Hypertension, or high blood pressure, is a very common condition. In the United States, one in four adults are affected (Wang & Vasan, 2005). It is the leading cause of premature death among adults worldwide (Falkner, 2009) and the primary risk factor for both stroke and coronary heart failure (Bartholomy, 2008). The incidence of high blood pressure increases with age. However, even pediatric hypertension is on the rise (Falkner, 2009).
Blood pressure is a measurement of the force exerted by the blood against vessel walls, or simply, how hard the heart has to work to pump blood through the body. High blood pressure indicates an elevated workload on the heart and arteries. This, over time, weakens these vessles and may lead to potentially fatal cardiovascular disease, such as plaque build-up in arteries, aneurisms, stroke, heart attack, or congestive heart failure. Hypertension can also damage the kidneys and the retina of the eye leading to blindness (Bartholomy, 2008).
Hypertension is often called “the silent killer” because there are usually no symptoms associated with the condition. Because of this, health care providers routinely measure blood pressure with the hope of normalizing it before complications arise. Once recognized, high blood pressure can easily be monitored at a health care facility or at home.
Blood pressure measurement consists of systolic pressure (the force when the left ventricle is contracting) over diastolic pressure (the force when the heart is at rest). Normal adult blood pressure is 120 mmHg over 80 mmHg. An individual may be diagnosed with hypertension when blood pressure numbers consistently read 140 over 90, or higher. If only the systolic pressure number is elevated this is known as isolated systolic hypertension. When systolic pressure exceeds 158, the probability of cardiovascular disease doubles regardless of diastolic pressure (Bartholomy, 2008). Blood pressure readings that fall between normal and hypertensive are considered pre-hypertension.
There are two types of hypertension: primary and secondary. Secondary hypertension is caused by another condition or medication such as kidney damage, endocrine dysfunction, oral contraceptive, or hormone replacement therapy. However, in 85 to 90 percent of the cases, the cause of hypertension is unknown and is considered primary hypertension.
Although the causes of primary hypertension are unknown, there are many predisposing lifestyle and dietary factors that are known to precipitate the condition.
- Oxidative stress describes an imbalance between reactive oxygen species (ROS) and the antioxidant defense mechanisms. ROSs cause structural and functional damage to endothelial cells, create oxidized low-density lipoprotein (LDL) cholesterol, promote the increase of blood sugar and insulin, and degrades the vasodilator nitric oxide. Hypertensive individuals not only have an impaired antioxidant defense mechanism, but they also have a strong response to oxidative stress. (Houston, 2009).
- Stress causes an increase in free radical activity and cortisol. Cortisol then raises blood pressure and blood sugar and depletes magnesium and potassium, which are necessary to maintain normal blood pressure.
- Nutrient deficiency or excess can impact blood pressure. For example, high sodium and low potassium consumption work together to increase blood pressure. These imbalances will be explored further in the holistic health supportive protocol.
- Many hypertensive individuals are insulin resistant and therefore have high serum insulin, which is vasoconstrictive.
- Obesity adds to the work required of the heart. This extra strain on the heart increases blood pressure.
- A sedentary lifestyle, even without obesity, can increase insulin resistance and stress, thus increasing risk of hypertension.
- Heavy metal toxicity (especially cadmium and lead) can play a role in high blood pressure.
- Smoking increases cadmium and cortisol levels while decreasing vitamins C and B and increasing oxidative stress.
The goal of treatment is to reduce blood pressure and this can usually be done with a combination of medication, diet, and lifestyle changes. Although allopathic medicine recognizes the impact of nutrition and lifestyle on hypertension, these practitioners usually rely heavily on medication to normalize blood pressure. Holistic practitioners prefer to focus on dietary and lifestyle changes, adding medications in smaller dosages and only when necessary. Many individuals can control blood pressure through diet and lifestyle changes alone, but antihypertensive drugs may be necessary for some, especially those with complications (Houston, 2009). Practitioners may use one or more of the following blood pressure medications (A.D.A.M, 2011).
- Diuretics help kidneys remove sodium from the body.
- Beta-blockers decrease the rate and force of the heart.
- Angiotensin-converting enzyme inhibitors (ACE inhibitors) relax blood vessels.
- Angiotensin II receptor blockers (ARBs) relax blood vessels.
- Calcium channel blockers relax blood vessels by blocking calcium from entering the cell.
- Other medications that are not used as frequently include alpha-blockers, centrally acting drugs that signal the brain and nervous system to relax blood vessels, vasodilators, and renin inhibitors.
