High blood pressure (known in the medical world as hypertension) is a common diagnosis for many people, and is often seen in conjunction with heart disease, diabetes, strokes, and high cholesterol. According to the Center for Disease Control, about 1 in every 3 American adults has hypertension and roughly half of them have it under control. 1 Often described as the “silent killer” due to its general lack of symptoms, hypertension is a major risk factor for heart attack, stroke, heart failure, kidney failure, encephalopathy, and aneurysm.2 Blood pressure is the measurement of the force of blood flow against arterial walls both when the heart is contracting (systolic blood pressure), and when the heart is at rest and refilling (diastolic blood pressure). Below is chart from the American Heart Association explaining how blood pressure is categorized.

Luckily, the body is designed to control its own blood pressure based on the body’s needs. Several factors assist in regulating this process. Changes to the amount of blood pumped out of the heart with each contraction (known as cardiac output) can be impacted by factors such as heart rate and stroke volume. Additionally, variations in resistance in the blood vessels as determined by factors such as how wide or narrow the blood vessels are, how viscous (thick) the blood is, and alterations to the length of blood vessels (as is seen in weight gain) can also impact blood pressure.4 The sympathetic nervous system (SNS) stimulates release of chemicals like norepinephrine and epinephrine that act as vasoconstrictors and make the blood vessels smaller in diameter by attaching to alpha and beta receptors in the heart and blood vessels to increase heart rate and blood pressure in fight or flight situations, shunting blood to vital organs. They also stimulate aldosterone secretion from the adrenal glands, which leads to renal fluid retention and increased blood volume. Specialized baroreceptors (pressure receptors) in the carotid arteries and aorta monitor levels of pressure against them, and can decrease heart rate and cause vasodilation (widening of the blood vessels) by inhibiting the SNS in an attempt to lower blood pressure if it is too high, or increase heart rate if the pressure is too low.

A second branch of the nervous system known as the parasympathetic nervous system (PNS) balances the SNS by causing vasodilation and slowed heart rate via the vagus nerve. The kidneys also play a significant role in blood pressure regulation by changing the amount of sodium and water retention via the renin-angiotensin-aldosterone system. When the kidneys note a drop in blood pressure or are stimulated by the SNS, they secrete renin, which converts angiotensin to angiotensin I, which is further converted by the enzyme ACE (angiotensin converting enzyme) into a potent vasoconstrictor known as angiotensin II. This chemical also stimulates aldosterone release from the adrenals, increasing sodium and water retention to improve blood volume. The blood vessels themselves also have tools for regulating their constriction and dilation. Substances such as nitric oxide are released by the endothelium to relax the blood vessels.

All of these regulatory systems can fail or become unbalanced by a number of factors, many of which are modifiable by lifestyle and diet changes. Primary or Essential hypertension is most responsive to diet and lifestyle changes, and makes up 90% of cases.4 Essential hypertension is currently understood as a multifactorial disease arising from the combined action of many genetic, environmental, and behavioral factors.5 Triggers for hypertension include the standard American diet high in saturated fats, trans fats, sugar, salt, and processed foods; obesity, sedentary lifestyle, alcoholism, stress/sympathetic dominance, overuse of stimulants, hypothyroidism, smoking, hyperinsulinemia, medications such as hormones, steroids, and NSAIDS; nutrient imbalance (high sodium, low potassium and magnesium), food allergies, and sodium sensitivity.5,6 Other factors may include oxidative stress, which causes inflammation in the blood vessels, resulting in endothelial dysfunction and autoimmune activation.

High blood pressure implications

Hypertension is usually asymptomatic, leading to its denotation as a “silent killer” and can be elevated for years without discovery unless the person regularly assesses it.7 Sometimes very high blood pressure can cause neurological symptoms such as blurred vision, headache, dizziness, ringing of the ears, and nosebleeds. Hypertension puts a huge strain on the heart, damages blood vessels in the brain and kidneys, and increases the risk of plaque rupture and blood clot formation. Sometimes the first diagnosis of hypertension may be made when the damage is already done and a stroke or heart attack has occurred.7 If a patient is being followed by a physician, diagnosis of hypertension will typically occur when several random blood pressure readings are over 140/90.

