LE Magazine August 2003
The New Guidelines For Hypertension
How Mainstream Medicine Has Again Caught Up With Anti-Aging Advocates
By Dr. Edward R. Rosick
Eating right with the DASH diet
The Dietary Approaches to Stop Hypertension (DASH) diet is recommended by both mainstream and integrative medical practitioners as a first line approach to manage hypertension.5 The DASH diet is high in fruits, vegetables and other nutritious foods that are rich in potassium, calcium and magnesium (essential minerals that are discussed in more detail below). People who utilize the DASH diet are encouraged to decrease their saturated fats and replace them with foods high in monounsaturated fats and omega-3 fatty acids, such as those found in fish. Salt restriction is also a major part of the DASH diet-recommendations are that people with hypertension limit their salt intake to less than 2,400 mg (about one teaspoon) a day. Studies have shown that people who follow the DASH diet can decrease their systolic pressure by 11 points and their diastolic pressure by about six points.6
Smoking cessation is essential for blood pressure control
It should come as no surprise that cigarette use is a major contributing factor of high blood pressure. Even just smoking one cigarette can cause transient blood pressure increases of 10 points or more. People who smoke on a regular basis will have a sustained rise in their blood pressure due to the effects of nicotine and other dangerous chemicals found in cigarettes.7 With all the other known health risks associated with smoking-heart disease, diabetes and impotence, to name just a few-smoking cessation should be at the top of anyone's list that is looking to improve his or her blood pressure and overall health.
Obesity-an ever-growing problem and a cause of hypertension
Obesity is literally a huge public health problem in the Western world and is a significant contributor to many modern diseases, including hypertension. Being obese puts a person at increased risk of developing hypertension at an early age, as well as developing more severe hypertension. The good news is that with weight loss, hypertension can be significantly controlled; in a seven-year study of people who restricted their salt intake and were on a weight loss program, 80% of the people who stayed on the diet lowered their blood pressure to such a degree that they were able to completely stop their prescription blood pressure medication.9
Natural supplements can help in the battle against hypertension
Besides making some common-sense health decisions, such as following a DASH-type diet, quitting smoking and maintaining a healthy body weight, hypertension can be combated with the judicious use of natural supplements. While mainstream practitioners would have you believe (and probably believe it themselves) that expensive prescription medications are the only proven way to combat hypertension, the truth is that there are some scientifically proven supplements that can help keep your blood pressure below that all important 120/80 figure.
Potassium, calcium and magnesium-essential minerals for controlling hypertension
One of the ways in which the DASH diet helps to decrease hypertension is through its emphasis on eating significant amounts of fruits and vegetables-foods that are high in potassium, calcium and magnesium, minerals that are an essential component of any hypertension-controlling regime. There have been numerous studies showing that changing to a diet high in these vitally important minerals, or taking them as supplements, can significantly help control hypertension.10,11,12,13 A very robust study, started in 1980, followed 58,218 nurses aged 34 to 59 years over a four-year period and recorded their dietary habits, as well as their risk of developing hypertension. Over that four-year period, 3,275 of those women developed high blood pressure, with advancing age, obesity and excessive alcohol consumption being the strongest predictors of hypertension development. However, the authors of the study noted that the amounts of dietary calcium and magnesium consumed were also strong indicators for hypertension. Women who consumed at least 800 mg of calcium and 300 mg of magnesium were at significantly less risk for developing hypertension when compared to women who consumed less of these minerals.12 A recent review article that examined the data from several large studies done over the past 15 years on the association between calcium, potassium and magnesium intake and hypertension came to the conclusion that "it appears prudent for physicians and health care providers to ensure that patients who are either hypertensive or at risk of developing high blood pressure consume adequate calcium, potassium, and magnesium on a daily basis."13
It seems like you can't read a health-related magazine and not see at least one article on the many beneficial effects of vitamin E. Now the list of those beneficial effects has gotten even longer as studies have indicated that vitamin E supplements can help in the fight against hypertension. One manner in which vitamin E may control hypertension is through its actions as an antioxidant, molecules that decrease the destructive effects of free radicals. These highly reactive compounds are formed continuously in the body and are now being linked to a variety of disease states, including hypertension. Preliminary studies have shown that people who have hypertension often have low levels of essential antioxidants such as vitamin E.14 While human studies are forthcoming, animal studies with rats have shown that supplementation with a form of vitamin E (gamma tocotrienol) protected the animals against the development of age-related hypertension.15
Are You Taking The Proper Anti-Hypertensive Medication?