In addition to medication, the allopathic approach often includes daily exercise as well as dietary changes outlined in the DASH diet (dashdiet.org). This diet has a strong emphasis on whole grains, low-fat foods, fruits, and vegetables. The following holistic protocol for hypertension differs from DASH in its inclusion of quality fats, reduced grain consumption, and specific anti-hypertensive foods and supplements.
Holistic health supportive protocol for hypertension
A holistic health protocol for hypertension begins with an assessment of current diet and
exercise regimen. A comprehensive cardiovascular assessment, an oxidative stress test,
and a kidney analysis may also be recommended. Current medications or conditions may affect nutrient digestion or absorption and should be considered as well.
A dietary plan will focus on nutrient rich whole foods with a strong emphasis on plant-based foods from organic sources. Many hypotensive individuals have poor digestion. And so, in addition to following these nutritional guidelines, it is important to take a deep breath and relax before eating. Hydrochloric acid tablets and digestive enzymes may also be considered.
Protein should constitute about 30% of the diet. Appropriate protein foods include whole grains, legumes, nuts, wild caught fish, pastured chickens and their eggs, grass-fed beef, lamb, bison, and grass-fed dairy products. Soy is often suggested as healthy protein food, but individuals should be wary of the phytoestrogens in soy which can have harmful hormonal effects (Sinatra, 2003).
Fats should constitute about 30% of the diet, and should include mono-unsaturated fats, especially omega-3, omega-6, and omega-9 fatty acids (Bartholomy, 2009). Good sources of omega-3 fatty acids are coldwater fish, fish oil, flax oil, and nuts. Extra virgin olive oil is a good source of omega-9 fatty acids. Saturated fat, found primarily in animal fats and coconut oil, should be about 30% of fat calories (Barton, 2008). Damaged or altered fats, including trans fats and refined oils, should be completely avoided.
Carbohydrates should constitute the remaining 40% of the diet and come primarily from fruits, vegetables, beans, and whole grains. Many individuals select grains to fulfill their recommended carbohydrate consumption. Although grains do contain valuable nutrients, they can be difficult to digest and the nutrients may not be accessible for absorption. Instead of grains, look to vegetables and fruit. Half of every meal and snack should be vegetables or fruit. Avoid refined sugars and refined grains completely.
Fiber has been shown to reduce blood pressure and the need for antihypertensive medications (Houston, 2009). At least 30 grams of fiber should be consumed daily. Most plant foods contain fiber: beans, greens, herbs, and berries are good sources.
Sodium should be limited to that found naturally in whole foods and small amounts of unrefined salt. Salt sensitive individuals should see a reduction in blood pressure with a reduction in sodium consumption. These individuals should slowly reduce their sodium consumption to 1000 mg (Houston, 2009). Avoid white salt. All white salt has be processed even when labeled “sea salt.”
Potassium is a diuretic and vasodilator (Bartron, 2008) should be consumed at a 5:1 ratio with sodium. Potassium rich foods include all fruits and vegetables, especially dark leafy greens.
Magnesium is a vasodilator and is usually low in hypertensive individuals (Bartholomy, 2008). A dietary intake of 500 – 1000 mg/day has shown a reduction in blood pressure in epidemiologic, observational, and clinical studies (Houston, 2009). Foods rich in magnesium include green vegetables and herbs, sunflower seeds, pumpkin seeds, and nuts.
Calcium is also a vasodilator and should be consumed in a 2:1 ratio with magnesium. Dietary calcium has been shown to be more effective at lowering blood pressure than supplemental calcium. Foods rich in calcium include dairy products as well as green vegetables and herbs.
Vitamins and Supplements
Full spectrum antioxidants will help stop free radical damage. These can be consumed in food and taken as a supplement. Many of the following vitamins and supplements are antioxidants.
Vitamin A and beta-carotene are important for their antioxidant capabilities. Consume 10,000 IUs per day with no more than 2,500 IUs from preformed vitamin A (Sinatra, 2003). Food sources include good quality cod liver oil, liver, and all green and orange fruits and vegetables.
Vitamin C is a powerful antioxidant that is also essential for tissue growth and repair, and plays a role in the absorption and utilization of calcium. Studies of supplemental vitamin C have demonstrated a reduction in blood pressure. Vitamin C is sensitive to air, water, and heat so the best food sources are fresh fruits and vegetables, especially bell peppers, strawberries, papaya, and citrus fruits. Supplemental vitamin C should be limited to 500 mg (Sinatra, 2003).