Naturopathic approaches to hypertension

Naturopathic approaches to treating hypertension focus on identification of the underlying cause and then the use of diet and lifestyle modifications, stress management, herbal supplements, and occasionally pharmaceutical medications to aid in its control. Testing for renal function, hyperparathyroidism, thyroid function, and inflammatory markers in the blood such as CRP as well as other factors like the aldosterone to renin activity ratio and homocysteine can indicate possible causes of high blood pressure. Urine testing may also be helpful. Patients’ cardiovascular risk factors must be assessed in depth, as these risk factors are generally associated with hypertension. Adiposity, sleep apnea, dyslipidemia, insulin resistance, and systemic inflammation should all be considered in this work-up.6

Some believe that high blood pressure is regularly mismanaged across medical paradigms and that the current trend of treating hypertension as a disease rather than a symptom is at the root of the problem.6 It is of the utmost importance that the true cause of hypertension be determined whenever possible in order for true curative measures to be taken. While the cause is being determined however, using pharmaceutical or natural management techniques can be implemented to preserve cardiovascular health and reduce risk of further end organ damage due to the elevated blood pressure levels. Among the most common naturopathic therapies used include dietary interventions, lifestyle modifications, and stress reduction as well as the use of herbs and supplements.

Dietary interventions

Dietary changes are among the most basic interventions for nearly all types of conditions and high blood pressure is no different. Specific dietary systems such as the Mediterranean diet and the DASH diet are among the most fundamental strategies to manage elevated blood pressure and many of the conditions that cause it such as insulin resistance, type II diabetes, and obesity.

The Mediterranean diet focuses on the consumption of vegetables, fresh fruit, whole grains, fish and seafood, legumes, nuts, extra virgin olive oil, and red wine, whereas red and processed meat are limited, and dairy foods are moderate. The Mediterranean diet is known to have a favorable effect on hypertension. A number of large scale observational studies have revealed significant negative associations with both systolic and diastolic blood pressure reductions.8

The DASH diet is a flexible and balanced nutritional system that helps create a cardio healthy lifestyle. The DASH system focuses on eating vegetables, fruits, and whole grains and includes fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils. The program limits foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils as well as sugar-sweetened beverages and sweets.9 When compared to other popular dietary systems such as paleo diet, low carb diet, low fat, and others, the DASH diet proved to have the greatest impact on blood pressure.10

Stress management

Since stress and sympathetic nervous system over stimulation appear to play a role in hypertension, it is important to keep stress under control. Stress can cause hypertension through repeated blood pressure elevations as well as by stimulation of the nervous system to produce large amounts of vasoconstricting hormones that increase blood pressure.11 A variety of non-pharmacologic treatments to manage stress have been found effective in reducing blood pressure and development of hypertension, examples of which are meditation, acupressure, biofeedback and music therapy.11 Exercise is also useful in stress management and plays a role in lowering blood pressure. A single exercise session evokes immediate blood pressure reductions that persist for at least 24  hours.12 Becoming more active overall can lower your systolic blood pressure by an average of 4 to 9 millimeters of mercury.13

Supplements

A number of herbs and supplements can also be used to aid in the management of hypertension. Nutrients from various categories including amino acids, vitamins, minerals, and herbs can be useful tools in keeping blood pressure within an optimal range. An important consideration however is that the effects of various nutrients or herbs can be cumulative and care must be taken not to drive blood pressure too low, particularly if combining herbs and supplements with pharmaceutical medications that lower blood pressure.

L-Arginine is a commonly used supplement for cardiovascular conditions. L-Arginine is an amino acid which is a precursor to nitric oxide (NO) production. Nitric oxide is a substance that stimulates vasodilation or widening of the arteries thereby reducing the necessary pressure to push blood through. Arginine produces a statistically and biologically significant decrease in blood pressure and improved metabolic effect in normotensive and hypertensive humans that is similar in magnitude to that seen in the DASH-I  diet.14 Human studies in hypertensive and normotensive subjects of parenteral and oral administrations of L-arginine demonstrate an antihypertensive effect as well as improvement in coronary artery blood flow and peripheral blood flow in peripheral artery disease.15 Doses of 10g of arginine daily have been shown to lower blood pressure by up to 6.8 mmHg.14 Further, similar results were obtained whether the arginine came from supplemental or food sources.14

