Articles

Hypertension

The following is a reproduction of a Millennium Health Centre editorial article which appeared in the fall 2004 issue of the Health Educator.

Regards,

Dr. Stephen F. Jones B.Comm., N.D.
Doctor of Naturopathic Medicine

The word 'hypertension' is known by many readers, as this condition affects a substantive percentage of the North American and, indeed, global population(s). 'Hypertension' is defined as a higher than 'normal' blood pressure - meaning the pressure inside your arteries and veins. No different than water flowing through pipes, as blood is pushed through your arteries and veins, there is an associated pressure created by this process. With hypertension, this pressure is considered higher than it should be. This is a significant concern as, depending on the cause of the elevated blood pressure along with the individual's unique health history and medical status, a high blood pressure can lead to serious health conditions. Much like the plumbing pipes, if pressure becomes too high, the pipes can suffer damage or even rupture. Similarly, in humans prolonged hypertension (or even short episodes with very high pressure) can lead to stroke, heart attacks, aneurysms, changes in heart size and other potentially life threatening illnesses. On a less severe level, continued high blood pressure can cause headaches, impaired vision, ringing in the ears, impaired circulation and other seemingly unrelated health concerns.

So what is a 'normal' blood pressure and what is considered too high (ie. ' considered hypertension'). Well, as with all aspects of medicine, you will not get a simple answer here! First, blood pressure (B.P.) must be assesses on 2 or 3 (depending on the guidelines used) occasions BEFORE the diagnosis of 'hypertension' can be applied. The reason is that B.P.s vary and just the process of having a doctor or nurse take the B.P. can cause many to have an elevation that is unusual for them (and could lead to a faulty diagnosis). This is called the proverbial 'white coat' syndrome - one reason why many of us do not wear white coats…..

Next, one must evaluate the B.P. in context. That means the individual's historical B.P. must be considered, as should their age, gender, weight, personal and family history of heart disease and presence of other complicating health conditions (such as diabetes or high cholesterol - factors which will make a high B.P. even more 'risky'). One should see then, that a 'textbook normal' B.P. is a little misleading. We're all individuals and should be examined and evaluated as such.

Never the less, the textbook guidelines define hypertension as follows. An 'optimal' B.P. (ie. what you may wish to strive for) is around 120 / 80. We say around here because it is not optimal to have too low a B.P. ( I will need, however, to defer a detailed discussion of that concept). A 'normal' B.P. is around 130/85 (implying that most do not have the 'optimal' B.P.). 'High-normal' B.P. is 130-139/85-89. 'Hypertension' is any B.P. above the high normal, but is further sub-divided into 3 stages. 'Stage 1' is defined as 140-159/90-99. 'Stage 2' is defined as B.P. of 160-179/100-109. 'Stage 3' is defined as greater than 180/110. These 'numbers' (from Physical Examination and Health Assessment, Jarvis) have some fluctuation depending on the guidelines the individual's doctor wishes to follow. They must be interpreted in light of the person's individual health history, current medical status and lifestyle circumstances. Doctors may wish to treat patient's whose B.P. appears to be 'high-normal' according to the above definitions and, likewise, may hold off on treating B.P.s that appear to be of some concern based on the above definitions.

Understanding the classifications that define hypertension, patients must come to realize the hypertension is the outcome, or result if you will, of an underlying process and not a fixed 'condition' in its own right. Stated another way, a patient can have hypertension for several different reasons. The actual cause of the hypertension should be explored and attempted to be defined, before treatment is prescribed, as different causes require different treatments. This requires a detailed physical examination, detailed blood work and a detailed review of the patient's life circumstances and medical history. This also means that until such a review is conducted, patients (and their doctors) may wish to defer immediate medication use until all considerations and possible causes are explored.

The known causes of hypertension are, indeed, varied. To attempt to summarize a rather detailed subject, suffice it to say there are two general categories of hypertension, that being 'Primary Hypertention' and 'Secondary Hypertension'. With Primary Hypertension, also known as 'Essential Hypertension', there is no known etiological factor (Merck Manual, 16th Ed.). The central nervous system and a chemical process in the kidneys called the Renin-angiotensin-aldosterone system are currently the most speculated factors involved in Primary Hypertension.

