Hypertension – the no-tension prescription
An important measure of health status used by the medical profession is the assessment of blood pressure.
Blood pressure (BP) is a measure of blood flow in and out of arteries, as shown through a systolic and diastolic reading. High blood pressure means the heart, for example, must work harder to pump the blood to circulate around the body. This obviously places an increased strain on the heart and other organs, and causes further reason for concern as high blood pressure is considered a major risk factor for many other chronic illnesses including cardiovascular diseases such as congestive heart failure, arrhythmias, angina and hyperlipidemia, and other illnesses such as type 2 diabetes and insulin resistance, dementia, kidney disease and cognitive impairment.
It is estimated that one in three people suffer from high blood pressure and as a risk factor for cardiovascular disease, high blood pressure is one of the leading causes of mortality worldwide – according to the World Heath Organization, over 17 million people died from a cardiovascular diseases in 2008. The incidence of high blood pressure is steadily rising and one of the first ways we can effectively start to address this health issue is to understand that when we measure blood pressure, what we are really measuring is the presence of hypertension (HT).
Hypertension is caused by a range of lifestyle factors and it is important to understand that it is hypertension that needs treatment, not blood pressure. The explanation is simple; we need to treat the causes of high blood pressure – stress and tension, not the effects – elevated blood pressure. In this way, we use the principles of integrative medicine to modify the causes of stress, rather than only prescribing a pill that reduces the blood pressure but does little to address why it is elevated in the first place. A recent study has revealed that drugs alone may have a questionable impact on longevity.
In most cases it is impossible to isolate a single underlying cause for hypertension – causes are lifestyle related and multi-factorial. Consequently, there are non-drug treatments that can be effective in the management and treatment of hypertension, either alone or in addition to the use of drugs.
The lifestyle prescription for hypertension includes:
• Stress reduction and management
• Adequate sleep and/or sleep restoration
• Physical activity
• Smoking cessation
• Healthy diet and nutrition, including appropriate supplements
• Maintaining a healthy body weight and/or weight loss management
• Salt restriction
• Sun exposure and fresh air
• Moderate restriction of alcohol and caffeine intake
• Chocolate, specifically cocoa
Research into the lifestyle interventions that are fundamental to integrative medicine has clearly shown:
Those who were rushed, impatient and hostile had nearly double the incidence of HT over 15 years. Cumulative mental stress also affects HT.
Meditation (particularly Transcendental Meditation) showed significant outcomes for reduced blood pressure, with individual therapy for anger management and stress management also showing demonstrable effects.
Chronic insomnia and shortened sleep patterns can increase the risk of HT by 2.4 times. Insufficient sleep is directly linked to HT.
An active life can reduce the risk of developing HT by between 35 and 70 percent compared to sedentary individuals. Exercise is highly beneficial with 75 percent of HT sufferers significantly reducing their blood pressure in as little as one week.
Weight loss of 4.5 kilograms can reduce blood pressure as much as an anti-hypertensive medication, especially when combined with dietary salt restriction. In one recent weight loss study, 80 percent of participants were able to control their BP without blood pressure medication. Even as little as a three to nine percent reduction in body weight (in overweight individuals) can be beneficial to blood pressure.
Dietary changes can be used very effectively to manage blood pressure levels.
Our diet can be affected by tension and stress, especially as we typically don’t eat in an optimal way in times of stress. Nutritional deficiencies can then contribute to our body’s inability to cope with stress, so what we eat is doubly important with regards to hypertension. A recent study has shown that stress can lead to the retention of body salts. Many studies have highlighted the importance of a diet rich in fruits and vegetables and wholegrains such as the Mediterranean or DASH (Dietary Approaches to Stop Hypertension) diets. But there are also specific foods or macronutrients which can regulate blood pressure.
Protein, particularly non-animal protein sources have consistently been associated with a reduction in blood pressure. Lean wild meats and other protein sources such as fermented milk proteins, soy, whey and fish proteins can also be useful in managing hypertension, and good fibre sources are also desirable.
Fats in the diet can impact on blood pressure in both positive and negative ways. Trans fat or unhealthy fats can increase blood pressure while healthy fats, in particular fish oils high in omega-3, are very effective in reducing blood pressure, especially when combined with weight loss. Including oily fish in the diet has many protective benefits. In fact, heart disease was noticeably absent in Eskimo populations with traditional high fish intake diets.
There is good evidence that foods rich in potassium, magnesium, vitamin C and calcium can reduce blood pressure. A supplement can be useful if dietary intake is inadequate. The mineral sodium, or salt, has continually proven to raise BP so it is wise to minimise sodium intake by not adding salt to meals during cooking or at the table.
Garlic, in a fermented supplement form, can also reduce blood pressure in hypertensive patients plus lower cholesterol. Over thirty research studies have been conducted on the value of fermented garlic and its hypotensive and protective properties, proving garlic a valuable part of any HT treatment plan.
Co-enzyme Q10 is an important component of the energy production of our bodies at a cellular level. It has been shown to significantly reduce blood pressure and is found to be deficient in many patients with a cardiovascular disease. In one study, over 51 percent of patients were able to discontinue antihypertensive drugs in a four to six month trial during which Co-Q10 supplements were taken. There is also evidence that normalising vitamin D levels can help in improving hypertension.
For chocolate lovers, there is excellent news. Cocoa, as found in dark chocolate or raw cocoa powder, has been proven to reduce blood pressure. Blood pressure is reduced when polyphenols, a naturally occurring compound in cocoa, form nitric acid in the body, which has the effect of relaxing and opening blood vessel walls. A daily dose of a high-cocoa content dark chocolate (not sugar-laden milk or white chocolate) is an ideal and tasty adjuvant therapy to other lifestyle interventions.
It is commonsense that to manage hypertension, we need to manage the tension or stress that is causing it. Eighty percent of all people will naturally experience some level of increased blood pressure in response to stress. Some of the best lifestyle interventions are exercise, diet and relaxation - all of which are free and without side effects. These and the other factors listed above are evidence-based, effective ways to limit, prevent, delay the onset, reduce the severity, treat and control hypertension in all people. It is not a natural state for the body and mind to be tense. While the pace of life does create extra demands on our time and resources, the management of tension and stress, and therefore the prevention of hypertension, should be considered just as important, if not more important, to the daily practice of life as our other responsibilities and commitments. Dial down the pressure and enjoy good health and a happy life - the best prescription a doctor can write.
Professor Avni Sali is Founding Director of the National Institute of Integrative Medicine (NIIM)