A startling statistic in the May 4, 1999, edition of The New York Times revealed that only 18% of people with high blood pressure (hypertension) are successfully treated to achieve normotensive ranges. Untreated hypertension carries enormous health risks, such as increased risk of heart disease, stroke, kidney disease, and eye disease, yet fear of medication side effects and improper prescribing by physicians are contributing to an epidemic of hypertension-induced disease.
"Blood pressure" can be defined as the pressure or force that is applied against the artery walls as blood is carried through the circulatory system. It is recorded as a measurement of this force in relation to the heart's pumping activity, and is measured in millimeters of mercury (mmHg). The top number, or systolic pressure, is the measurement of the pressure that occurs when the heart contracts or beats. The bottom number, or diastolic pressure, is the measurement recorded between beats, while the heart is at rest. The systolic number is placed over the diastolic number. For example, 110/70 (read as "110 over 70") means a systolic pressure of 110 mmHg and a diastolic pressure of 70 mmHg. The systolic number is always the higher of the two numbers.
"Hypertension" is an indicator that the force required for blood flow is greater than normal. A blood pressure measurement of less than 130/85 is considered "normal," while 130-140/85-90 is defined as "high normal." A large study reported in the March 1997 issue of the journal Circulation indicates that "even borderline blood pressure readings represent a risk factor for atherosclerosis and stroke." Blood pressure is considered to be elevated when repeated measurement shows a systolic pressure greater than 140, a diastolic pressure greater than 90, or both.
Because the heart is working harder than normal, high blood pressure increases the risk of coronary heart disease, heart attack, stroke, aneurysm, kidney failure, and atherosclerosis. When the heart works harder than normal over an extended period of time, it tends to enlarge. High blood pressure also causes the arteries and arterioles to become scarred, hardened, and less elastic. This, in turn, can limit the amount of blood flowing to the organs; can cause blood clots in the arteries; and can ultimately damage the heart, brain, and kidneys.
The cause of hypertension is unknown in 90 to 95% of all cases. People who have a family history of high blood pressure may be more likely to suffer from it. People who suffer from stress, worries, fear, pressure from events from daily life, and nervous stress can also suffer from hypertension.
Because persons with hypertension may not exhibit any symptoms, they often go undiagnosed until complications occur. Regular (yearly) blood- pressure screening can facilitate early diagnosis and treatment and reduce the risk of further complications associated with hypertension.
Hypertension is generally classified as primary or secondary. Primary or essential hypertension has no known cause; however, certain lifestyle factors such as body weight and salt intake are involved. Ninety-five percent of persons diagnosed with hypertension fall into this category. The diagnosis is made when no other cause is found. Secondary hypertension is caused by some other medical diagnosis or problem, such as kidney disease, Cushing's syndrome, pregnancy, oral contraceptive use, chronic alcohol abuse, or the use of certain medications.
There are several factors that put people at risk for hypertension. Gender, age, heredity, and race are factors that cannot be controlled. As people age, their chances of developing hypertension increase. Men are generally at greater risk than women. However, as women age, their risk increases with the onset of menopause, and later in life it exceeds that of men. Heredity can be a risk factor if one or more parents have been diagnosed with hypertension. African Americans are at higher risk for contracting hypertension than Caucasians are.
According to the journal Ethn. Dis., (winter 1998), other risk factors that can be controlled are lifestyle related: obesity, lack of exercise, diet, stress, the use of certain medications, smoking, and excessive alcohol consumption.
Hypertension usually has no evident symptoms. Many people can have high blood pressure for years without knowing it, and that is why it can be so dangerous. The only way a person can find out if he or she has hypertension is to have his or her blood pressure checked at least once every 2 years by a doctor or other health professional. Some of the warning signs of hypertension can include nosebleeds, an irregular heartbeat, headaches, and dizziness; however, if a person does not have these warning signs, it does not necessarily mean he or she does not suffer from it.
Hypertension can occur in children or adults. It occurs predominantly in middle-aged and elderly people, obese people, heavy drinkers, blacks, and women who are taking oral contraceptives. Called the silent killer, there may not be any symptoms for many years until a vital organ is damaged. A person can be calm and relaxed and still have high blood pressure, even though tension or nervousness also causes hypertension.