Secondary Hypertension is known to result from numerous causative factors. Included in these are kidney disorders (eg. chronic glomerulonephritis, polycystic renal disease etc.), a hyperactive thyroid, a condition known as Cushing's syndrome and other hormonal conditions. Included in this category, however, is the use of oral contraceptives, excessive alcohol consumption, excessive (body) weight and/or obesity and a sedentary lifestyle with poor stress coping strategies.

So, with a thumbnail sketch of how hypertension is defined and categorized and an indication of the significant health consequences that hypertension can impart, one must ask the question 'what can be done to treat hypertension'. Well, the answer is as detailed as the condition itself. Pharmaceutically, there are numerous drugs available to control hypertension. Some affect the rate at which the heart beats, some affect calcium (and its impact on the heart), some inhibit a chemical produced by the kidney's that influences B.P., and some work to decrease the amount of fluid in the body (allowing for a decrease in overall pressure). Obviously, one should determine what is the likely cause of the hypertension before using drugs that can and do work in very different manners. The topic of pharmaceutical (drug) therapies, however, will not be examined in this column, as hypertension can be controlled in many instances without long term drug intervention and dependency. A review of some of the more common options may allow you to discuss your hypertension treatment in more detail with all your Naturopathic and Medical doctors and come to a solution that fits your individual needs and desires.

When discussing hypertensive treatment options, one must always begin with the most critical considerations, that being long term prevention. As we known that excessive weight, diabetes, elevated cholesterol, sedentary lifestyles, smoking and numerous other 'lifestyle' factors significantly impact upon your B.P., any doctor would be remiss if these considerations are not discussed before any other medication is recommended (natural medication or otherwise). Arguably, the most applicable of these given current social trends is weight control. It's been stated that "excess weight gain is a major cause of increased B.P. in most patients with essential hypertension" (Curr Hypertens Rep, 2003; Oct: 5(5): 386-92). As Canada is experiencing record levels of the population being defined as overweight or outright obese, readers should see why weight may be a starting place in preventing and treating hypertension. A recent study (conducted by the University Health Network) reported that the number of Canadian women diagnosed as obese has doubled between 1981 and 1996 (and more than doubled for men). In fact, the Canadian Community Health Survey has assessed that 14.9 % of the population is medically defined as obese and 33.3 % are defined as overweight.

An appropriate review of a patient's weight, along with tangible exercise and nutrition programs must be provided to all hypertensive patients. In many cases of Stage 1 and Stage 2 hypertension, medications can be avoided with daily exercise programs and a whole foods diet that eliminates 'refined' carbohydrates (like bagels, breads, cookies, muffins etc.), increases fruits and vegetables, focuses on quality proteins like chicken, ocean fish, beans, lentils and soya and eliminates caffeine, alcohol and saturated fats. Exercise can be a structured walking program, all the way through to working with a trainer at a local gym. In addition to the exercise, however, many patients require structured stress management programs which could include yoga, Tai Chi, breathing exercises and visualizations.

Next, should one not be able to fully control their blood pressure with daily exercise, stress management and a proper diet, one can look to herbal medicines. Dr. Peter Pang of the University of Alberta has reported positive findings in the treatment of hypertensive patients with a combination of the plant Cordyceps sinensis along with Shark Cartilage (as published in the Townsend Letter, March 2002: 82-84). While the structure of the study mentioned has limitations, the results appear intriguing and patients may wish to seek the counsel of a doctor familiar with these medicines.

Likewise, the plant Cratageus oxycantha has been shown to possess blood pressure lowering abilities. It appears to accomplish this through the dilation of coronary vessels (Arzneimittelforschung, 1967;17:490-91) and by inhibiting the chemical secreted by the kidneys (angiotensin) that impacts on B.P. (Jon J Pharm 1987;43:242-46). Numerous other herbal medicines may be examined such as Leonurus cardiaca and Convallaria majalis.