Vitamin E contributes to cardiovascular health is several ways. It is an antioxidant, and anticoagulant, a plaque stabilizer, and a vasodilator. Almonds, sunflower seeds, wheat germ, and wheat germ oil are food sources of vitamin E but fall short of the recommended intake for supporting heart health. A supplement of 200 to 400 IUs per day in the form of mixed tocopherols is recommended (Sinatra, 2003).
Coenzyme Q-10 (CoQ10) not only supports the formation of ATP, which is the energy source for the cells in the body, but it also serves as an antioxidant. The heart consumes a huge amount of energy and therefore large amounts of CoQ10. Although the body can produce CoQ10, this ability declines with age. Dr. Sinatra (2003) recommends 60 to 120 mg of the hydrosoluble form taken in four to eight divided doses over the course of the day. Food sources include sardines, salmon, mackerel, heart, and liver.
L-Carnitine delivers fatty acids to heart cells for energy and removes waste products. It has a synergistic effect with CoQ10. 1000 to 2000 mg are recommended for lowering blood pressure (Sinatra, 2003). Red meat is the best food source of L-carnitine.
L-Arginine is an amino acid that enhances the synthesis of nitric oxide and reduces plaque buildup in vessels (Sinatra, 2003). Six to nine grams of nuts, seafood, eggs, or red meat, will satisfy the need for this nutrient, as will a 1000 mg supplement (Sinatra, 2003).
Hawthorn is an herb whose leaves, berries, and blossoms have antioxidant properties. Additionally, it increases coronary blood flow and decreases blood pressure. A 500 mg capsule can be taken two or three times a day, but check with a physician if antihypertensive medications are being taken (Sinatra, 2003).
Celery contains several components that may help reduce blood pressure: 3-n-butyl phthalide, apigenin, and potassium (Houston, 2009). Four stalks of celery or eight teaspoons of celery juice should be consumed daily to obtain these effects.
Garlic has been shown to reduce systolic and diastolic blood pressure by 20 points when two to three raw cloves of garlic are consumed daily (Bartholomy, 2008).
Seaweed has been shown to significantly reduce blood pressure. In a Japanese study, participants consumed 3.3 g of dried wakame for four weeks and saw significant reductions in both systolic and diastolic blood pressure (Houston, 2009).
Stress management plays an important role in reducing blood pressure. By effectively managing stress, an individual can reduce cortisol production, activate the parasympathetic nervous system, and slow the creation of free radicals. Deep breathing, meditation, yoga, and prayer are some of the ways to reduce stress.
Exercise is necessary to strengthen the heart, reduce excess weight, and can be a stress reliever as well. An exercise routine should include resistance training at least twice a week and 45 minutes of light to moderate aerobic activity at least 4 times a week.
Stop smoking and avoid caffeine. Both raise blood pressure and should be avoided.
Hypertension is most likely a modern condition born from a processed foods/high sugar diet and sedentary/high stress lifestyle. It is unfortunate that the effects of today’s world and culture sneak up on us so quietly. Perhaps if the consequences of our actions were more immediately noticeable, we would be more likely to correct them before so much damage has been done.
A.D.A.M. Medical Encyclopedia. (2011). Hypertension. Retrieved January 4, 2012 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001502/
A.D.A.M. Medical Encyclopedia. (2011). High blood pressure medications. Retrieved January 4, 2012 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010384/
Bartholomy, Paula. (2008). MSHN 213 – Cardiovascular Nutrition [lecture transcripts]. Retrieved December 15, 2011, from https://student.hawthornuniversity.org/Course_AudioLectureList.aspx
Bartron, Laura. (2008). Key nutrients for lowering blood pressure. Retrieved January 11, 2012, from https://student.hawthornuniversity.org/Course_ReadingMaterialDetails.aspx?id=105
Falkner, B. (2010). Hypertension in children and adolescents: epidemiology and natural history [Electronic version]. Pediatric Nephrology, 25(7): 1219-1224.
Houston, M.C. (2009). Hypertension: Utilizing nutrition in treatment. In I. Kohlstadt (Ed.), Food and nutrients in disease managements (pp. 75-97). Boca Raton: CRC Press.
Sinatra, Stephen. (2003). Lower your blood pressure in eight weeks: a revolutionary program for a longer, healthier life. New York: Ballantine Books.
Wang, T.J. & Vasan, R.S. (2005). Contemporary reviews in cardiovascular medicine: epidemiology of uncontrolled hypertension in the United States. Circulation. Retrieved January 3, 2012, from http://circ.ahajournals.org/content/112/11/1651.full