Blood pressure may rise as people get older. Males suffer from hypertension earlier than females and are more likely to develop high blood pressure than females in early adulthood into early middle age. By the time women reach the age of 55, their chances of getting hypertension even out with men. Three fourths of all women past the age of 75 suffer from hypertension.
There is no cure for hypertension, but conventional doctors treat it in one or both of two ways: (1) by changing the patient's lifestyle and eating habits and (2) by prescription medications. The change of lifestyle is preferable to taking medication. Alternative doctors seek to address the underlying cause of hypertension and correct it.
A January 1998 Harvard Medical School study sums up the impact of excess weight or small weight gains relative to the risk of hypertension: "Excess weight and even modest adult weight gain substantially increase risk for hypertension. Weight loss reduces the risk for hypertension."
An earlier Harvard 1996 study that included 41,541 female nurses, published in Hypertension Journal, stated that "these results support hypotheses that age, body weight, and alcohol consumption are strong determinants of risk of hypertension in middle-aged women. They are compatible with the possibilities that magnesium and fiber as well as a diet richer in fruits and vegetables may reduce blood pressure levels."
If a person is overweight, or only a little overweight, it is suggested he or she lose weight. Losing 2 pounds can cause a 1 to 2 point drop in blood pressure. Brisk walking or bike riding for 30 to 40 minutes, 3 times a week, can lower blood pressure a few points. Strenuous exercise can lower blood pressure even more. (Also refer to the section "The DASH Diet" in this protocol, for a diet that many people say "requires them to eat too much.")
A New Rational Approach for Hypertension Therapy
Several basic concepts are often ignored despite being relevant to the treatment of hypertensive patients and associated cardiovascular disease.
Although people often consider hypertension as a disease, it is not itself a disease but, rather, one warning manifestation of a disease. Approximately 90% of the time, the underlying cause(s) of hypertension are unknown; thus, the condition itself is named according to its sign, as essential hypertension.
Commonly, physicians are told that by eliminating the hypertension-i.e., by merely reducing blood pressure-the increased risk and mortality associated with underlying cardiovascular disease will be reversed. Unfortunately, the cumulative experience of over two decades of worldwide clinical trials indicates that getting rid of only one aspect of hypertensive disease, the elevated blood pressure, reduces only part of the cardiovascular risk associated with hypertension.
We must appreciate that what we call "hypertension" is a powerful indicator of disease in other body systems, such as left ventricular hypertrophy, that may exist prior to and progress independently of the hypertension itself and insulin resistance, reflecting the same underlying pathophysiology in skeletal muscle, fat, and other tissues. Thus, the disease we call hypertension is not just a blood pressure reduction or numbers game. We must consider the treatment of associated disease to treat hypertension successfully.
Ultimately the goal would be to identify underlying disease-not only the elevation of blood pressure, but also the other multisystemic aspects of hypertensive cardiovascular disease-and implement an integrated medical approach as well. Focusing on such underlying factors would allow treatment of the disease process itself, rather than just the elevated blood pressure.
A second concept is also often overlooked but quite obvious: people are different. By analogy with an elevated temperature, the same elevation of blood pressure that leads to the diagnosis of "essential" hypertension may result from many different "primary" causes, which just happen to have hypertension as one shared clinical manifestation. This immediately implies that when we ask, "Is this drug or integrated therapy good, or preferred for hypertension?" the answer should be, "It depends." As an obvious example, the salt-sensitive hypertensive patient responds to dietary salt recommendations and to different drug classes differently from an individual who is not salt sensitive.
Therefore, it is worthwhile to consider associated underlying cardiovascular disease and treatment protocols present in the cardiovascular section of this book when treating hypertension as well as an individual's unique response to various conventional and integrated therapies. Working closely with your physician to monitor your individual response to integrated therapies is recommended.
There are nutrients that may reduce or eliminate the need for antihypertensive medications. However, nutrients may not work immediately to lower blood pressure the way drugs do, so it is important to carry nutritional blood pressure-lowering therapy through over a period of 4 to 12 weeks. Also, physician cooperation is crucial if you are to reduce your intake of blood pressure-lowering drugs safely. Routine, ongoing blood pressure monitoring is mandatory to determine whether the nutritional or integrated medical regimen you are following is controlling or reducing your blood pressure or not.
Coenzyme Q10 (CoQ10) and garlic provide aid in the reduction of blood pressure. These supplements may also mitigate the underlying disease that may be the cause of hypertension.
