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High Blood Pressure

Dietary & Lifestyle Approaches To Managing Blood Pressure

Dietary modifications aim to balance macro- and micronutrient intake to favorably influence the body’s inherent blood pressure regulating systems.

Weight management, increased physical activity, limitation of alcohol consumption, and dietary modification (particularly the reduction of dietary sodium) are among the best studied, and most effective lifestyle changes for blood pressure management. A Body Mass Index (BMI) between 18.5 and 24.9 carries the lowest risk of hypertension. Reductions of systolic blood pressure by 5-20 mmHg per 10 kg (22 pounds) of weight loss have been observed in several studies (The Trials of Hypertension Prevention Collaborative Research Group 1997; He 2000). Regular exercise has been associated with average reductions in blood pressure of 3.2 mmHg (systolic) and 3.5 mmHg (diastolic) in thousands of subjects across many studies (Cornelissen 2005; Kelley 2000; Xin 2001). Limitation of alcohol consumption (≤ 2 drinks per day for men, less than this for women) can further reduce systolic blood pressure by 2-4 mmHg (Xin 2001).

A sodium restricted diet (< 1.5 grams/day) can significantly reduce blood pressure. The DASH (Dietary Approaches to Stop Hypertension) eating plan has been shown to lower systolic blood pressure by 8-14 mmHg, and is included among suggested dietary guidelines (Sacks 2001; Svetkey 1999). The first DASH eating plan focused on fruits, vegetables, whole grains, was especially high in fiber (31 grams/day) and potassium (4.7 grams/day), and low in animal products. Ironically, the original DASH was not a low sodium diet (allowing up to 3 grams/day), but nonetheless had blood pressure lowering effects (Appel 1997).

Fiber. How dietary fiber (both soluble and insoluble) reduces blood pressure is poorly understood. Possible mechanisms include a reduction of the glycemic index of foods and the attenuation of insulin response (insulin plays a role in blood pressure regulation). Soluble fibers may also increase mineral absorption (such as calcium, magnesium, and potassium) by several mechanisms (Greger 1999). A comprehensive review of 24 randomized, controlled clinical trials examined the effects of fiber in people with both normal and high blood pressure. They demonstrated modest reductions in systolic (1.13 mmHg) and diastolic (1.26 mmHg) blood pressure at an average dose of 11.5 g fiber/day (Streppel 2005). Another review found an average reduction in both systolic and diastolic blood pressure in trials conducted among patients with hypertension (systolic 5.95 mmHg and diastolic 4.20 mmHg) and in trials with a duration of intervention ≥ 8 weeks (systolic - 3.12 mmHg and diastolic 2.57 mmHg) (Whelton 2005).

Protein. Results from a comprehensive review of hypertension studies indicate an association between low dietary protein intake and elevated blood pressure (Myers 2007). A recent review of 46 studies demonstrated the effects of plant protein on reductions in blood pressure (up to a 1.4 mmHg reduction in systolic blood pressure and a 1 mmHg reduction in diastolic blood pressure for every 11 g of plant protein consumed daily). The blood pressure lowering effect was stronger in both middle-aged and hypertensive individuals, as well as those with a high initial BMI (Altorf 2010). The mechanism for the blood pressure lowering effect of protein is unclear. It may increase sodium (and water) excretion from the kidneys, increase blood concentration(s) of arginine (the precursor to nitric oxide), or improve insulin sensitivity (especially if it replaces carbohydrates in the diet) (Myers 2007).

Caloric restriction (CR) is the chronic reduction of dietary calories (typically 30%, but sometimes up to 50% in some protocols), without malnutrition (Lane 1998). Restriction in energy intake slows down the body’s growth processes, causing a focus on protective repair mechanisms. The overall effect is an improvement in several measures of health.

Observational studies have tracked the effects of calorie restriction on lean, healthy individuals, and have demonstrated that a moderate calorie restriction (22-30% decrease in caloric intake from normal levels) improves cardiac function as well as reduces markers of inflammation and risk factors for cardiovascular disease (LDL-C, triglycerides, blood pressure) (Walford 2002; Fontana 2004; Fontana 2006; Meyer 2006). Reductions of systolic blood pressure (5-10 mmHg) and diastolic blood pressure (4-6 mmHg) have been observed in studies of individuals with normal and high blood pressure that adopted a caloric-restricted regimen (Fontana 2007; Lefevre 2009; Riordan 2008; Bloomer 2010).

