Hypertension

Blood pressure is the measure of blood being pumped from the heart through the rest of the body via the arteries. Hypertension, also known as high blood pressure, is when there is either too much pumping force from the heart or, more likely, too much resistance form the arteries. Blood pressure is measured as a fraction: the first number, the systolic pressure, is the peak reading of the pressure exerted by the heart muscle contraction. The second number in the reading is the diastolic pressure. It is when the heart relaxes during beats and the blood pressure drops.

Normal blood pressure is 120 (systolic)/80 (diastolic). The units for measure are units of mercury; one unit is the blood pressure moving the mercury one mm in the measurement device.

High blood pressure is considered to be one of the main risk factors for a heart attack or stroke. Atherosclerosis is a major cause of high blood pressure.

High blood pressure is also known as hypertension (HTN) or arterial hypertension.

Signs and Symptoms

For most people it is the assessment of high blood readings at the doctor’s office when diagnosis happens. For others it is the experience of a heart attack or a stroke, as heart disease is called the “silent killer”. It is usually without symptoms until complications develop, in the heart or other organs (i.e. brain and kidneys).

Blood vessels changes may be seen in the arteries of the retina in the eye using a special lens by a doctor or ophthalmologist. Observable changes in retinal blood vessels are diagnostic indicators of the degree of damage caused to the body by the hypertension.

Diagnosis and Pharmaceutical Interventions

Blood pressure is classified as primary (essential) hypertension when there is no other condition that may be causing the increase in pressure; secondary hypertension is when the elevated pressure is caused by a condition in another organ (i.e. the kidneys,) or due to drugs.

There are several classifications of hypertension based on how high the numbers are. Borderline or what is starting to be Prehypertension is classified as 120-139/80-89. Stage 1 or mild HTN is 140-159/90-99. Stage 2 or moderate is 160 or higher / 100 or higher. Stage 3 or severe HTN is >180/>110.

Blood pressure should be taken three times before a diagnosis should be made. Especially useful is a reading done outside of a doctor’s office, to avoid a ‘white coat effect’ that some people may get that refers to a BP that is consistently elevated in the physician’s office but normal when measured at home.

Medications

Diuretics

These medications are often the first choice for medical doctors when prescribing medication for HTN. Diuretics increase urinary output, reducing the volume of blood that travels through the vessels by reducing the water and sodium concentration. By reducing the blood volume this reduces the blood pressure. Some diuretics also increase the elimination of potassium, a mineral needed by the body for normal muscle, including the heart muscle contraction. Diuretics do not act directly on the heart or vessels, and not only do they not treat heart disease directly they frequently need other pharmaceutical medications as adjunctive. There are 3 types: Thiazides (hydrochlorothiazide, metolazone), Loop (frusemide) and potassium sparing (spirnolactone).

Beta blockers

B- Blockers act on a specific type of chemical receptor, the b-adrenergic receptor. These receptors allow for the proper flow of neurotransmitter epinephrine, which is increased in stressful situations to allow for increased heart beating and blood flow to the extremities. Beta blockers are thought to decrease the levels of CoQ10 in the body, a nutrient needed for healthy heart function. Some examples are atenolol, carvedilol and propanolol.

ACE inhibitors

ACE inhibitors block the enzyme reaction of angiotensin to angiotensin II, which causes a decrease in water and sodium in the blood, relaxation of the blood vessels and decreases blood pressure. ACE inhibitors work with diuretics, actually making them work better. ACE inhibitors can interfere with B- blockers, tetracycline and non steroidal anti-inflammatory medications. Some examples are captolpril, lisinopril and quinapril.

Ca++ channel blockers

This class of medication blocks the activity of calcium to cause contraction of the blood vessels which would increase resistance and blood pressure. These meds can cause gastro-esophageal reflux disorder, by reducing the contraction of the lower esophageal sphincter muscle. Constipation may also be a side effect. Some examples are nifedipine, felopine, and verapamil.

Lifestyle and Dietary Modifications

For many years it was thought that just by reducing your salt (sodium chloride) intake high blood pressure would be reduced. Sodium causes retention of water, and a larger blood volume being pumped through the blood vessels. It is now known that a healthy diet, including a modest salt intake, help reduce blood pressure and heart disease.

Dietary Approaches to Stop Hypertension (DASH diet): The DASH diet was created by US National Institutes of Health to reduce heart disease. It emphasizes whole-grains, fruits, vegetables, fish, and non-fat dairy. It reduces intake of fats, sweets, prepared foods, and alcohol. This diet reduced blood pressure significantly every time it was tested. Smoking is particularly injurious for people with hypertension. The combination of hypertension and smoking greatly increases the risk of cardiovascular disease-related sickness and death. All people with high blood pressure need to quit smoking.

Many people with high blood pressure are overweight. Weight loss lowers blood pressure significantly in those who are both overweight and hypertensive. In fact, reducing body weight by as little as ten pounds can lead to a significant reduction in blood pressure. Weight loss appears to have a stronger hypotensive effect than dietary salt restriction.

Studies have shown a link between job and personal stress and hypertension. Relaxation techniques such as deep breathing exercise, meditation and yoga have shown to have value in reducing blood pressure.

Nutritional Factors Shown to be Beneficial

Fish Oil

Fish oils consist of omega 3 fatty acids that improve the risk of heart disease and hypertension by improving blood flow. Fish oils also have a beneficial effect on lowering cholesterol and blood lipids, a contributing factor in heart disease.

Dose: range from 3-5 grams a day.

Garlic (allium sativa)

Garlic is not only a food but good medicine! Garlic has a direct anti-atherosclerotic effect and can reduce platelet aggregation, allowing for smooth flow of blood in the vessels.

Doses of allicin containing garlic preparations should be are typically 900 mg per day (providing 5,000 to 6,000 mcg of allicin), divided into two or three administrations.

Rauwolfia alkaloids

Also known as Indian snakeroot, Rauwolfia serpentia is an ayuvedic herb shown to lower blood pressure by acting similar to b-blockers. When Rauwolfia is used as a whole herbal product, it is very effective and safe for the treatment of hypertension. Reserpine, an alkaloid chemical isolated from it, has a strong blood pressure lowering effect, however, using resperine alone may potentially cause side effects like depression, fatigue and lowered libido.

Dose: 50 to 200 mg/day.

CoQ10

Coenzyme Q10, also known as ubiqinone, is an antioxidant nutrient involved in the production of energy, and is especially good for nutrition of the heart muscle itself. Many people with HTN have low levels of CoQ10. It reduces oxidation of the plaques and may help normalize heart function brought on by other conditions, i.e. abnormal heart beats and cardiomyopathies. It has been shown to be particularly effective in systolic hypertension.

Dose: 100 mg or more per day

Arginine

Arginine is an amino acid; it is the most abundant nitrogen carrier in the human body. Arginine converts to nitric oxide, a chemical which relaxes endothelial cells and can lower BP.

Dose: 2 g tid

Magnesium

Magnesium is deficient is many with high blood pressure, and 50% of magnesium deficient individuals with HTN will respond when Mg is given that restore serum magnesium levels.

Dose: 300-500 mg / day.

Calcium

Calcium is almost always low in individuals with HTN. As with Magnesium, when given, it can bring elevated blood pressure back to normal.

Dose: 800 mg / day.

Vitamin C

Vitamin C is needed for several metabolic pathways in the body. Vitamin C helps eliminate toxic elements such as lead, which is associated with high blood pressure. Vitamin C also reduces LDL cholesterol, which when elevated can have an effect on the size of the arteries and increase resistance and blood pressure.

Dose: 1000 mg or more / day

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