In March 1999, the results of a randomized, double-blind trial among patients receiving antihypertensive medication was published. Patients known to have essential hypertension and presenting with coronary artery disease were given 60 mg of CoQ10 twice a day. The doctors conducting the study stated,
"Findings indicate that treatment with Coenzyme Q10 decreases blood pressure, possibly by decreasing oxidative stress and insulin response in patients with known hypertension receiving conventional antihypertensive drugs (Journal of Human Hypertension, 1999 [March], 13 [3]:203-8)
Another study using higher doses of CoQ10 concluded:
"Patients treated with an average of 200 mg/day of CoQ10 showed improvement in symptoms of fatigue and dyspnea with no side effects noted. Previous observations on the improvement in diastolic function and left ventricular wall thickness through the therapeutic administration of coenzyme Q10 in patients with hypertensive heart disease prompted the investigation (Molecular Aspects of Medicine, 1997, 18 Suppl:S145-51)
CoQ10 was tested in 109 cardiology patients presenting with hypertension for at least 1 year. An average dose of 225 mg/day orally of CoQ10 was administered along with antihypertensive medication. The aim was to attain blood levels greater than 2.0 mcg/mL (average 3.02 mcg/mL on CoQ10). Rather than being fixed, dosage was adjusted according to clinical response and blood CoQ10 levels. Researchers reported, "A definite and gradual improvement in functional status was observed with the concomitant need to gradually decrease antihypertensive drug therapy within the first one to six months." A remarkable 51% of patients were completely removed from between one and three antihypertensive medications an average of 4.4 months after starting CoQ10 administration. A highly significant improvement was seen in left ventricular wall thickness and diastolic function in those patients (9.4% of total) who were monitored by echocardiogram before and during treatment.
In a study conducted to clarify the mechanism of the antihypertensive effect of CoQ10, 26 patients with essential arterial hypertension were treated with oral CoQ10, 50 mg twice daily for 10 weeks. Plasma CoQ10, serum total and high-density lipoprotein (HDL) cholesterol, and blood pressure were determined in all patients before and at the end of the 10-week period. At the end of the treatment, systolic pressure decreased from 164.5 ± 3.1 to 146.7 ± 4.1 mmHg, and diastolic pressure decreased from 98.1 to 86.1 mmHg. Plasma CoQ10 values increased from 0.64 mcg/mL to 1.61 mcg/ mL. Serum total cholesterol decreased from
222.9 mg/dL to 213.3 mg/dL, and serum HDL cholesterol increased from 41.1 mg/dL to 43.1 mg/dL ± 1.5 mg/ dL.
High doses of fish oil concentrates have lowered blood pressure in some people. There are cardiovascular as well as other health benefits associated with taking fish oil.
A study published in the October 1997 American Journal of Clinical Nutrition stated that "fish oils have been shown to lower blood pressure in hypertensive subjects." According to a January 1999 Journal of Nutrition study, the fatty acid DHA (docosahexaenoic acid, obtained directly from fish oil) was shown to alter the membrane fatty acid composition as well as the amount of ATP released from vascular endothelial cells, and also decrease plasma noradrenaline. The doctors who conducted this study stated that these factors may ameliorate the rise in blood pressure normally associated with advancing age. The Journal of Vascular Research (January 1998) corroborated these findings by showing that the EPA (eicosapentaenoic acid) fatty acid fraction of fish oil, when administered to aged rats, increases the release of ATP from the vascular endothelial cells, leading to repression of the blood pressure rise seen with advancing age. The October 1997 American Journal of Clinical Nutrition stated that "fish oil has a mild blood pressure-lowering effect in both normal and mildly hypertensive individuals."
Fish oil has been shown to reduce high levels of triglycerides by an average of 35%; however, fish oil does not reduce cholesterol as originally thought. Fish oil supplements do lower triglycerides dramatically, however.
If your gastrointestinal tract can tolerate high daily doses of fish oil, then you may lower your blood pressure and gain other benefits. One consideration is to start with a half dosage and then slowly increase to the dosage that will be recommended.
