increased Fiber Diet
 A study suggests that oatmeal can improve blood pressure and reduce drug costs for 60 million hypertensive Americans. The study found that 73% of participants, each of whom who ate oat cereal daily for 12 weeks, were able to reduce or eliminate their need for blood-pressure medication. Consumption of high-fiber cereals is an easy and simple way for a person
to increase total and soluble fiber intakes, thus helping to reach the dietary fiber goal of 25-30gm per day. [Preventive Medicine in Managed Care; March 1, 2002]

  Low Fat Diet
 The DASH diet is rich in fruits, vegetables, and lowfat dairy foods and reduced in total and saturated fat . It also is reduced in red meat, sweets, and sugar-containing drinks. It is rich in potassium, calcium, magnesium, fiber, and protein.

One month of a DASH (Dietary Approaches to Stop Hypertension) diet and reduced sodium intake were each associated with reduced blood pressure in untreated hypertension (systolic blood pressure of 120-160 mm and diastolic blood pressure of 80-95 mm. DASH diet plus reduced sodium intake produced the greatest reductions in blood pressure. [Ann Intern Med 2001;135(12): pp.1019-1028]

  Coconut
  Vegetarian/Vegan Diet
  Sugars Avoidance / Reduction
  Cabbage Family Vegetables
 Researchers put broccoli sprouts to the test and found that they contain high levels of glucoraphanin, also known as sulforaphane glucosinolate (SGS). In addition to being a cancer preventative, SGS boosts production of Phase 2 enzymes, which are part of the body's antioxidant system. This extra boost lowers blood pressure and the body's inflammatory response, leading to better cardiovascular health overall. Just 5 grams of broccoli sprouts contain concentrations of SGS equal to that found in 150 grams of mature broccoli.

  Caffeine/Coffee Avoidance
 An increased risk of developing hypertension was associated with drinking five or more cups of coffee per day in a large study of former white male medical students followed for an average of 33 years. [Arch Intern Med 2002;162(6): pp.657-662]

  Olive Oil
 The relationship between dietary fats and blood pressure is not definitively answered. However, evidence suggests that the multiple components of the Mediterranean diet, i.e. low saturated fatty acids (SFAs), high monounsaturated fatty acids (MUFAs), and carbohydrate, fiber, and micronutrient content have favorable blood pressure effects, and therefore that this diet is desirable for health. Dietary MUFAs may have a greater protective effect than initially realized.

In 207 men without hypertension, 175 men with hypertension, 406 women without hypertension and 232 women with hypertension, the risk of hypertension was positively and independently associated with the intake of cooking oil polar compounds (read polyunsaturated oils), and inversely related to blood levels of monounsaturated fatty acids (read primarily olive oil). [Am JClin Nutr. 2003;78: pp.1092-1097]

Examples of foods high in MUFA are olives, olive oil, canola oil, peanuts, peanut oil, almonds, pecans, hazelnuts, cashew nuts, macadamia nuts, pistachio nuts, and avocados.

Digestion

Not recommended:
  Bromelain
 While bromelain is considered to have very low toxicity, caution is advised when treating individuals with hypertension. One report has indicated that those with pre-existing hypertension might experience tachycardia following high doses of bromelain. [Hawaii Med J 1978;37: pp.143-146]

Drug

  Conventional Drugs / Information
 While hypertension may be controlled naturally, if you have very elevated pressure and are having trouble getting it down, prescription drug use may be necessary. When additional factors in your live change down the road, you can try tapering off your medication to see if it is still needed. It is best to do this with your doctor's help. The dangers of untreated hypertension are too great to ignore.

Hypertension is caused by a variety of factors, and different classes of drugs are used to treat these different factors. The main classes of hypertension drugs and the added benefits they can provide are listed below.

Diuretics (furosemide, hydrochlorothiazide, indapamide, others). Commonly referred to as water pills, diuretics reduce the amount of fluid in your body. They cause your kidneys to excrete more sodium in your urine than they would normally. The sodium takes with it water from your blood. This means there's a smaller volume of blood pushing through your arteries and, consequently, less pressure on your artery walls.

Beta blockers (atenolol, metoprolol, propranolol, others). Beta blockers primarily work by blocking the effects of certain adrenaline-related chemicals in your body, causing your heart to beat more slowly and less forcefully.