The Life Extension Foundation has repeatedly warned those with high blood pressure to not depend on one-a-day dosing of anti-hypertensive drugs. The reason is many of these drugs do not provide complete 24-hour protection. When an anti-hypertensive drug wears off, the patient is vulnerable to suffering a stroke. One solution to this problem is to take a lower dose of the anti-hypertensive drug twice a day, even though the FDA claims that one-a-day dosing is adequate.
Failure to keep blood pressure at optimal low levels (below 120/80) dramatically increases mortality risk. The government used to state that blood pressure readings as high as 140/90 were acceptable,18 but published human studies clearly show that maintaining levels below 120/80 confer longevity and protection against heart attack and stroke.19,20
The best selling anti-hypertensive drugs in the United States are not necessarily the most effective. Drug company advertising and physician "force-of-habit" prescribing often results in hypertensive individuals taking drugs that do not provide optimal blood pressure lowering effects.
Life Extension long ago recommended a class of anti-hypertension drugs known as angiotension II receptor blockers. Some of the first drugs approved in this class where Cozaar® and Hyzaar® and Life Extension suggested them as first line therapy. The only drawback to these drugs was that they did not provide consistent one-a-day protection.
A new drug in this class is called Benicar®, and a recent study indicates that it may be the first to provide true 24-hour blood pressure reduction.21 Typical starting dose of Benicar® is 20 mg a day. For patients requiring further reduction in blood pressure, the dose can be increased to 40 mg a day after two weeks.
Optimal control of hypertension requires blood pressure checks throughout the day. This is the only way to make sure the anti-hypertensive drug is not wearing off and endangering the arterial system. Even if you are taking Benicar®, it is still critical to verify it is really keeping your blood pressure suppressed during the entire 24-hour period.
Like vitamin E, its antioxidant first cousin, vitamin C is proving to be increasingly useful in treating more and more age-related disease states including heart disease, cancer and hypertension. Several studies have now shown that there is a significant link between vitamin C levels and hypertension.16,17,18,19 Studies done as early as the 1980s showed that people who had low levels of vitamin C intake had higher levels of hypertension.16,17 Other randomized, placebo-controlled studies have shown that 500 mg of vitamin C daily caused a statistically significant drop in blood pressure in both men and women who had hypertension.18 The manner in which vitamin C works to control hypertension is still being studied. While some researchers believe that vitamin C controls hypertension through its antioxidant actions, others believe that vitamin C may also work through its role of modulating the activity of a chemically simple, yet very important gas known as nitric oxide.
Similar to vitamin C, arginine, an amino acid, may be a potent weapon in the fight against hypertension. Arginine is thought to work through its ability to produce nitric oxide (NO), a simple gas made up of nitrogen and oxygen that penetrates and crosses the membranes of almost all cells in the human body and helps regulate many cellular functions. In blood vessels, NO is extremely important because it regulates the tone of the layer of cells known as endothelial cells that line the inside of blood vessels. If these endothelial cells become dysfunctional, they can cause spasms or constrictions of the blood vessels that can then lead to hypertension.
With this knowledge, researchers have begun to examine the effects of NO enhancers such as arginine on hypertension, and the results have been quite promising. A recent study from Italy examined blood pressure changes among six male volunteers who were placed on three different diets.20 The first diet consisted of foods that contained three to four grams of arginine. The second diet was high in arginine-rich foods so that these volunteers consumed about 10 grams of arginine daily. People in diet three ate the same foods as people in diet one, but took 10 grams of arginine supplements daily. After only one week on either diet two or diet three (the arginine-rich/supplementation diets) significant decreases in blood pressure were observed in the volunteers on those diets, as compared to those on diet one. Because of these impressive results, the authors concluded "the present study indicates that an approximately two-fold increase in dietary arginine intake had significantly hemodynamic and metabolic effects in a group of healthy men."
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