Several studies suggest that garlic may have protective effects against cardiovascular diseases. One cross-sectional observational study reported in Circulation, October 1997, tested the hypothesis that regular garlic intake would delay the stiffening of the aorta related to aging. Chronic garlic powder intake was shown to attenuate age-related increases in aortic stiffness. Arterial stiffening with age is one cause of hypertension. The doctors conducting this study stated,
These data strongly support the hypothesis that garlic intake had a protective effect on the elastic properties of the aorta related to aging in humans.
As reported in the June 1998 Journal of Cardiovascular Pharmacology, garlic preparations have also been shown to have a beneficial effect on lipids, blood pressure, and platelet function.
An April 1998 study (Prostaglandins Leukotrienes, and Essential Fatty Acids, Scotland) reported the effect of garlic on blood lipids, blood sugar, fibrinogen, and fibrinogenic activity of 30 patients who received 4 grams of garlic daily for 3 months. The patients were monitored at 1.5 and 3 months when it was determined that garlic had significantly reduced total serum cholesterol and triglycerides and increased the beneficial HDL cholesterol fraction. With regard to fibrinogenic activity, it was determined that the garlic inhibited platelet aggregation.
To analyze the effect of garlic on blood pressure, researchers in Australia reviewed published literature on randomized controlled trials of garlic preparations that were at least 8 weeks in duration. The researchers identified eight trials using Kwai, a dried garlic powder preparation involving 415 subjects. In seven trials that compared garlic to placebo, three showed a significant reduction in systolic blood pressure (SBP) and four showed a reduction in diastolic blood pressure (DBP). The overall pooled mean difference in the absolute change (from baseline to final measurement) of SBP was greater in subjects treated with garlic than in those treated with placebo. In DBP subjects, the corresponding reduction was slightly smaller. The researchers concluded that there may be some clinical use in patients with mild hypertension and recommended that more thorough and rigorously designed trials be conducted.
Another randomized, placebo-controlled, double-blind trial was conducted on 47 nonhospitalized patients using Kwai garlic preparation. The patients who were admitted had diastolic blood pressures between 95 and 104 mmHg after a 2-week acclimatization phase. Blood pressure and plasma lipids were monitored during treatment after 4, 8, and 12 weeks. Researchers found significant differences between the placebo and Kwai groups. Systolic blood pressure fell from 102 to 91 mmHg after 8 weeks and again to 89 mmHg after 12 weeks in the drug group. Researchers also reported a significant reduction in serum cholesterol and triglycerides in the same group. No significant changes were noted in the placebo group.
Other researchers evaluated a garlic preparation containing 1.3% allicin (2400 mg) in nine patients with relatively severe hypertension (DBP 115 mmHg). At peak effect, about 5 hours after dosing, sitting blood pressure fell 7/16 (± 3/2 standard deviations) mmHg, with a significant decrease in diastolic blood pressure from 5 to 14 hours after dosing. Researchers concluded that the garlic preparation reduced blood pressure with no evident side effects.
Studies continue in this area, with investigations pointing strongly toward the benefits of garlic, fish oil, and CoQ10 aiding in the treatment of hypertensive disease. The amount of standardized garlic extract needed to lower blood pressure is 1500 to 6000 mg per day. The amount of coenzyme Q10 needed to lower blood pressure is 200 to 300 mg per day.
A popular combination of supplements to take three times a day is
a. 2 to 3 Mega EPA fish oil capsules (each capsule contains 400 mg EPA/300 mg DHA)
b. 1 CoQ10 (100 mg) supplement
c. 2 garlic powder (900 mg) capsules
d. 2 vitamin C (1000 mg) capsules (more about vitamin C later in this protocol)
Coenzyme Q10 should be taken in a liquid oil capsule for optimal assimilation. The garlic powder should contain a high allicin content (greater than 8000 parts per million). Consideration should also be given to diet changes during this same period to maximize results. After 4 weeks, consult your physician about your blood pressure, and depending on its drop, your physician may be able to reduce the dosage of your antihypertensive medication. The rationale and objective is to be able to reduce your intake of drugs slowly as the natural antihypertensive properties of garlic/coenzyme Q10 begin to take effect.
IMPORTANT NOTE: It is crucial to monitor your blood pressure closely, since the garlic/coenzyme Q10 combination does not work for everyone. Consult your physician on how you might integrate this therapy as part of your hypertensive treatment. (We recommend that you refer to the Atherosclerosis, Congestive Heart Failure, and Cholesterol Reduction protocols for more information relative to taking an integrated medical approach to hypertension.)