Restoring Youthful Hormone Balance To Control Blood Pressure

The risk of developing primary hypertension is significantly higher in postmenopausal women and men older than 55 years of age. As hormone levels decline with age, the risk of high blood pressure and heart disease rise.

Vascular endothelium and smooth muscle cells have sex steroid receptors (Natoli 2005). Research has supported bioidentical hormone restoration of estrogen, progesterone, and testosterone for use in the management of blood pressure and overall cardiac health.

Sex hormones stimulate endothelial cell growth, inhibit smooth muscle proliferation contraction, and relax the vascular endothelium via nitric oxide and prostacyclin (Khalil 2005). When hormones are present in youthful concentrations, vascular function in patients with high blood pressure may be modulated (Khalil 2005).

Japanese scientists found that a group of menopausal women treated with estriol for 12 months had a significant decrease in both systolic and diastolic blood pressure (Takahashi 2000). Another placebo-controlled study demonstrated that estriol replacement for 30 weeks improved flow-mediated dilation, a measure of arterial relaxation (Hayashi 2000). Estriol accomplishes these effects by strongly activating nitric oxide signaling systems and stabilizing atherosclerotic plaques (Kano 2002).

In a two-year-long study involving postmenopausal women, hormone replacement therapy (HRT) (upon initiation of treatment) was able to quickly and significantly lower blood pressure. Moreover, the effects were maintained over the two-year period as women receiving HRT displayed significantly lower blood pressure at 12 and 24 month checkups (Ichikawa 2008).

Likewise, in males, low testosterone levels are predictive of hypertension and cardiovascular disease risk (Torkler 2010). Life Extension suggests that aging men maintain free testosterone levels of 20 – 25 pg/ml for optimal health.

Those individuals interested in learning more about the numerous benefits of restoring hormone concentrations to youthful levels should read Life Extension’s Female Hormone Restoration and Male Hormone Restoration protocols.

Nutrients To Support Healthy Blood Pressure Levels

Nutritional approaches to hypertension management mirror many of the strategies of pharmaceutical therapies. The inclusion of specific dietary compounds with blood pressure lowering (hypotensive) or cardioprotective properties can significantly support cardiovascular health.

Several dietary compounds can also lower blood pressure through the mechanism of anti-oxidation. Hypertension is associated with an increase in oxidative stress and the activity of pro-oxidant enzymes. Oxidative stress can inactivate the vasodilation signal nitric oxide by converting it into the peroxynitrite free radical. Several hypotensive antioxidants appear to function by reducing this oxidative damage, and preserving the bioavailability of NO.

Cardioinhibitory & Cardiotonic nutraceuticals

Magnesium. As early as the 1950’s, the hypotensive effects of magnesium were a focus of speculation based on findings showing that drinking hard water (which is high in magnesium and other minerals) is associated with lower cardiovascular mortality (Mizushima 1998). Dozens of observational studies have demonstrated that magnesium intake is associated with lower blood pressure, and hypertensive individuals have lower intakes of magnesium than those with normal blood pressure (Mizushima 1998). Magnesium may lower blood pressure both by acting like a natural calcium channel blocker and serving as a cofactor for the production of the vasodilator prostaglandin E1 (Houston 2008).

Interventions using magnesium have shown modest effects on blood pressure. An analysis of twelve controlled trials containing over 500 patients demonstrated that supplemental magnesium for 8 to 26 weeks led to an average decrease in diastolic blood pressure of 2.2 mmHg (Dickinson 2006). A comprehensive analytical review of 44 human studies of supplemental magnesium showed that it may enhance the blood pressure lowering effect of anti-hypertensive medications in early-stage hypertensive subjects. Patients treated with medications continuously over 6 months saw significant further decreases in systolic and diastolic blood pressure with magnesium supplementation as low as 230 mg daily (Rosanoff 2010).

Daily supplementation with 300 to 500 mg of elemental magnesium is vital for those taking diuretic drugs. Absorption of magnesium into the bloodstream is not particularly effective. Higher blood magnesium levels may be achieved by taking 2,000 mg of magnesium threonate daily, even though its elemental magnesium is relatively low (Slutsky 2010).

