Overview

High blood pressure is associated with a number of serious diseases, including stroke, heart attacks, renal (kidney) failure, and blindness. While blood pressure is an important predictor of future morbidity and mortality and therefore merits serious attention, some scientists have suggested other nutritional parameters that are also important, such as body levels of vitamins A, C, and E [Gey1991], [Rogers2005, pg 30].

Please see conventional, complimentary and alternative medical treatments for important background information regarding the different types of medical treatments discussed on this page. Naturopathic, Complimentary and Alternative treatments that may be considered include:

Etiology

Regulation of blood pressure is complex, with numerous interacting systems and signaling pathways. Possible causes are discussed below in the DDX (differential diagnosis) section.

Diagnosis

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Differential Diagnosis

  • Primary (idiopathic) - No known secondary cause 90% of cases
  • Secondary (caused by an identifiable problem)
    • Lifestyle: obesity, stress, physical inactivity, excessive salt use, excess alcohol use
    • Medications:
      • Nonsteroidal Anti-inflammatory drugs (NSAIDs), including Vioxx (rofecoxib), Bextra, ibuprofen, Motrin, Naprosyn, and Celebrex, may have the side effect of reducing renal blood flow, leading to increased blood pressure [Fitzgerald2004], [Rogers2005, pg 16].
      • Oral contraceptives
      • Decongestants
      • Antidepressants
      • Sympathomimetics
      • Corticosteroids
      • Ergot alkaloids
      • Lithium
      • Cyclosporine
    • Herbs:
      • Tobacco
      • Yohimbe
      • Licorice
    • Street drugs:
      • Withdrawal from central nervous system depressants: alcohol, benzodiazepines, opioids, "downers", etc.
      • Central nervous system stimulants: Cocaine, amphetamines, "uppers", etc.
    • Sleep Apnea (very common in treatment resistant HTN)
    • Renal Artery Stenosis (up to 35% of treatment resistant HTN in the elderly, rare in the young)
    • Hyperaldosteronism (about 20% of treatment resistant HTN) One of the most important systems is the renin-angiotensin system. When oxygenated blood flow to the kidneys is reduced, the kidneys respond by releasing a hormone called renin. Renin travels in the blood to the lungs, where it activates an enzyme called angiotensin converting enzyme (ACE). The ACE then acts to make the hormone angiotensin which raises blood pressure in an effort to increase the flow of oxygenated blood to the kidneys.
    • Kidney disease: polycystic kidney disease, Glomerulonephritis, Pyelonephritis (about 5% of treatment resistant HTN)
    • Cushing's Disease/Disorder (rare)
    • Pheochromocytoma (rare)
    • Hyperthyroidism (Graves) (rare)
    • Hyperparathyroidism (rare)
    • Coarctation of the Aorta (rare)
    • Intracranial tumor (rare)
    • Genetic factors (African American)

Treatment

Conventional Treatment

  • Diet, exercise, and weight loss are among the most effective interventions for hypertension.
  • Angiotensin Converting Enzyme Inhibitor (ACE-I) or Angiotensin Receptor Blocker (ARB) drugs are often the first-line drug of choice. Concerns have been raised that ACE inhibitors such as Accupril, Altace, Captopril, Lotensin, Monopril, Prinivil, Univasc, Vasotec, Zestril, Accuretic (includes hydrochlorothiazide), Aceon, Atacand, Avalide (includes a diuretic), Avapro, Capoten, Capozide (includes a diuretic), Cozaar, and Diovan may contribute to a significant increase in the risk of anaphylaxis [Kemp1997], [Rogers2005, pg 15]. A more well-known side effect of ACE inhibitors is the dry cough that is caused by inflammatory irritation of the lung tissues by ACE inhibitors.
  • Diuretic drugs are often prescribed. However, these drugs may be counterproductive, since many of them deplete potassium and magnesium, which can raise blood pressure and give rise to arrhythmias, and increased mortality [Cappuccio1991], [Krishna1991], [Mountokalakis1983], [Psaty1995], [Rogers2005], [Siscovick1994], [Valdes1991], [Warram1991]. Note that due to the normal action of cellular ion pumps, potassium and magnesium are mostly inside cells and are not accurately measured using blood serum tests; the body's true status of these important minerals must be measured using more expensive tests that measure potassium inside red blood cells (erythrocytes) [Rogers2008, pg 7].

    Hydrochlorothiazide (HCTZ) is an inexpensive diuretic that is frequently prescribed as a first-line antihypertensive agent. Unfortunately, it depletes potassium and also increases the inflammatory marker called homocysteine [Westphal2003], which has been reported to cause hypertension [Kuan2002]. Both of these effects are counterproductive to cardiovascular health. Chlorthalidone is a safer and more effective alternative to HCTZ [Yarnell2013].

    Concerns have been raised that diuretics may contribute to diabetes [Rogers2008, pg 14], [Skarfors1989] or dyslipidemia [Ames1976], [Day1979], [Rogers2005, pg 14], [Tanaka1976], [Waal-Manning1977] have been raised.