Angiotensin-converting enzyme (ACE) inhibitors (benazepril, enalapril, lisinopril, others). ACE inhibitors help relax your blood vessels by blocking the formation of a natural chemical inside your body that narrows blood vessels.

Angiotensin II receptor blockers (ARB) (candesartan, irbesartan, losartan, others). ARBs act in a manner similar to ACE inhibitors, but they block the action of the chemical instead of the formation of the chemical.

Calcium channel blockers (calcium antagonists) (amlodipine, diltiazem, nifedipine, verapamil, others). These medications help relax blood vessel muscles. Some slow your heart rate.

Each of these classes may have additional benefits which will help your doctor select the one that is the most appropriate for you.


Not recommended:
  GHB (Gamma-Hydroxybutyrate)
 GHB should be avoided in cases of severe hypertension.

Electrical

  Biofeedback
 One device that could be considered using feedback methods has been proven to lower blood pressure through changing breathing habits. Information about RESPeRATE can be found here.

RESPeRATE is the first and only non-drug medical device clinically proven to lower high blood pressure with no side effects. It provides you with a new option for lowering blood pressure, and can be safely used along with your current medication(s) and lifestyle modifications such as diet and exercise.

Extract

  Fibrinolytic Enzymes
  Plant Sterols / Sterolins (Phytosterols)

Habits

  Aerobic Exercise
 Postmenopausal women with hypertension who walked 3km per day experienced an 11 point drop in systolic blood pressure over 6 months. [Med Sci Sports Exerc 2001;33(11): pp.1825-1831]

  Tobacco Avoidance

Hormone

  Melatonin
 Researchers discovered that if men take melatonin before bedtime, their blood pressure may decrease as much as if they were taking a antihypertensive drug. The participants in the study took 2.5mg of melatonin for a three week period. As expected, melatonin also increased their quality and quantity of sleep. [Hypertension. 2004 Feb;43(2): pp.192-7]

The authors of this study caution that melatonin should not be used for treating hypertension based on this single trial, and that more studies are required.

Lab Tests/Rule-Outs

  Test Uric Acid Levels
 New research shows that higher levels of uric acid are strongly associated with high blood pressure in blacks, suggesting that a simple blood test could predict risk and that treatments to lower uric acid may be a novel way to reduce hypertension-related complications in this population.

Uric acid levels are influenced by dietary factors, such as high levels of protein, and by the breakdown of the body's cells. Most uric acid is eliminated in urine. However, if excess uric acid is being produced or if the kidneys cannot remove enough of it, levels build up in the blood.

Very high levels of uric acid cause gout, but recent animal and human studies suggest that modest elevations of uric acid are one cause of hypertension. Currently, studies are under way to evaluate whether lowering uric acid prevents hypertension.

"If these studies show that lowering uric acid is an effective treatment, our research suggests that it may be especially appropriate for blacks," said Mellen.

Uric acid can be lowered by medications such as allopurinol and newer agents under development. [Hypertension Nov 7, 2006]

Mineral

  Salt Intake Reduction
 If you have high blood pressure, reducing the level of salt in your diet may reduce your blood pressure. In some people with mild high blood pressure this could free them from blood-pressure-lowering medications entirely. In people with marked high blood pressure, it should mean that a reduction in medications is possible. If you are taking medication for high blood pressure, particularly diuretics, let your doctor know that you are reducing your salt intake.

Salt restriction is recommended for those individuals with hypertension who are "salt-sensitive" or are prone to retaining sodium, gaining weight, and developing a rise in blood pressure as a result of a high-salt diet. Those who are "salt-resistant", on the other hand, do not experience change in weight or blood pressure on either high- or low-salt diets. For the salt-sensitive population, extreme amounts of salt restriction are not needed for improvement of blood pressure. Several studies have shown that diets containing 1600 to 2300mg of sodium per day are associated with average reductions in systolic pressure of -9 to -15mm Hg and in diastolic pressure of -7 to -16mm Hg in salt-sensitive individuals. Thus, salt restriction in this range is recommended in the dietary management of most individuals with hypertension.