Like herbal medicines, hypertensive patients have several minerals and 'neutraceuticals' (natural chemicals that work similar to drugs) options which they can use under the supervision of their doctor. One simple yet powerful example includes magnesium. Several studies have illustrated that patients provided with the right dosages of magnesium can achieve a noteworthy lowering of their B.P. (Am J Clin Nutr, 1994;60:129-35 and Hypertension, 1989;13:227-32). Those doctors who use intravenous vitamin therapies (a focus of many Naturopathic Doctors) are most familiar with this effect after infusing magnesium directly into the blood supply. B.P. is often seen to drop 10-20 'points' just after taking the I.V. therapies.

Like magnesium, the nutrient ubiquinone (a.k.a. Coenzyme Q10) as been shown to lower blood pressure in clinical study (Curr Ther Res, 1990;47:841-45 and J Hum Hypertens, 1999;13:203-208). Other neutraceutical considerations would include calcium citrate and some essential fatty acids. As always, a doctor trained and clinically experienced in the use of these treatments must be consulted.

What is worth noting in the discussion of the above neutraceuticals is that many of these can be administered via intravenous injection. Doing such allows for larger amounts of the ingredients to be directly infused into the bloodstream. Accordingly, these injections bypass intestinal absorption (which can often be compromised) and can often provide results that are much more dramatic and which are realized in a shorter period of time than oral (pill) form. Another benefit of these I.V. therapies is that the doctor using the I.V. treatment can simultaneously treat other cardiovascular concerns (such as arrythmias, congestive heart concerns etc.).

Worth noting is that depending on the doctor's specific education, license and provincial jurisdiction, the use of EDTA chelation therapy may be offered to the patient. While this treatment is used primarily to increase systemic circulation and to 'unplug' blocked arteries, a common result of chelation therapy is a dramatic reduction of B.P. and often the ability to lower or even stop the use of pharmaceutical medications. Patients looking for more information on EDTA chelation therapy should look up the Ameican College for the Advancement of Medicine on the internet or read the books 1) The Scientific Basis of EDTA Chelation Therapy by Halstead & Rozema or 2) Forty Something Forever: A Consumer's Guide to Chelation Therapy by Harold & Arline Brecher. Quite succinctly, those who use chelation therapy will often note that few therapies work as fast or as well as chelation in lowering B.P. and maintaining it long term.

Naturopathic Doctors being varied in the treatments they can use, may look to treat hypertension with either acupuncture (and Traditional Chinese Medicine) or homeopathy, in addition to those treatments already mentioned. With homeopathy, several 'remedies' are known to lower blood pressure quite successfully. Included in some of the most common remedies are Lachesis, Aurum metallicum, Natrum muriaticum and Baryta carbonicum. With Traditional Chinese Medicine several Chinese herbal (called 'Pattent') formulations may be used inclusive of 'Coptis and Scute' and Zhen Gan Xi Feng Tang to name just a couple. Numerous acupuncture 'points' (places where the acupuncture needles are inserted) are also known to have profound ability to lower blood pressure (some times during the treatment itself). Patients must be aware of the status of acupuncture in their home province, as some provinces do not officially license acupuncture and some practitioner's who offer these services have not studied acupuncture in great detail and use it solely for pain relief. Most Naturopathic Doctors have studied acupuncture for 4 years and are able to treat conditions like hypertension, as well as other chronic medical conditions. Ask your doctor as to their specific training or contact the licensing body of your health care provider to better understand his or her licensure with respect to acupuncture and Chinese medicine.

In all, hypertension is a rather complicated condition despite its common place in our society. Patients have numerous treatments and medical approaches to combat this condition and will often benefit from seeking varied opinions as to how to treat their individual case. The point to bear in mind, however, is that in the vast majority of cases of hypertension (ie. regardless of the cause for the most part), patients need to place a high priority on daily exercise, proper nutrition, weight reduction and management and stress management. Only when these considerations have been professionally reviewed should medication (natural or otherwise) be consulted.

Take your health seriously and have your blood pressure checked by a health care provider. If it is high, do not make the mistake of assuming that it's 'not a problem' because of your age, your own belief regarding your health status or the fact that someone in your family had hypertension. YOU require individual examination and supervision and YOU have the ability to contribute to your own care through lifestyle modification.

Best of luck to you and your families in the pursuit of optimal health.

If you have any inquiries or requests for future columns, please contact the Seaway News or email Dr. Jones at dr.jones@millenniumhealthcentre.com.