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Modifiable Lifestyle Factors for a Suitable Treatment Plan
Certainly, smoking cessation, for well-established reasons, is a high priority. Air pollution is a risk that might be hard to avoid. Assessment and treatment for toxic metals, especially lead, mercury, cadmium, arsenic, and aluminum is major factor. Accumulations of lead and cadmium have been strongly linked to vascular disease.4 High levels of toxic metals have been detected in many US cities. Lead is a common pollutant in the environment. Cadmium is found in cigarettes and batteries. Gadolinium dye used for MRI testing is an emerging risk factor. Not only is it toxic but as with other metals, it also stays in the body much longer than most doctors realize. Typically, toxic metals reside in the bloodstream for no more than two weeks. Then they are stored in the bone, brain, and fats. Blood tests might not detect accumulated metals. A challenge test with a chelating agent is suggested to assess the body burden of toxic metals and the risk that results. A series of intravenous EDTA chelation treatments is generally the best way to reduce such metals to a safe level.
The Trial to Assess Chelation Therapy (TACT) headed by Gervasio Lamas5 showed that treatment with 40 IV infusions of EDTA significantly reduced future cardiac events in patients with established coronary artery disease. Toxic metals appeared to be the primary mechanism of action. Sometimes hyperbaric oxygen alone or with chelation can be used to treat resistant cases of hypertension.
Desensitization for airborne, mold, food, and harmful chemicals can lower hypertension as well as improve quality of life. Sensitivities of this type are extremely common. Low-dose antigen (LDA) therapy has been particularly effective in treating these problems. Simply identifying food allergies and avoiding those foods can be helpful. NSAIDs should only be used with extreme caution to control pain. They are known to raise BP and increase mortality.
Obesity, overweight, and the metabolic syndrome are identified by history, physical exam, and BMI measurements. Ideally, a BMI of 25 is a suitable goal. Each physician’s office should have a program for weight loss and a list of healthy foods recommended for most patients. Even ten pounds of weight loss can lower blood pressure by several points. A baseline diet for weight loss and blood pressure control might be Trowbridge's anti-yeast low carbohydrate diet, a Mediterranean diet, the DASH diet, or a vegetarian diet. The most important aspect of any diet is the maintenance phase. The amount of improvement in BP control with weight loss has been reported to be comparable to treatment with metoprolol. If a patient has cravings, either for food or cigarettes, a simple supplement called Crave Arrest can be very helpful. If candida imbalance is suspected from a symptom questionnaire or from stool testing, probiotics and anti-fungal agents will probably be required. Otherwise, the toxins produced by yeast will contribute to hypertension.
Dietary factors that have been shown to reduce hypertension at least for some patients include raw foods, onion, garlic, whole oats, soy, olive and sesame oil, dark chocolate, pomegranate juice, fish, and reduction of excessive of salt intake. Five servings of fresh fruits and vegetables daily can reduce elevated blood pressure.6
Alcohol consumption is discouraged because it can raise blood pressure and contribute to kidney and liver damage. However, small amounts of red wine (<300ml per day) can have a positive effect on mortality. Multiple studies have shown that supplemented intake of dietary fiber (30 grams per day) can lower both systolic and diastolic blood pressure. Similar amounts of flax seed can also be of benefit. A cup or two of coffee has a relaxing effect for some patients, but excessive caffeine and sugar can raise blood pressure. Green tea is a good alternative.
Approximately two and a half hours of exercise per week is generally recommended. The type of exercise depends of the capabilities of the patient. A pedometer reading of 10,000 steps per day can be recommended for motivated patients. Interval training with three twenty-second bursts of almost all-out effort three times a week plus warm-up might often achieve fitness with a total of 10 minutes per week! Especially for those who have difficulty performing vigorous exercise, a vibration machine such as the Vibabody, will accomplish a mild workout in ten minutes. A sit-down trampoline has similar benefits. Either one can be purchased for $200-300.
The effects of stress are sometimes more difficult to identify and measure but can be a very important factor.7 Heart rate variability testing, salivary adrenal measurements, serial urine neurotransmitter assessments, and brain wave testing are four ways to objectively document dysfunction due to stress. Once an abnormality is identified, there are specified ways to improve the response of the body to stress. Herbal preparations and homeopathics can reduce anxiety and improve autonomic dysfunction. Adrenal supplements can improve adrenal exhaustion. Neurotransmitters can be balanced with specific amino acids. Neurofeedback, a form of biofeedback, can improve brain wave function. Other techniques not specifically linked to testing include meditation, yoga, and tapping techniques such as NAET and the Emotional Freedom Technique (EFT). Various devices, including portable sauna and biomat, can generate far infrared waves, which are particularly effective in reducing stress. The price of the far infrared devices is in the range of $600-1400. Qi Gong, Yoga, Tai Chi, Heart Math, Transendental Meditation, and the Relaxation Response are all techniques that can reduce the effects of stress, if practiced regularly. Acupuncture and manipulation by chiropractors and osteopaths might also be helpful.
Special workshops like those presented by Steve Kaufman for Pain Neutralization, Dietrich Klinghardt for Neural Therapy, William Schrader for LDA and IV nutrient therapy, and Frank Shallenberger and Robert Rowen for Ultraviolet Blood Irradiation teach skills that are applicable for lowering blood pressure without drugs.