Hawthorn (Crataegus laevigata; Crataegus monogyna; Crataegus oxyacantha). Hawthorn is a traditional cardiovascular tonic that has been in use since the Middle Ages. Hawthorn extracts are believed to exhibit mild blood pressure lowering activity by multiple mechanisms, including the dilation of coronary and peripheral blood vessels, inhibition of ACE, anti-oxidative and anti-inflammatory effects, and mild diuretic activity (Graham 1939; Furey 2008). It also improves cardiac oxygen consumption (Pittler 2008).

Three trials have supported the potential blood pressure lowering activity of Hawthorn extracts. A small randomized controlled study of 36 untreated, mildly hypertensive, middle-aged subjects compared standardized hawthorn extract (500 mg) and magnesium (600 mg), both separately and in combination for 10 weeks. There was a small decrease in diastolic blood pressure in the hawthorn group (Walker 2006). In a second larger study, 92 middle aged hypertensive participants were randomized to take standardized hawthorn extract or placebo 3 times daily for 4 months. Hawthorn demonstrated a significant decrease in both systolic and diastolic blood pressure (Asgary 2004). In the third study, a group of 39 patients with type 2 diabetes took hawthorn extract in conjunction with existing blood pressure or blood sugar lowering drugs. Test participants receiving 1,200 mg hawthorn extract daily for 16 weeks saw a 2.6 mmHg drop in diastolic blood pressure from baseline values, while the control group saw no change (Walker 2006).

Regulation of blood volume

Potassium. Potassium is one of the most abundant electrolytes in the body. Due to their antagonistic roles in metabolism, the balance of sodium and potassium plays a critical role in blood pressure regulation. Potassium increases excretion of sodium from the kidneys (reducing blood volume) and reduces the sensitivity of blood vessels to vasoconstriction by angiotensin II (Krishna 1993).

Evidence from observational studies and clinical trials consistently indicate that high levels of potassium are associated with lower blood pressure (Houston 2008). Four comprehensive reviews of potassium trials report average reductions in systolic blood pressure of 2.4-5.9 mmHg and diastolic blood pressure of 1.6-3.4 mmHg when supplementing with potassium for 2-8 weeks (Cappuccio 1991; Whelton 1997; Geleijnse 2003; Dickinson 2006). The degree of blood pressure lowering appears to be dose dependent, with the largest decreases in blood pressure occurring at the high end of the dosage range (daily doses of 1.9-4.7 g were used in the trials).

The adequate intake (AI) of potassium is 4.7 g daily for adults. Most adults have a median dietary intake substantially lower than this (2.8 - 3.3 g daily in men and 2.2-2.4 g daily in women) (Food and Nutrition Board 2005). Less than 3 percent of the population consumes the AI (Nicklas 2009). It should be noted that the amount of potassium in over-the-counter supplements is typically <100 mg, so individuals with high blood pressure should consume potassium rich foods to ensure AI.

Top 10 foods highest in potassium according to the USDA (USDA, Release 20)

Food

Serving Size

Potassium Content (mg)

Tomato paste, without salt added

1 cup

2657

Orange juice, frozen concentrate, unsweetened, undiluted

6 fl-oz.

1436

Beet greens, cooked, boiled, drained, without salt

1 cup

1309

Beans, white, mature seeds, canned

1 cup

1189

Dates, deglet noor

1 cup

1168

Milk, canned, condensed, sweetened

1 cup

1135

Tomato puree, without salt added

1 cup

1098

Raisins, seedless

1 cup

1086

Potato, baked, flesh and skin, without salt

1 potato

1081

Grapefruit juice, white, frozen concentrate, unsweetened, undiluted

6 fl-oz.

1002

Calcium. In addition to magnesium and potassium, population-based studies suggest a role for calcium in the prevention of hypertension, possibly through its ability to promote sodium excretion, balance the concentrations of other minerals (particularly magnesium and potassium), and its role in the activity of smooth muscle cells in blood vessels (Hamet 1995; Resnick 1991). In a review of 40 randomized controlled trials, an average daily calcium dose of 1,200 mg was associated with a reduction in systolic (1.9 mmHg) and diastolic (1.0 mmHg) blood pressure. In persons with habitually low calcium intake (< 800 mg/day), the hypotensive effect was even greater (2.6/1.3 mm Hg) (van Mierlo 2006).