A report in the American Journal of Clinical Nutrition stated that there is growing evidence that maintaining an adequate dietary mineral intake protects against high blood pressure. The report specifically noted the beneficial effects of meeting or exceeding dietary allowances of calcium, magnesium, and potassium in controlling elevated arterial pressure due to high intake of dietary sodium chloride. The report further noted that educating individuals to maintain adequate levels of these minerals may be a more valid health recommendation than simply reducing sodium intake. Another report in the Annals of Medicine stated that "in certain patients potassium, calcium, and magnesium may be protective electrolytes against hypertension." The report went on to suggest that "with appropriate dietary modifications, it is possible to prevent the development of high blood pressure and to treat hypertensive patients with fewer drugs and with lower doses. In some patients antihypertensive medication may not be at all necessary."
Anyone with elevated blood pressure should be taking 500 to 1500 mg of elemental magnesium per day. About 80% of Americans are magnesiumdeficient, and low levels of magnesium are associated with hypertension and arterial disease. Even if magnesium fails to lower your blood pressure, it can reduce the risk of complications, such as stroke.
In the early 1990s, several large population studies showed a reduction in cardiovascular disease in those who consumed vitamin C. The most significant report emanated from UCLA in 1992, where it was announced that men who took 800 mg a day of vitamin C lived 6 years longer than those who consumed the FDA's recommended daily allowance of 60 mg a day. The study, which evaluated 11,348 participants over a 10-year period of time, showed that high vitamin C intake extended average life span and reduced mortality from cardiovascular disease by 42%. This study was published in the journal Epidemiology (1992 3 [3]:194-202).
In 1998, several well-controlled studies showed that vitamin C enables the arterial system to expand and contract with youthful elasticity. Enhancing the elasticity of the arterial system is one method of reducing blood pressure. Cardiologists often prescribe nitroglycerin and longer-acting nitrate drugs to dilate the coronary arteries and relieve angina pain. Nitrate drugs not only improve coronary blood flow but also lower the oxygen demand of the heart by reducing peripheral vascular resistance. Unfortunately, nitrate drugs also produce negative effects. The main limiting factor to the nitrate drugs is tolerance: the vascular system stops responding to the dilating effects of the drugs, and angina is no longer controlled. Nitrate drugs may also cause a progressive weakening of the heart muscle cells' ability to produce energy. When vitamin C is administered to coronary artery disease patients, the vasodilating effects of the nitrate drugs may be significantly prolonged and the energy-producing capacity of the cells maintained.
A double-blind study published in the Journal of the American College of Cardiology (1998, 31 [6]:1323-29) compared the effects of nitrate drugs in people receiving vitamin C to a placebo group not receiving vitamin C. The doctors administered nitrate drugs to healthy people and patients with coronary artery disease and then measured vasodilation response and cellular levels of cGMP (cyclic guanosine monophosphate), an energy substrate that is depleted by nitrate drugs. At day zero, all participants were measured to establish a baseline. After 3 days of vitamin C administration (2 grams, 3 times daily), there was no change in either group. After 6 days of vitamin C therapy an impressive 42% improvement in vasodilation response was observed and a 60% improvement in cellular cGMP levels was measured in coronary artery disease patients receiving vitamin C compared to placebo. A similar improvement occurred in the healthy subjects taking vitamin C compared to the placebo group. The doctors concluded the study by stating, "These results indicate that combination therapy with vitamin C is potentially useful for preventing the development of nitrate tolerance."
Another study published in the Journal of Clinical Investigation (1998, [July 1]) looked at the effects of nitrate drug therapy on human patients. Tolerance development was monitored by changes in arterial pressure, pulse pressure, heart rate, and activity of isolated patients. All patients experienced the deleterious effects of nitrate tolerance. However, when vitamin C was coadministered with the nitrate drugs, the effects of nitrate tolerance were virtually eliminated. The most significant improvement was a 310% improvement in the arterial conductivity test. The nitrate drugs induced a dangerous up-regulated activity of platelets, but this too was reversed with vitamin C supplementation. The doctors who conducted this study indicated that vitamin C may be of benefit during long-term, nonintermittent administration of nitrate drugs in humans.