Medications and Supplements
There are five major drug categories for blood pressure treatment. They include the following with the most common side effects listed: thiazide diuretics (low potassium leading to fatigue), ACE inhibitors (high potassium causing arrhythmias and cough), calcium channel blockers (constipation, swelling, headaches), beta-blockers (dizziness, fatigue), and angiotension receptor blockers (dizziness). For Caucasian patients with BP exceeding 140/90 mmHg, an ACE inhibitor or ARB is usually the initial prescription, followed by a calcium channel blocker. For blacks, the calcium channel blocker is first line. A diuretic is next for whites and blacks, and then spironolactone as a fourth drug. Lower doses from multiple categories are preferred in an attempt to minimize side effects. Several drugs from other categories, such as clonidine, alpha blockers, and hydralazine, are occasionally called upon for resistant cases.
Nutritional supplements could be considered a sixth category.8 Most effective in that category might be garlic and magnesium. The latter is commonly deficient. One way to find the most effective dose of magnesium is to gradually increase the dose until the patient gets diarrhea. Then reduce the dose to the highest level tolerated by the patient.
Other nutritional supplements that might help lower high blood pressure include vitamin C with lysine (as recommended by Linus Pauling), fish oil, calcium (balanced with at least half as much magnesium), potassium, thiamine, l-arginine to increase nitric oxide, folic acid, vitamin B6, and a tomato extract containing lycopene. Vitamin D3 deficiency is common. If detected with a blood test, vitamin D supplementation might significantly lower blood pressure. The vitamin D effect can be enhanced with ultraviolet blood irradiation. Coenzyme Q10 lowers blood pressure independently with doses of 200-400 mg a day and is particularly important to replace if a patient is taking a statin drug, which can reduce the body’s production of endogenous CoQ10 by 40%. Vitamin B12 shots can be self-administered at home several times per week to reduce stress and increase energy. The shots either work well within a month or there is no effect. Jonathan Wright has been a proponent of B12 injections for many years. He has taught many physicians about the effective use of many nutritional supplements and the frequent need for hydrochloric acid for proper digestion.
Herbal preparations and homeopathics can be helpful to treat anxiety and depression, which in turn might benefit patients who have hypertension. Examples of herbs for anxiety are kava, valerian, and passiflora for anxiety and St. John's wort, l-tryptophan, and SAMe for depression. CBD and hemp oils have a nice relaxing effect.
In order for optimal results, several lifestyle changes must be addressed, and long-term maintenance must be practiced. Medications for hypertension, anxiety, and depression can be prescribed, but often have side effects. Natural supplements are usually safer and can be quite effective. Each physician must choose which modalities she wants to utilize in her practice. Additional training might be required. Enough team care support must be provided for each intervention to be successful. A great deal more can be done to improve hypertension with lifestyle interventions than the six measures recommended in the AHA/ACC guidelines.
Two textbooks that contain further information on detecting and treating hypertension with integrative medicine are Nutritional Medicine by Alan Gaby and Integrative Medicine by David Rakel. Some of the organizations that teach techniques mentioned in this article include the International College of Integrative Medicine (ICIM), the American College for Advancement in Medicine (ACAM), the American Academy of Environmental Medicine (AAEM), the Academy of Integrative Health and Medicine (AIHM), and the Institute for Functional Medicine (IFM).
The AHA/ACC has given us a new paradigm for detecting and treating hypertension, our number one cardiovascular risk factor. We should embrace it, improve it, and work together to achieve the best results possible. First, we must be certain that we have a consistent protocol for measuring blood pressure and treating it effectively. We should have three to five minutes of silent relaxation prior to taking the readings, both at home and in the office. Home readings usually have precedence over office readings. Second, the AHA/ACC guidelines are preferable over the older guidelines reaffirmed by the AAFP, because they save added lives and reduce complications from the disease. Effective lifestyle changes and a more natural treatment are strongly preferred to reduce BP to acceptable levels with an upper limit of 130/80 mmHg. Third, additional medications are to be avoided whenever possible to control Stage 1 hypertension. In fact, fewer medications than currently used are preferable. The lifestyle recommendations in the AHA/ACC guidelines are a good start, but we can do far better with the suggestions that have been offered by integrative physicians for many years. Fourth, more testing, office visits, phone call follow-ups, procedures, supplements, and devices will be required for lifestyle improvements to succeed. A team care approach is usually necessary. This will increase the cost of care somewhat in the short run, but in the long run, better BP will result in improved health and reduced costs for individual patients and society at large.
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1. Whelton PK, chairman. Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. November 13, 2017 (Epub ahead of print).
2. Ioannidis, JP. Diagnosis and treatment of hypertension in the 2017 ACC/AHA guidelines and in the real world. JAMA. 2018;319:115-116.
3. Go A. Systolic blood pressure intervention trial (SPRINT). N Engl J Med. 2015; 373: 2103-2016.
4. Solenkova NV, et.al. Metal pollutants and cardiovascular disease: mechanisms and consequences of exposure. Am Heart J. 2014; 168:812-822.
5. Lamas GA, et.al. Effect of disodium EDTA chelation regimen on cardiovascular events in patients with previous myocardial infarction: the TACT randomized trial. JAMA. 2013; 309: 1241-1250.
6. Hypertension. In: Gaby AR, ed. Nutritional Medicine. Concord, NH: Fritz Perlberg Publishing; 2011: 323-335.
7. Dickinson HO, et.al. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens. 2006; 24:215-233.
8. Plotnikoff, GA, Dusek J. Hypertension. In Rakel D, ed. Integrative Medicine, 4th edition. Philadelphia: Elsevier; 2012: 230-241.
After graduating from the University of Michigan Medical School, Dr. Chappell became certified by the American Board of Family Medicine and later by the National Board of Physicians and Surgeons. He is the author of Questions from the Heart and has published many articles in the Townsend Letter and in other journals showing the effectiveness of chelation therapy for vascular disease.