  • Calcium Channel Blocker (CCB) drugs such as Adalat, Cardene, Cardizem, Covera, Dynacirc, Isoptin, Nimotop, Plendil, Procardia, Sular, Tiazac, Verelan, Norvasc ® are often prescribed. However, [Heckbert1997], [Rogers2005, pg 11] points out reports of brain damage caused by these agents, and [Iseri1984], [Rogers2005, pg 11] suggests that increasing magnesium levels is a better way to balance the calcium channels. [Rogers2008, pg 12], [Susman2000] suggest that there these drugs do not produce a significant clinical reduction in blood pressure, and are therefore essentially useless. Furthermore, [Fitzpatrick1997], [Rogers2005, pg 12] suggest a linkage between CCB drug use and cancer due to disruption of normal cell membrane function.
  • Beta blocker drugs, also known as beta-adrenergic receptor antagonists are often prescribed. Concerns have been raised that beta-blockers may contribute to diabetes [Rogers2008, pg 14], [Skarfors1989] or dyslipidemia [Ames1976], [Day1979], [Rogers2005, pg 14], [Tanaka1976], [Waal-Manning1977] have been raised.
  • Hydralazine is sometimes prescribed, but is generally not a first-line agent.
  • Concerns have been raised that hydralazine may contribute to diabetes have been raised [Rogers2008, pg 14], [Skarfors1989].
  • Reduction in salt intake reduces blood pressure in some (but not all) patients.

Naturopathic, Complimentary and Alternative Treatments

Balance Metabolism

Measure and treat elevated homocysteine levels [Rogers2008, pg 10].

Treat hypothyroidism if present [Barnes_Research_Foundation], [Starr2005, pg 15]. When treating hypothyroid patients with hypertension, the rate of titration must be kept slow in order to prevent aggravating the problem [Starr2005, pg 180].

Acupuncture

For example, St-36, Sp-6, LI-4, LI-11 [PIHMA].

Nutrition and Supplements

Measure and treat low magnesium levels [Iseri1984], [Itoh1997], [Kh2000], [Seeliig1989], [Rogers2005, pg 10ff]; [Widman1993]. Other studies also show the importance of adequate magnesium intake for cardiovascular health [Abbott2003], [Altura1985], [Baker1991]; [Johnson1979], [Rogers1991], [Seelig1989]; [Shils1969], [Singh1982]. [Rogers2005, pg 17] suggests supplementing magnesium 400-600mg/day; However Dr. Weyrich notes that this amount of magnesium supplementation may cause diarrhea, and therefore food sources should be used rather than supplements as much as possible. [Rogers2005, pg 18] has pointed out that the serum magnesium that is usually measured by lab tests is a poor indicator of actual magnesium status of the body, because most magnesium is found inside cells rather than circulating in the blood serum. Dr. Weyrich recommends evaluating the cellular stores of magnesium using the Red Blood Cell (Erythrocyte) minerals test.

Measure and treat low potassium levels [Cappuccio1991], [Krishna1991], [Rogers2005, pg 10ff], [Valdes1991]. Due to the risk of sudden absorption of large amounts of potassium, the US Government limits potassium in supplements to 99mg per tablet. Many foods contain higher levels of potassium that are released more slowly as the foods are digested. For this reason, Dr. Weyrich recommends that food sources should be used rather than supplements as much as possible. [Rogers2005, pg 18] has pointed out that the serum magnesium that is usually measured by lab tests is a poor indicator of actual magnesium status of the body, because most magnesium is found inside cells rather than circulating in the blood serum. Dr. Weyrich recommends evaluating the cellular stores of magnesium using the Red Blood Cell (Erythrocyte) minerals test.

Herbal Medicines

The TCM herbal preparation Eucommia Combination (Du Zhong Pian, from Plum Flower) may be useful for some patients.

Diuretic herbs are sometimes useful. However, herbs like dandelion leaf and nettle leaf work by dilating the afferent arteries to the kidney, which raises the glomerular pressure and increases the filtration rate, making the kidneys work harder. This increased pressure is counterproductive, since it adds to the damage already inflicted on the kidneys by elevated blood pressure [Yarnell2013].

Mind-Body Approaches Stress Relief

Biofeedback and Heart-Rate-Variability

Neurotransmitter Balancing

Neuro Research [Hinz2015] reports that chronic diseases such as High Blood Pressure can be benefited by balancing neurotransmitter levels in the body.

Dr. Weyrich has been trained in neurotransmitter balancing protocols, but has not treated High Blood Pressure using this technique.

Please see What is Neurotransmitter Balancing? for more information.

Hypotheses

Hypertension is sometimes associated with hypothyroidism and it has been observed that hypertension resolved (80%) if the hypothyroid condition is treated. It may take several months to several years to achieve maximum therapeutic effect [Barnes_Research_Foundation], [Starr2005, pg 137]. It has been proposed that in these cases, the body is compensating for low thyroid status by increasing sympathetic tone (adrenaline or other adrenal hormones) [Starr2005, pg 15].

References