An especially damaging effect of nitrate drugs is that they cause a decrease in the intracellular (inside the cells) production of cGMP, an energy substrate that is required to maintain cellular energy levels. Vitamin C has been shown to protect against nitrate-induced depletion of cGMP. In a study published in the May 22, 1998, issue of FEBS Letters (Netherlands), kidney cells exposed to 5 hours of pretreatment with a nitrate drug showed a substantial depletion of intracellular cGMP. When vitamin C was present during pretreatment with nitrate drugs, cGMP levels were 3.1-fold higher.
Chronic heart failure is associated with reduced dilating capacity of the endothelial lining of the arterial system. Scientists tested heart failure patients by high-resolution ultrasound and Doppler to measure radial artery diameter and blood flow. Vitamin C restored arterial dilation response and blood flow velocity in patients with heart failure. The scientists determined that the mechanism of action was that vitamin C increased the availability of nitric oxide, an important precursor to cGMP. This study was published in the February 1998 issue of the journal Circulation.
Also in 1998, another aspect of vitamin C's effect on coronary artery disease was discovered. A study published in the Journal of the American College of Cardiology (1998, 41 [5]:980-86) showed that low plasma ascorbic acid (vitamin C) levels independently predict the presence of an unstable coronary syndrome in heart disease patients. According to the doctors, the study's results showed that the beneficial effects of vitamin C in treating coronary artery disease may result, in part, by an influence on arterial wall lesion activity rather than a reduction in the overall extent of fixed disease.
The Institute of Public Health, Cambridge, UK, conducted one of the first systematic reviews of epidemiological studies of vitamin C and blood pressure in 1997. The scientists reviewed published cross-sectional studies, prospective studies, and trials in humans that examined the association between vitamin C intake or plasma vitamin C levels and blood pressure. Relevant references were located by MedLine search (1966-1996) and EMBASE search (1980-1996), by searching personal bibliographies, books and reviews, and from citations in located articles. The conclusion from this analysis of the published literature was as follows:
We found a consistent cross-sectional association between higher vitamin C intake or status and lower BP, though no study controlled adequately for confounding by other dietary factors. Further cross-sectional studies are required to establish whether an independent association exists. If this is shown to be the case, larger and longer-term trials will be needed to confirm the association is causal. Potentially, the impact on cardiovascular disease of a modest change in mean population vitamin C intake is large (Journal of Human Hypertension, 1997 [June], 11 [6]:343-50).
A British Medical Research Council in Cambridge, UK, reported the benefits of vitamin C in 1998 from a large national survey as follows:
Plasma ascorbate concentration was inversely correlated to systolic and diastolic blood pressures and pulse rate. Other covariates of blood pressure included age, sex, domicile, plasma retinol, fibrinogen and gamma-tocopherol concentrations, erythrocyte count, prothrombin time, and urine sodium:creatinine ratio. Covariates of pulse rate included sex, domicile, plasma fibrinogen and platelet count. Blood pressure was also correlated to intake of vitamin C. CONCLUSIONS: Plasma ascorbate concentration and intake of vitamin C are covariates of blood pressure in older people living in Britain (Journal of Hypertension, 1998 [July]).
Note: It is important to take complete Vitamin supplement & not just a (one) vitamin type. Having too much of a certain vitamin type (example Vit. C) will cause a reduction in other vitamins.
Arginine can work synergistically with such ACE-inhibiting antihypertensive drugs as Vasotec, Capoten, and Zestril (see more on ACE inhibitors under the "Currently Prescribed Drugs" section of this protocol). This is important for those with chronic hypertension who fail to respond to conventional or alternative therapies.