Antioxidants

Coenzyme Q10 (CoQ10). As a critical component of mitochondrial function and energy production, CoQ10 has a central role in proper cardiac function (Adrash 2008). Within blood vessels, CoQ10 may directly contribute to the functionality of vascular smooth muscle cells, allowing them to properly dilate (Digiesi 1992). As a lipid-soluble antioxidant, CoQ10 may quench free radicals and spare levels of vasodilatory nitric oxide (Rosenfeldt 2007).

In two separate reviews of human CoQ10 studies (a total of 12 studies comprising 328 hypertensive patients), all showed improvements in blood pressure (Ho 2009; Rosenfeldt 2007). Three randomized, controlled trials of CoQ10 (100-120 mg daily for up to 8 weeks) demonstrated mean decreases in systolic and diastolic blood pressure of 11 mmHg and 7 mmHg, respectively, while open label trials revealed slightly larger average decreases (-13.5/-10.3 mmHg) (Rosenfeldt 2007).

CoQ10 (at 200 mg daily) has also been shown to improve blood pressure and blood sugar control in type 2 diabetics when combined with the cholesterol-lowering drug fenofibrate (Chew 2008). CoQ10 may lead to modest reductions in diastolic blood pressure in chronic kidney disease patients when combined with fish oil (Mori 2009).

Carotenoids. Epidemiological evidence suggests that the risk of hypertension decreases as the concentration of four serum carotenoids (α- and β-carotene, lutein/zeaxanthin, and β-cryptoxanthin) increases (Hozawa 2009). In addition, lycopene (a carotenoid) has demonstrated hypotensive activity in a human intervention study. A small crossover study of 31 patients with stage 1 hypertension taking 250 mg of a lycopene-enriched tomato extract for 8 weeks demonstrated significant reductions in blood pressure (-10/-4 mmHg), while no changes in blood pressure were observed during the placebo period. Thiobarbituric acid–reactive substances (TBARS), a marker oxidative stress, also decreased during the test period (Engelhard 2006).

Chlorogenic acid. Chlorogenic acid from green coffee (unroasted coffee beans) is a hypotensive antioxidant, likely increasing the availability of nitric oxide (for vasodilation) by inhibiting enzymes that form reactive oxygen free radicals (Chen 2009). The roasting of coffee reduces the effects of chlorogenic acid on blood pressure. Still, the activity of chlorogenic acid remaining in roasted coffee is enough to counteract some of the hypertensive effects of caffeine, explaining why coffee consumption raises blood pressure less than an equivalent amount of caffeine alone (Noordzij 2005). Green coffee bean extract supplements are available to provide standardized doses of chlorogenic acid with minimal amounts of caffeine.

Two multi-center, randomized controlled trials investigated the effects of different doses of chlorogenic acid on volunteers with mild hypertension. In the first, 117 male volunteers were randomized into 3 dosage groups (46 mg, 93 mg, or 185 mg) of green coffee extract versus placebo once daily for 28 days. At study end, average reductions in systolic blood pressure from baseline (4.7 mmHg and 5.6 mmHg for the medium and high dose groups, respectively) varied significantly from placebo. Differences in diastolic blood pressure from the placebo group were also observed in the medium and high dose groups (-3.2 mmHg and- 3.9 mmHg, respectively) (Kozuma 2005). The second trial, with a similar design and duration, tested four doses of green coffee bean extract standardized to chlorogenic acid (0 mg, 82 mg, 172 mg, or 299 mg) in 203 pre- and stage 1 hypertensive volunteers (male and female). Green coffee bean extract had an anti-hypertensive effect on systolic blood pressure in a dose-dependent manner (ranging from -2.7 mmHg to -3.3 mmHg for the low and high doses, respectively). Diastolic blood pressure reduction was consistent across all dosages (approximately 3 mmHg) (Yamaguchi 2008).

Vitamin C. Vitamin C is an essential water-soluble antioxidant vitamin in humans. It is thought to exert hypotensive effects through an improvement in endothelial function, reduction in arterial stiffness, and its ability to bind the angiotensin receptor (thereby lowering its ability to bind angiotensin II) (Leclerc 2008). Higher plasma levels of vitamin C are associated with lower blood pressure (Bates 1998). In observational studies, individuals with the highest plasma ascorbic acid (vitamin C) concentrations had 4.66 mmHg lower systolic blood pressure and 6.04 mmHg lower diastolic blood pressure than those with the lowest concentrations (Block 2008).

