Integrative Management of Hypertension
By: Dr. Landon Opunui ND
Hypertension is often referred to as the silent killer because it is typically a condition without symptoms. It is a very common condition with a high prevalence in the Hawaii, the United States and worldwide. Elevated blood pressure is mostly a byproduct of lifestyle which suggests that naturopathic medicine can be a very effective strategy for treatment. Although it is a very common health challenge and diagnosed frequently in health care, roughly half of hypertensive individuals do not have adequate blood pressure control.
Survey data from the United States Census found that 46 percent of adults 18 years or older had hypertension. This translates into approximately 103 million US adults with hypertension. Worldwide, about 31 percent of adults or 1.39 billion people have hypertension. In Hawaii, 30.2% of adults, or 304,000 people, reported that they were told by a health care professional that they had high blood pressure. These statistics are higher in Native Hawaiians.
Essential or Primary Hypertension often results in individuals being asymptomatic until complications develop. Complications may include dizziness, flushed faces, headache, fatigue, epistaxis (bloody nose), nervousness, left ventricular failure, vision changes, heart disease, stroke and kidney failure. Hypertension is present in 69% of people who have a first heart attack, 77% of those who have a first stroke, and 74% of those who have congestive heart failure.
Blood Pressure Goals (JNC8 Guidelines):
In patients 60 years or over, treatment should be started in individuals with blood pressures >150 mm Hg systolic or >90 mm Hg diastolic. Treatment targets should be under these thresholds.
In patients <60 years, treatment initiation and goals should be 140/90 mm Hg, the same threshold used in any patients >18 years with either chronic kidney disease (CKD) or diabetes.
Maintain an ideal body weight
Get regular exercise (if you are ill or injured consult your physician before starting an exercise program)
Limit or avoid alcoholic beverages
Limit excessive dietary sodium and avoid all processed foods
Include adequate amounts of calcium, potassium, & magnesium in the diet.
Include adequate amounts of dietary fiber, 25g daily is the goal
Decrease dietary intake of excessive calories
Avoid smoking and all environmental toxins
Find successful ways of managing stress, consider daily mental training
Caffeine may raise blood pressure – limit or avoid coffee, soda & energy drinks
Excessive body weight and uncontrolled diabetes are two of the most common reasons for hypertension in the US population. Working to control these two risk factors should be a primary treatment strategy in hypertension management. More important than the number on the scale, body composition should be optimized by decreasing excessive body fat and building lean muscle mass.
DASH (Dietary Approaches to Stop Hypertension) is a diet rich in fruits & vegetables, low-fat or non-fat dairy foods, seafood, and lean meats & poultry that has documented efficacy in lowering blood pressure. There are many free and readily available resources to help guide individuals pursing this diet.
Vegetarian and plant based diets are associated with lower blood pressure than omnivorous diets. Some, but not all, studies have shown increasing dietary fiber may reduce blood pressure. The addition of 40 g of soy protein daily has been shown to reduce blood pressure by >5mmHg in hypertensive adults. Non-heme iron from plants may control blood pressure, while red meat has been associated with increased blood pressure in some studies.
Salt restriction should be profound (< 1,500mg of sodium daily), as mild restriction does not appear to have much effect. Avoidance of prepared, processed and fast food is an important step in salt restriction. Simply preparing all meals from whole foods ingredients is an effective strategy to achieving this goal.
Increase consumption of potassium-rich foods to include grapefruit, grapes, tomatoes, beans, apricots, asparagus, beets, broccoli, corn, cucumbers, dates, salt-water fish, lamb.
Excessive alcohol intake (three or more per day) is associated with high blood pressure. Consider a healthy relationship with alcohol or avoid it all together.
Research suggests that disordered sleep, particularly sleep deprivation and obstructive sleep apnea, is associated with increased BP and risk of hypertension. Studies indicates that excessively longer and shorter periods of sleep may both be risk factors for high blood pressure. These associations are stronger in women than men.
There is an increasing prevalence of obstructive sleep apnea, which now afflicts at least 25 million adults in the US according to the National Healthy Sleep Awareness Project. Studies demonstrate a strong correlation between the severity of obstructive sleep apnea (OSA) and the risk and severity of hypertension.
Exercise, including Tai Chi, is an effective way to reduce blood pressure. Exercise can help with weight loss which will accelerate improvements in patients with hypertension.
Start slowly and build up gradually. The American College of Sports Medicine (ACSM) recommends at least 30 minutes of moderate intensity aerobic exercise 5 days weekly. 30 minutes of strength training targeting the major muscle groups is also recommended 2 days weekly. Remember and consistency is key so groove this habit into your daily routine.
Studies have shown a link between job and personal stress and hypertension. Studies on meditation and biofeedback have been shown to be an effective treatment or adjunct support for patients with hypertension. Participants in a stress reduction program were more likely to eliminate blood pressure medications that those on lifestyle modification alone.
Relax your Mind, Relax your Body
Try this simple breathing technique once or twice a day
Sit comfortably or lie down
Slowly breathe IN through your nose and into your belly for a count of 6
Hold for 2 seconds
Slowly breathe OUT through your nose for a count of 7
This will be a breath rate of 4 breathes per minute which you should repeat for 5-15 minutes until feeling relaxed
Measure your blood pressure before and after, you will likely notice a difference.
In nonblack patients with hypertension, initial treatment can be a thiazide-type diuretic, CCB, ACE inhibitor, or ARB, while in the general black population, initial therapy should be a thiazide-type diuretic or CCB.