Since the Life Extension Foundation's original recommendations about using arginine to treat hypertension were made in 1991, numerous new studies have been published indicating that arginine may be even more effective as an antihypertensive agent than was previously reported. Here is a summary of these new studies:
"The l-arginine-nitric oxide pathway appears to play an important role in systemic hypertension, progressive renal disease, nephrotoxicity (lead poisoning), inflammation and atherosclerosis (Current Opinions in Nephrology and Hypertension, 1998 [Sept], 7 [5]:547-50). These results support the roles of both increased endothelin synthesis and decreased nitric oxide activity in the pathogenesis of cyclosporin A-induced hypertension (Journal Human Hypertension, 1998 [Dec], 12 [12]:839-44). l-arginine supplementation improved the urinary NOx excretion and prevented hypertension. We conclude that hypoxia-induced sustained arterial hypertension is associated with depressed NO production and can be mitigated by l-arginine supplementation (Kidney Int., 1998 [Jul], 54 [1]:188-92). Supplementation of l-arginine normalized the abnormality of renal hemodynamics accompanying salt-induced hypertension (American Journal of Hypertension, 1997 [May], 10 [5 Pt 2]:89S-93S). These findings demonstrated that l-arginine ameliorated adverse cardiovascular effects of hypertension in aged spontaneously hypertensive rats (SHRs) as demonstrated by reduced arterial pressure and total peripheral resistance, diminished left ventricular mass and collagen content, and improved coronary hemodynamics (Hypertension, 1999 [Jan], 33 [1 Pt 2]:451-55). University of Southern California researchers in Los Angeles reported a fall in blood pressure using l-arginine for hypertension in African Americans. The researchers pointed out that a defect in nitric oxide production may be a possible mechanism of hypertensive disease. Arginine enhances the body's natural synthesis of nitric oxide (Journal of Human Hypertension, 1997 [Aug], 11 [8]:527-32).)
The suggested dose of arginine to lower blood pressure is 4500 mg, 3 times a day.
WARNING: If you'd like to see whether any of the nutritional antihypertensive agents can help you reduce the dosage or replace your antihypertensive drugs, extreme caution is mandatory and physician cooperation is essential. You should reduce the dosage of your antihypertensive drug very slowly while increasing your intake of the nutrient supplement(s). Monitor your blood pressure on a daily basis. If you do not exercise caution, an acute hypertensive event could occur, resulting in a stroke.
The DASH Diet enables many people to experience a blood pressure drop in 2 weeks, and many complain about having to eat too much food! What a diet! What a way to lower blood pressure without drugs.
High blood pressure affects one in four Americans, yet very few dietary guidelines have been promoted to control its effects on the body. However, a recent study known as the DASH trials, published in the New England Journal of Medicine, has provided evidence of a diet that seems to lower blood pressure quickly. The low-fat diet is high in fruits and vegetables and includes low-fat dairy products. The trials were funded by the National Heart, Lung, and Blood Institute (NHLBI) and supported by the other two branches of the National Institutes of Health (NIH).
The DASH trials began with 459 adults with systolic blood pressure of less than 160 mmHg and diastolic blood pressure between 80 and 95 mmHg. Of the participants, 133 had Stage I hypertension (140-159 mmHg systolic and 90-99 mmHg diastolic) for which no medication was taken. One half of the subjects were women; 60% were African Americans, who seem to develop hypertension earlier and more frequently than other racial groups. High blood pressure is defined as a systolic measure equal to or greater than 140 mmHg, a diastolic pressure greater than 90 mmHg, or both.
At the start of the study, all participants were given a control diet for 3 weeks that was low in fruits and vegetables, included low-fat dairy products, and approximated the daily fat intake of the average American. After this initial period, the subjects were divided into three groups. One continued with the control diet, one was given a "fruit and vegetable" diet, and one was given the "combination" diet: high in fruits and vegetables together with low-fat dairy products, and low in saturated and total fat.
Both noncontrol diets had about 8 to 10 times the average American's intake of fruits and vegetables, and the "combination" diet had about 2 to 3 times the normal intake of low-fat dairy products. The diets did not focus on a reduction in salt intake. In fact, the three diets had a sodium intake of about 3 grams per day, which is just slightly lower than that consumed by the average American. None of the diets was vegetarian or used any kind of fat substitutes, and all included a variety of foods that were fresh, dried, frozen, or canned. All three of the diets controlled for sodium levels, a possible confounding factor of the study because of its traditional role in blood pressure elevation.
Throughout the trials, blood pressures were monitored, and after 8 weeks the final levels were recorded. The "fruit and vegetable" diet produced a 2.8/1.1 mmHg reduction in blood pressure overall as compared to the control: among the 133 subjects with hypertension, it produced a reduction of 7.2/ 2.8 mmHg. The combination diet caused the most dramatic reduction in blood pressure, with an overall reduction of 5.5/3.0 mmHg and, in hypertensive participants, an overall reduction of 11.4/ 5.5 mmHg. An interesting phenomenon that was observed during the trials was that blood pressure reductions for the most part occurred within the first 2 weeks of the diet program, and subjects maintained these levels for the rest of the trials.