Intervention studies with vitamin C in hypertensive adults have shown mixed results. Several small studies have shown modest reductions in systolic (1.8 to 4.5 mmHg) and diastolic (2.8mm Hg) blood pressure at doses of 500 mg to 2000 mg daily (Mahajan 2007; Sato 2006; Ward 2005; Duffy 1999; Fotherby 2000; Hajjar 2002), while others failed to reveal significant effects (Kim 2002; Ghosh 1994; Magen 2004).

Vasodilators

Grape Seed Extract. Grape seed extract contains oligomeric procyanidins (OPCs) that support vasodilation through an increase in nitric oxide production and ACE inhibition (Clouatre 2010). Two 4-week studies of standardized grape seed extract (150 mg or 300 mg) in pre-hypertensive patients with metabolic syndrome demonstrated a marked reduction in systolic and diastolic blood pressure. The reduction averaged -12/-7 mmHg between the two studies and did not significantly differ between the two dosages (Siva 2006; Sivaprakasapillai 2009). Another trial is underway as of August 2011 (ClinicalTrials.gov 2011).

Pomegranate. Pomegranate contains several bioactive antioxidant polyphenols, including punicalagins. Pomegranate juice consumption (50 ml [1.7 oz.] daily) has been associated with decreases in systolic blood pressure of 8 mmHg in a 2 week study (Aviram 2001), and 21 mmHg in a 1 year study (Aviram 2004).

In addition to its potent antioxidant activity (it has been shown to reduce LDL oxidation and increase levels of the cellular antioxidant glutathione) (Aviram 2004), pomegranate polyphenols also function as ACE inhibitors. Reductions in ACE activity by 36% have been demonstrated after 2 weeks of pomegranate juice consumption (Aviram 2001).

L-arginine. L-arginine, an amino acid, serves as the main raw material for the production of the vasodilator nitric oxide. Low cellular levels of L-arginine and nitric oxide are evident in individuals genetically predisposed to hypertension, likely due to inefficient transport of L-arginine across the cellular membrane (Schlaich 2004). Test diets rich in arginine-containing foods, or supplemented with arginine, demonstrated decreases in blood pressure (6.2 mmHg systolic, 5.0-6.8 mmHg diastolic) when compared to control diets in a short term human study (Siani 2000). Reductions in systolic and diastolic blood pressure were also observed in a pilot trial where kidney transplant patients were supplemented with 18 g daily of arginine (Kelly 2001), as well as in a small controlled trial with diabetic patients (Martina 2008).

Soy isoflavones. Soy isoflavones have been suggested to increase arterial vasodilation, improve endothelial function, and decrease blood pressure, possibly by reducing oxidative stress and increasing the availability of nitric oxide (Mahn 2005). Two analyses of 25 randomized controlled trials confirm the effect of isoflavone intake on reductions in blood pressure. In the first analysis, 14 clinical trials with 789 participants (both with normal blood pressure and pre-hypertension) revealed that a daily ingestion of 25–375 mg of purified soy isoflavones for 2–24 weeks decreased systolic blood pressure by an average of 1.92 mmHg compared with placebo (Taku 2010). Decreases in systolic blood pressure were greater in studies of longer duration (3.45 mmHg in studies longer than 3 months).

A second analysis of 11 trials (with a total of 549 participants) looked at isoflavone intake from soy protein, revealing a similar average reduction of systolic (2.5 mmHg) and diastolic (1.5 mmHg) blood pressure when compared to placebo (Liu 2011). These trials used a narrower range of isoflavone dosage (65-153mg daily). Within the trials utilized in this analysis, the blood pressure lowering effects of soy isoflavones were greatest in hypertensive patients and in trials lasting longer than 3 months.

Olive leaf (Olea europaea). Olive leaf has traditionally been used to treat high blood pressure, atherosclerosis, and diabetes (Janicke 2003). The leaves contain the active compounds oleuropein and oleacein, which may function as a vasodilator and ACE inhibitor, respectively (Somova 2003). They also contain ursolic and oleanic acids, two compounds shown to promote normal heart rhythm and lower cardiac output (acting as beta blockers) in rats (Somova 2004). Olive leaf extract has also shown calcium channel-blocking activity (Scheffler 2008).