However, for those who like salt, it was found in a review of many studies, that the degree of reduction in sodium intake and change in blood pressure were NOT related. This review included a total of 2,326 normotensive people, 387 with untreated hypertension and 801 being treated for hypertension [BMJ 2002;325(7365): pp.628-632]. So you may not have to limit salt strictly, but you will need to experiment to find out if, and to what degree, you are sensitive.

  Potassium
 The blood pressure lowering effect of supplemental potassium may be greater in patients receiving a high-salt diet. The amount of dietary potassium required to achieve this effect is, however, not easily obtained.

  Calcium
  Magnesium
 In a double-blind, placebo-controlled trial, it was demonstrated that oral magnesium resulted in a significant dose-dependent reduction of systolic and diastolic blood pressure. A mean reduction of 6mm Hg in diastolic pressure in patients with hypertension results in approximately 10% lower risk of coronary artery disease, and a 40% reduction in risk of strokes.

When magnesium levels are low, more calcium flows into the vascular muscle cells, which contracts them - leading to tighter vessels and higher blood pressure. Adequate magnesium levels prevent this.


Not recommended:
  Increased Salt Consumption

Nutrient

  CoQ10 (Ubiquin-one/ol)
 Eighty-three hypertensive patients were treated with either coenzyme Q10 (60mg bid with 150IU of vitamin E) or placebo with vitamin E. The coQ10 treated group experienced an average reduction in systolic blood pressure of 17.8mm without any significant side effects. [S Med J, November 2001;94(l]): pp.1112-1117]

Oriental Medicine

  Acupuncture
 A doctor Arabinda Das, MD reported using acupuncture points LIV-3, SP-9 and GB-34 bilaterally. After 2-3 visits he sutured the points. He reported immediate and lasting normalization of pressure in 80% of cases.[Townsend Letter for Doctors and Patients, Aug/Sept 2002; p.66]

A separate study suggests 12 treatments over a course of 6 weeks.

It was found that acupuncture at the Heart otoacupoint produced marked immediate depressor effects, with a short-term effective rate of 100% and long-term effective rate of 63%. [Journal of Traditional Chinese Medicine, 1992 Jun, 12(2): pp.133-6 ]

Physical Medicine

  Calming / Stretching Exercises
 The relaxation and exercise components of yoga have a major role to play in the treatment and prevention of high blood pressure. A combination of biofeedback and yogic breathing and relaxation techniques has been found to lower blood pressure and reduce the need for high blood pressure medication. In 20 patients with high blood pressure who practiced biofeedback and yoga techniques, 5 were able to stop their blood pressure medication completely, 5 were able to reduce significantly the amount of medication they were taking, and another 4 experienced lower blood pressure at the end of the 3 month study.

Vitamins

  Bioflavonoids
 Researchers reported that consuming dark chocolate and cocoa improves the function of blood vessels. In one study, consumption of cocoa in healthy volunteers, aged 18 to 77, resulted in significantly improved vascular responsiveness. The measure the researchers used looked at the "stiffness" of blood vessels. In patients whose blood vessels that are "stiff," hypertension is common. The beneficial effect was most pronounced in patients over 50 years of age and was due to the high flavonoid (polyphenol) content of dark chocolate.

In a second study, after volunteers ate 100 grams (3.5 ounces) of dark chocolate vascular responsiveness was again significantly improved. Investigators postulate that it is the flavonoids in chocolate that causes vascular improvement. Dark chocolate contains more flavonoids than lighter chocolate - and adding milk to chocolate (milk chocolate) inhibits the absorption of flavonoids. Any benefit gained by eating chocolate may be limited to dark chocolate (and cocoa).

These short-term studies demonstrated an immediate benefit, but it remains to be proven if there will be a long-term benefits. Polyphenols are a broad class of phytochemical compounds, to which flavanols belong. [JAMA, August 27, 2003]

  Vitamin C (Ascorbic Acid)
 A 1999 study found that in systolic and diastolic hypertension as well as elevated pulse rate, blood plasma vitamin C levels were reduced.