Taurine is considered a conditionally essential amino acid. It is a sulfur-containing amino acid that is not used in protein synthesis. Taurine is found in high concentrations in the heart muscle itself.16  Taurine lowers BP and heart rate, decreases arrhythmias, CHF symptoms and sympathetic nervous system activity, increases urinary sodium and water excretion, increases atrial natriuretic factor, improves insulin resistance, increases NO and improves endothelial function.17 In a study of prehypertensive patients, it was found that taking 1.6 grams (1600mg) of taurine daily for 12 weeks led to a 7.2 mmHg drop in systolic blood pressure and a 4.7 mmHg drop in diastolic blood pressure.18

Beyond amino acids, other nutrients that can also benefit blood pressure include such nutrients as omega 3 fatty acids, fiber, and CoQ10. Research has shown that doses of 2 grams daily can produce reductions in blood pressure of up to 8 mmHg within a six-week time frame. Fiber, especially soluble fiber may also be helpful. Studies have shown that increased fiber consumption can support blood pressure through a number of benefits including improvement in insulin sensitivity, endothelial function, reduction in sympathetic nervous system activity and increase in renal sodium loss.17 CoQ10 is another nutrient that has shown significant benefit for those with high blood pressure, particularly essential hypertension. Compared to normotensive patients, essential hypertensive patients have a 6 fold higher incidence of coenzyme Q10 deficiency.17

Vitamins and minerals can also support the body in maintaining healthy blood pressure. In fact, clinical trials involving as little as 250mg of vitamin C twice per day over an eight week period have revealed drops in systolic blood pressure of 5-7 mmHg and 3-5 mmHg for diastolic hypertension.17 Vitamin B6 (pyridoxine) can also be helpful as low levels of B6 have been shown to be associated with the development of hypertension in humans.19 As far as minerals go, a high dietary intake of magnesium of at least 500-1000 mg daily reduces blood pressure in most of the reported epidemiologic, observational and clinical trials.17 Magnesium also increases the effectiveness of all anti-hypertensive drug classes.20

Botanical medicine

In the botanical realm, there are a number of herbs that can be helpful in promoting healthy blood pressure and cardiovascular health. When speaking of herbs and the cardiovascular system, the herb Hawthorn (Cartaegus oxycantha) is among the top contenders. Hawthorn belongs to the Rosaceae family and consists of bright green leaves, white flowers, and bright red berries. Hawthorn extracts exert a wide range of cardiovascular pharmacological properties, including antioxidant activity, anti-inflammatory effect, antiplatelet aggregation effect, vasodilating effect, endothelial protective effect, antiarrhythmic effect, lipid-lowering effect and decrease of arterial blood pressure effect.21

Garlic (Allium sativum) is another herb with significant blood pressure benefits. Meta-analysis studies of randomized, controlled trials concluded that garlic supplements can induce a significant reduction in both systolic and diastolic blood pressure by 3.75 and 3.39 mmHg, respectively.22  Garlic’s ability to regulate nitric oxide, reduce inflammation, and act as an ACE inhibitor have all been recognized.23

Rauwolfia serpentina, a common Auyrvedic herb, also has potent impact on blood pressure. The first study on the anti-hypertensive effects of rauwolfia were published in 1949 when a study showed that 40 out of 50 participants experienced a drop in blood pressure.24 Further, the hypotensive action of the drug was perceptible two weeks after stopping the drug in 91% of patients and in 75% of patients after four weeks of discontinuing the drug. No serious adverse side effects were noted.24

Next steps

The number of natural treatments available to aid in managing blood pressure are plentiful. The exact combination is best to treat the cause of any one specific individual’s blood pressure challenges should be determined by a naturopathic physician. Utilizing a proper diagnostic work up including both physical exam and a thorough medical history combined with diagnostic and laboratory testing to uncover the true cause of the hypertension, a naturopathic physician is uniquely qualified to develop an appropriate plan to address the true underlying cause of the problem. Click here to find an ND in the US and Canada.

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