Despite traditional usage, controlled human clinical trials on olive leaf extract have, until recently, been equivocal (Cherif 1996; Scheller 1955). Two recent studies using a standardized commercial extract, however, have produced promising results. The first was an open-label, controlled study using 20 pairs of identical twins with borderline hypertension. Supplementation with 1,000 mg of olive leaf extract over eight weeks resulted in a decrease of up to 19/10 mmHg within pairs. Within pairs of subjects, differences in blood pressure could be observed at a lower dosage of 500 mg (Perrinjaquet-Moccetti 2008). In the second study, 148 stage-1 hypertensive patients were randomized to captopril (a prescription ACE Inhibitor) or olive leaf, 500 mg twice daily. After 8 weeks, mean reductions from baseline were -11.5 and -13.7 mmHg (systolic) and -4.8 and -6.4 mmHg (diastolic) in the olive leaf and captopril groups, respectively, indicating that olive leaf extract was nearly as effective as the prescription drug for lowering blood pressure. The olive leaf extract group also demonstrated reductions in serum total cholesterol (2.8%) and triglycerides (7.8%), as well as a borderline statistically significant reduction in LDL-cholesterol (2.9%) (Susalit 2011).

Other Hypotensive Dietary Factors

Vitamin D. Vitamin D has several direct and indirect effects on cardiovascular health. It contributes to the maintenance of blood pressure by suppressing the production of renin in the kidneys (lowering angiotensin II production) (Li 2003). It can also suppress parathyroid hormone and pro-inflammatory cytokines, which are both associated with cardiovascular disease. The endothelial cells, which line the insides of blood vessels, have receptors for vitamin D, which suggests a direct effect of vitamin D on vascular metabolism. Several observational studies have revealed an increased risk for hypertension when comparing persons with the lowest and highest vitamin D intake. An analysis of 18 studies revealed a 16% reduction in the risk of hypertension for every 16 ng/ml increase in serum vitamin D (Burgaz 2011). According to data from the National Health and Nutrition Examination Survey (NHANES), nearly 75% of light-skinned, and up to 90% of dark-skinned Americans are vitamin D insufficient (Adams 2010).

Interventions using vitamin D have demonstrated modest results for lowering blood pressure. A review of 11 randomized, controlled vitamin D intervention trials (including over 700 subjects) demonstrated a small reduction in systolic (3.6 mmHg) and diastolic (3.1 mmHg) blood pressure at daily doses of 800-2,500 IU (Witham 2009). Supplemental D2 and D3 exhibited an average systolic blood pressure reduction of 6.2 mmHg, while alfacalcidol (a synthetic, activated analogue of vitamin D3) had no effect. A second review of vitamin D trials, including 2 newer studies, revealed a mean systolic blood pressure reduction of 2.44 mmHg (Wu 2010).

Life Extension suggests that all individuals maintain a blood 25-hydroxyvitamin D level of 50 – 80 ng/ml. Doing so often requires daily supplementation with 5,000 – 8,000 IU of vitamin D. Supplemental doses should always be based upon an individual’s blood test results.

Vitamin K. Atherosclerosis is a leading cause of disability and death in civilized societies. Many factors are involved in the initiation and progression of atherosclerosis. Vascular assaults including homocysteine or oxidized low-density lipoprotein (LDL) can initially damage the inner arterial lining (the endothelium) (Mallika 2007). To repair this damage, the endothelium accumulates collagen that forms a cap over the injury site (Lafont 1999).

These endothelial collagen caps attract calcium that accumulates (calcifies) and forms a hard material resembling bone; this is why atherosclerosis is sometimes referred to as “hardening of the arteries.” Ultimately, this process suppresses vascular flexibility and causes narrowing of the passage through which blood must flow, leading to increased blood pressure. Calcification of the coronary arteries markedly increases heart attack risk as well (Bellasi 2007).

Studies reveal that vitamin K plays an indispensible role in the balance of calcium deposition as it relates to both skeletal and vascular health. Vitamin K ensures that adequate calcium remains in the bones for strength while keeping calcium out of the arteries to maintain flexibility (Schurgers 2001; Doherty 2003; Beulens 2008). A substantial volume of research shows that insufficient vitamin K2 accelerates arterial calcification (Beulens 2008). Animal models indicate that supplemental vitamin K is able to reverse arterial calcification (Schurgers 2007).

Garlic. Garlic’s promotion of cardiovascular health has been substantiated by several human trials, particularly its hypotensive activity and ability to induce favorable blood lipid profiles. Garlic also reduces systolic and diastolic blood pressure in hypertensive individuals, as well as systolic blood pressure in persons with normal blood pressure. A recent review and analysis of 11 controlled human trials showed a mean systolic decrease of 4.6 mmHg in the garlic group compared to placebo, while the mean decrease in hypertensive subjects was 8.4 mmHg for systolic and 7.3 mmHg for diastolic (Ried 2008).