30 adults with adult onset diabetes experienced reduced blood pressure and improved arterial stiffness with 500mg of vitamin C per day. [Hypertension 2002;40(6): pp.804-9]

However, vitamin C at 50mg or 500mg had no effect on blood pressure in a controlled study of 439 Japanese patients. These patients had atrophic gastritis. [Hypertension 2002;40(6): pp.797-803]
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Strongly counter-indicative
Very strongly or absolutely counter-indicative
May do some good
Likely to help
Highly recommended
Reasonably likely to cause problems







GLOSSARY

Alzheimer's Disease:  A progressive disease of the middle-aged and elderly, characterized by loss of function and death of nerve cells in several areas of the brain, leading to loss of mental functions such as memory and learning. Alzheimer's disease is the most common cause of dementia.

Calcium:  The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. Calcium is also important to heart health, nerves, muscles and skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.

Cardiovascular:  Pertaining to the heart and blood vessels.

CD4:  A symbol for glycoprotein expressed on the surface of some lymphocytes, including Helper T cells. Human CD4 is the receptor that serves as a docking site for HIV viruses on certain lymphocyte cells. Binding of the viral glycoprotein gp120 to CD4 is the first step in viral entry, leading to the fusion of viral and cell membrane. In a healthy adult, helper T-cells account for between 32% and 68% of the total number of lymphocytes (which includes B-cells and other types of T-cells). The CD4 percentage is sometimes a more reliable measurement than the CD4 count because it tends to vary less between measurements. For example, one person's CD4 count may vary between 160 and 240 over a period of several months while their CD4 percentage remains constant at, say, 15%. The reason for this is that the CD4 count isn't actually a direct count of CD4 cells, but rather a calculation based on the results of three other tests (the CD4 percentage, the lymphocyte percentage, and the WBC count), each of which can vary slightly each time it's measured. Occasionally the CD4 count may be relatively high while the CD4 percentage is low (less than 21%). In this situation, many healthcare providers would consider the immune system to be significantly impaired based on the CD4 percentage.

CD8:  CD8 cells, also called suppressor and cytotoxic T-cells, play a role in fighting viral infections such as HIV. A T lymphocyte that secretes large amounts of gamma-interferon, a lymphokine involved in the body's defense against viruses. CD8 cells prevent the unnecessary formation of antibodies. A healthy adult usually has between 150 and 1,000 CD8 cells per cubic millimeter. In contrast to CD4 cells, people with HIV often have elevated numbers of CD8 cells, the significance of which is not well understood. Lab reports may also list the T-cell ratio, which is the number of CD4 cells divided by the number of CD8 cells. Since the CD4 count is usually lower and the CD8 count higher than normal, the ratio is usually low in people with HIV. A normal T-cell ratio is usually between 1.5 and 2.5 to 1. The expected response to effective combination anti-HIV treatment is an increase in CD4 count, a decrease in CD8 count, and an increase in the T-cell ratio.

Chelation:  Chelation therapy uses EDTA or other supplements that carry heavy metals such as lead, cadmium and arsenic, as well as other foreign substances, from the body. In the process of chelation, a larger protein molecule surrounds or encloses a mineral atom. The purpose of chelation is to increase the flow of blood to the vital organs and tissues of the body by reducing calcium deposits in the arteries and blood vessels.

Cholesterol:  A waxy, fat-like substance manufactured in the liver and found in all tissues, it facilitates the transport and absorption of fatty acids. In foods, only animal products contain cholesterol. An excess of cholesterol in the bloodstream can contribute to the development of atherosclerosis.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Chronic Renal Failure:  (CRF) Irreversible, progressive impaired kidney function. The early stage, when the kidneys no longer function properly but do not yet require dialysis, is known as Chronic Renal Insufficiency (CRI). CRI can be difficult to diagnose, as symptoms are not usually apparent until kidney disease has progressed significantly. Common symptoms include a frequent need to urinate and swelling, as well as possible anemia, fatigue, weakness, headaches and loss of appetite. As the disease progresses, other symptoms such as nausea, vomiting, bad breath and itchy skin may develop as toxic metabolites, normally filtered out of the blood by the kidneys, build up to harmful levels. Over time (up to 10 or 20 years), CRF generally progresses from CRI to End-Stage Renal Disease (ESRD, also known as Kidney Failure). Patients with ESRD no longer have kidney function adequate to sustain life and require dialysis or kidney transplantation. Without proper treatment, ESRD is fatal.

