High Blood Pressure

Hypertension or high blood pressure is a very common condition in the U.S. It usually begins after age 20 and up to half of all people over age 65 have high blood pressure. High blood pressure can lead to serious problems such as stroke or heart attack. For this reason you should try to keep your blood pressure within a normal range ideally under 140/90 ("140 over 90").

Signs and Symptoms

Most people with high blood pressure have primary hypertension also called essential hypertension. This common form causes no symptoms at all unless the pressure gets extremely high. High blood pressure is often called the silent killer because you can feel just fine when you have it—even though damage may be occurring in your body.

Severe hypertension or a hypertensive emergency (usually caused by some other condition) may produce headache nausea and vomiting convulsions visual problems and other symptoms.

What Causes It?

The causes of essential hypertension are unknown. Doctors know only that it is very common and that you are more likely to get it as you get older. Hypertension is more common in African Americans. Factors that increase your risk of high blood pressure include the following.

• Family history
• Alcohol use
• High salt intake
• Stress
• Lack of exercise
• Obesity
• High sugar intake

A rarer kind of hypertension may be caused by other medical conditions and many medications. Pregnancy also causes blood pressure to rise.

What to Expect at Your Provider's Office

Because blood pressure varies in different circumstances your health care provider will take your blood pressure at several different times to get an accurate average reading. You may be asked to refrain from smoking caffeine and using some medications before coming to the office because these may raise your blood pressure. You will have a physical examination and may have blood tests or other tests if needed.

Treatment Options

Treatment Plan

High blood pressure can be dangerous. It is important to try various lifestyle changes to help lower it. Weight reduction (if needed) exercise avoiding alcohol and caffeine and restricting salt intake can all be helpful. Biofeedback and relaxation techniques can also be effective. Your provider will prescribe a drug to help lower your blood pressure if it is severe.

Drug Therapies

Prescription

Drugs are usually used in combination to lower blood pressure.

• Diuretics—thiazides or potassium-sparing agents; various side effects
• Antiadrenergic—numerous types including alpha beta alpha/beta and centrally acting sympatholytics; various side effects
• Vasodilators—numerous types; various side effects
• Calcium-channel blockers—numerous types; various side effects especially for people with heart conditions
• Angiotensin-converting enzymes (ACE) inhibitors—numerous types; various side effects

Over the Counter

N/A

Complementary and Alternative Therapies

Mind/body techniques (such as biofeedback yoga and meditation) and nutritional and herbal support may help lower blood pressure.

Nutrition

• Avoid caffeine and decrease intake of refined foods sugar and saturated fats (meats and dairy products). Some kinds of hypertension also respond to a reduction of salt in the diet.
• Eliminate food allergens because these may make hypertension worse. Increase dietary fiber vegetables and vegetable proteins and essential fatty acids (cold-water fish nuts and seeds).
• MaxEPA flax oil or evening primrose oil (1 000 to 1 500 mg one to two times per day) lowers cholesterol and mildly reduces hypertension. Magnesium (200 mg two to three times per day) mildly dilates blood vessels to decrease blood pressure.
• Zinc (30 mg per day) may help reduce blood pressure associated with high levels of cadmium (usually found in cigarette smokers).
• Coenzyme Q10 (50 to 100 mg one to two times per day) is protective to the cardiovascular system.
• B complex (50 to 100 mg per day) with additional folic acid (800 mcg per day) B₁₂ (1 200 mcg per day) and betaine (1 000 mg) may increase resistance to stress and lower blood pressure.
• Vitamin E (400 IU per day) keeps certain types of blood cells from sticking together improving blood flow.

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Unless otherwise indicated teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

• Hawthorn (Crataegus oxyacantha) linden flowers (Tilia cordata) passionflower (Passiflora incarnata) valerian (Valeriana officinalis) and cramp bark (Viburnum opulus) may be safely used long-term. These herbs relax and strengthen the cardiovascular system while moderately reducing blood pressure. Combine equal parts in a tincture 20 to 30 drops three to four times per day.
• Hawthorn as a dried extract 250 mg three times per day.
• Dandelion leaf (Taraxecum officinalis) has a diuretic effect but does not deplete potassium. Drink 3 to 4 cups per day.

Some herbs have a stronger hypotensive (lowering) effect but may also have toxic side effects. These herbs must be used under the supervision of a qualified practitioner: Lily of the valley (Convallaria majalis) night-blooming cereus (Cactus grandifloris) mistletoe (Viscum album) motherwort (Leonorus cardiaca) and Indian tobacco (Lobelia inflata). Combine three to four of these herbs with equal parts of cramp bark and valerian and take 30 to 60 drops three times per day.

Homeopathy

Homeopathy may be useful as a supportive therapy.

Acupuncture

Acupuncture may help reduce blood pressure and alleviate stress.

Massage

Therapeutic massage may be effective in reducing the effects of stress helping relaxation and lowering blood pressure.

Following Up

Even if you need medication you will benefit from increased exercise changes in your diet and stopping smoking and drinking alcohol.

Special Considerations

Tell your health care provider if you are pregnant because certain blood pressure medications should not be used in pregnancy.

Supporting Research

Barker LR Burton JR et al eds. Principles of Ambulatory Medicine. 4th ed. Baltimore Md: Williams & Wilkins; 1995:803–843.

Bartram T. Encyclopedia of Herbal Medicine. Dorset England: Grace Publishers; 1995:240.

Dambro MR. Griffith's 5 Minute Clinical Consult 1999. Baltimore Md: Lippincott Williams & Wilkins; 1999.

Detre Z Jellinek H Miskulin R. Studies on vascular permeability in hypertension. Clin Physiol Bichem. 1986;4:143–149.

Golik A Zaidenstein R Dishi V et al. Effects of captopril and enalapril on zinc metabolism in hypertensive patients. J Am Coll Nutri. 1998;17:75–78.

Kwan CY. Vascular effects of selected antihypertensive drugs derived from traditional medicinal herbs. Clin Exp Pharmacol Physiol. 1995;(suppl 1):S297–S299. Review.

Liva R. Naturopathic specific condition review: hypertension. Protocol Journal of Botanical Medicine. 1995;1:222.

Murray MT. The Healing Power of Herbs. Rocklin Calif: Prima Publishing; 1991:90–96 107–112.

Murray MT Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin Calif.:Prima Publishing; 1998.

Stein JH ed. Internal Medicine. 4th ed. St. Louis Mo: Mosby-Year Book; 1994:302–323.

Werbach M. Nutritional Influences on Illness. New Canaan Conn: Keats Publishing; 1988:227–240.

The fifth report of the joint national committee on detection evaluation and treatment of high blood pressure. Arch Intern Med. 1993;153:154.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.