The principal complaint that subjects had about the diet was that they were required to eat too much food. A sample dinner might consist of 3 ounces of baked cod, 1 cup of rice, 1/2 cup of broccoli, 1/2 cup of stewed tomatoes, a small spinach salad, one whole-wheat dinner roll with a teaspoon of margarine, and 1/2 cup of melon balls. Participants said that they were not used to eating this much food. In a real-world situation, where a person is not required to maintain a constant body weight as the participants were in the DASH trials, the person would lose some weight.
The DASH trials produced some promising results. Blood pressure reductions were seen not only in those with hypertension, but also in those with normal-high blood pressure-in other words, those at risk of developing hypertension. These results suggest that the diet may be helpful not only in treating hypertension but in preventing it. Furthermore, the diet's results in hypertensive subjects were similar to what one might expect from single-drug therapy, suggesting that the DASH diet may be a suitable substitute for drug treatment in some patients.
Although DASH researchers believe the diet to be a possible alternative to drug treatment, they warn that personal physicians should always be consulted before any kind of treatment modification is made. They also estimate that if all Americans adopted this diet, heart disease would decrease by 15% and strokes would decrease by 27%. The most sound advice that DASH supporters can give is to start to eat the DASH way gradually. Try to structure meals around vegetables and carbohydrates instead of around foods high in protein. Also remember that 8 to 10 servings of fruits and vegetables are not as much as one would think, because the recommended serving sizes are half of what the average American would consider to be a "serving."
Despite treatment, there is often a higher incidence of cardiovascular complications in patients with hypertension than in normotensive individuals. Inadequate reduction of their blood pressure is a likely cause, but the optimum target blood pressure has not been known. A 1998 study to determine the impact of aspirin as an integrated therapy for hypertension was investigated. A total of 18,790 patients from 26 countries, aged 50 to 80 years (mean 61.5 years) with hypertension and diastolic blood pressure between 100 mmHg and 115 mmHg (mean 105 mmHg) were randomly assigned a target diastolic blood pressure. The study was designed to assess the optimum target diastolic blood pressure for hypertensive patients and the potential benefit of a low dose of aspirin in the treatment of hypertension. The doctors discovered:
Intensive lowering of blood pressure in patients with hypertension was associated with a low rate of cardiovascular events. The [study] shows the benefits of lowering the diastolic blood pressure down to 82.6 mmHg. Acetylsalicylic acid (aspirin) significantly reduced major cardiovascular events with the greatest benefit seen in all myocardial infarction. There was no effect on the incidence of stroke or fatal bleeds, but non-fatal major bleeds were twice as common (Lancet, 1998 [June 13], 351 [9118]:1755-62).
Please refer to newly added recommendation for aspirin, as part of an integrated hypertension therapy listed below in the protocol
Our general precaution is that is if you're going to attempt to use any of the nutrients the Foundation recommends to replace antihypertensive drugs, you must do so with the cooperation of your physician. You cannot assume that any nutrients will be able to replace a drug that already is effectively controlling your blood pressure. Daily blood-pressure monitoring is mandatory to ensure that the nutrient regimen you are following is really keeping your blood pressure under control.
Summary
1. Have your blood pressure checked regularly.
2. Stop smoking.
3. Avoid sodium (salt) intake. About a third of the people who have hypertension can be helped by lowering salt intake. Try to reduce your salt intake to about 1 to 2 teaspoons a day.
4. Eat more fresh fruits, vegetables, and foods high in fiber and food that has less fat.
5. Reduce stress on and off the job.
6. Moderate alcohol intake. It is now known that a moderate amount of alcohol can help decrease your risk for heart problems, but it should not exceed 3 ounces a day.
7. Exercise regularly and keep weight within normal limits.
8. Take garlic, 1500 to 6000 mg a day, and coenzyme Q10, 200 to 300 mg a day, in combination to lower blood pressure.
9. Take magnesium, 500 to 1500 elemental milligrams a day.
10. Take calcium, 1000 elemental milligrams a day.
11. Take potassium, to be prescribed by your doctor: often 400 to 500 mg a day.
12. Take fish oil concentrate, 8 to 10 capsules of Mega EPA fish oil capsules a day.
13. Take your vitamins. (Vitamin C 2000 mg, 3 times daily)
14. Take arginine in doses of 4500 mg, 3 times a day.
Source : Various