Fish Oil. Fish oil is a source of the omega-3 fatty acids Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA). EPA and DHA are made to a very limited degree in the human body from alpha-linolenic acid, but are nonetheless essential for several metabolic processes. Aside from reductions in the risk of cardiovascular mortality and non-fatal cardiovascular events (Marik 2008), fish oil fatty acids show reductions in blood pressure. In an analysis of 36 clinical trials on the effects of omega-3 supplementation in over 2,000 individuals with normal and high blood pressure, a median intake of 3.7 g daily of fish oil demonstrated an average blood pressure reduction of 2.1 mmHg (systolic) and 1.6 mmHg (diastolic) (Geleijnse 2002). The effects were greater in hypertensive individuals, with average reductions of 4 mmHg (systolic) and 2.73 mmHg (diastolic). Omega-3 fatty acids from fish oil have also demonstrated modest hypotensive activities in diabetic patients. A review and analysis of five small randomized controlled trials revealed a mean blood pressure reduction of 1.69/1.79 mmHg (Hartweg 2007).

Sesame lignans (including sesamin and sesamolin) are found in sesame seeds and present in sesame oil. Several animal studies have reported that sesame lignans suppress the development of hypertension (Matsumura 1998; Kita 1995; Nakano 2002). When used as a substitute for other types of cooking oil, sesame oil (about 35 g daily as part of meal preparation) exhibited significant reductions in systolic (20 mmHg) and diastolic (18 mmHg) blood pressure in 40 middle-aged, diabetic, hypertensive patients after a period of 45 days. These changes disappeared after switching back to groundnut or palm oil (Sankar 2006). A larger study of similar design (356 hypertensive patients on the calcium channel blocker nifedipine) produced similar reductions in systolic and diastolic blood pressure from baseline values. Sesame oil further increased the hypotensive efficacy of nifedipine (reducing blood pressures by an average of almost 15/10 mmHg over the drug alone) (Sankar 2005). A small randomized controlled trial of purified sesamin supplementation (30 mg, 2 times daily for 4 weeks) in 25 middle aged, pre-hypertensive subjects decreased systolic blood pressure by 3.5 mmHg and diastolic by 1.9 mmHg (Sankar 2005).

Sesame lignans may lower blood pressure due to their suppression of the vasoconstrictor 20-hydroxyeicosatetraenoic acid (20-HETE). A 30% reduction in 20-HETE levels has been observed in humans after 5 weeks of sesamin supplementation (39 mg daily) (Wu 2009). Sesame lignans may also lower blood pressure through antioxidant activity (sparing nitric oxide from oxidation) (Miyawaki 2009).

Whey protein peptides. Whey protein peptides have antioxidant potential and display blood pressure lowering properties (Chitapanarux 2009; Laviolette 2010; Marshall 2004). They also contribute to blood vessel relaxation and reduced “stiffness” (Pal 2010). The discovery that antioxidant status directly affects angiotensin availability further explains how whey proteins may fight elevated blood pressure (Zhou 2010). Human studies of whey-rich or whey-enriched milk products demonstrate convincing reductions in blood pressure compared with placebo- or casein-supplemented patients (Pal 2010; Kawase 2000; Pins 2006).

In recent years, scientists have found that whey proteins exert substantial direct angiotensin-converting enzyme (ACE)-inhibiting effects (Vermeirssen 2002; Manso 2003; Vermeirssen 2003). In the human stomach and intestine, some whey protein breaks down into very specific short amino acid chains (peptides) that function as efficient ACE-inhibitors (Abubakar 1998; Parrot 2003; Vermeirssen 2002). Laboratory studies consistently show that blood pressure is reduced in hypertensive animals given whey protein derivatives (Yamamoto 1999; Costa 2005). This effect is attributed, in part, to ACE inhibition. The ACE-inhibitory effect is substantially less powerful than those of prescription drugs. However, some people encounter side effects with those drugs (FitzGerald 2004). Whey protein derivatives, by contrast, can be used for long periods of time without adverse side effects. Other studies suggest that these active milk components also inhibit the release of other vessel-constricting molecules such as endothelin-1, offering a second pathway for blood Pressure Control (Maes 2004).