Congestive:  Pertaining to accumulation of blood or fluid within a vessel or organ.

Dementia:  An acquired progressive impairment of intellectual function. Marked compromise exists in at least three of the following mental activity spheres: memory, language, personality, visuospatial skills, and cognition (i.e., abstraction and calculation).

Diabetes Mellitus:  A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.

Diastolic:  Pertaining to the relaxation phase of the heartbeat, or period when the heart muscle is resting and filling with blood. When used in blood pressure readings (for example 120/80), it refers to the second/lower number.

Diuretic:  An agent increasing urine flow, causing the kidneys to excrete more than the usual amount of sodium, potassium and water.

Gout:  A disease characterized by an increased blood uric acid level and sudden onset of episodes of acute arthritis.

Hg:  The chemical symbol for mercury, often used to indicate pressure measurements in either inches or millimeters.

Hormones:  Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.

Hyperlipidemia:  Increased cholesterol level.

Hypertension:  High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.

Idiopathic:  Arising spontaneously or from an obscure or unknown cause.

Insulin:  A hormone secreted by the pancreas in response to elevated blood glucose levels. Insulin stimulates the liver, muscles, and fat cells to remove glucose from the blood for use or storage.

Ischemia:  Localized tissue anemia due to obstruction of the inflow of arterial blood.

ISH:  Isolated Systolic Hypertension.

Menopause:  The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.

Millimeter:  (mm): A metric unit of length equaling one thousandth of a meter, or one tenth of a centimeter. There are 25.4 millimeters in one inch.

MRI:  Magnetic Resonance Imaging. A technique used in diagnosis that combines radio waves and magnetic forces to produce detailed images of the internal structures of the body.

Parathyroid Gland:  One of many small structures, usually four, joined to the lobes of the thyroid gland. The parathyroid glands release a hormone that helps to keep the level of blood calcium normal.

pH:  A measure of an environment's acidity or alkalinity. The more acidic the solution, the lower the pH. For example, a pH of 1 is very acidic; a pH of 7 is neutral; a pH of 14 is very alkaline.

Potassium:  A mineral that serves as an electrolyte and is involved in the balance of fluid within the body. Our bodies contain more than twice as much potassium as sodium (typically 9oz versus 4oz). About 98% of total body potassium is inside our cells. Potassium is the principal cation (positive ion) of the fluid within cells and is important in controlling the activity of the heart, muscles, nervous system and just about every cell in the body. Potassium regulates the water balance and acid-base balance in the blood and tissues. Evidence is showing that potassium is also involved in bone calcification. Potassium is a cofactor in many reactions, especially those involving energy production and muscle building.

Protein:  Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.

Pulmonary:  Pertaining to the lungs.

Sodium:  An essential mineral that our bodies regulate and conserve. Excess sodium retention increases the fluid volume (edema) and low sodium leads to less fluid and relative dehydration. The adult body averages a total content of over 100 grams of sodium, of which a surprising one-third is in bone. A small amount of sodium does get into cell interiors, but this represents only about ten percent of the body content. The remaining 57 percent or so of the body sodium content is in the fluid immediately surrounding the cells, where it is the major cation (positive ion). The role of sodium in the extracellular fluid is maintaining osmotic equilibrium (the proper difference in ions dissolved in the fluids inside and outside the cell) and extracellular fluid volume. Sodium is also involved in nerve impulse transmission, muscle tone and nutrient transport. All of these functions are interrelated with potassium.

Stroke:  A sudden loss of brain function caused by a blockage or rupture of a blood vessel that supplies the brain, characterized by loss of muscular control, complete or partial loss of sensation or consciousness, dizziness, slurred speech, or other symptoms that vary with the extent and severity of the damage to the brain. The most common manifestation is some degree of paralysis, but small strokes may occur without symptoms. Usually caused by arteriosclerosis, it often results in brain damage.

Systolic:  Pertaining to the contraction phase of the heartbeat, or the pressure in the arterial system caused by the heart as blood is being pumped out. When used in blood pressure readings (for example 120/80), it refers to the first/upper number.

Vascular Dementia:  Mental incapacity due to inadequate blood flow to the brain.