Managing High Blood Pressure Naturally. Michael A. Smith, MD Life Extension s Healthy Talk Series

Size: px

Start display at page:

Download "Managing High Blood Pressure Naturally. Michael A. Smith, MD Life Extension s Healthy Talk Series"

Lesley Jordan
5 years ago
Views:

1 Managing High Blood Pressure Naturally Michael A. Smith, MD Life Extension s Healthy Talk Series

3 Part 1 What is Blood Pressure?

4 Blood Pressure

5 Systole Systolic Forward Pressure 110 mmhg 70 mmhg Diastole Diastolic Filling Pressure

6 Blood Pressure is Two Forces Perpendicular Force Diastolic - filling Blood volume Impacts Arterial wall proteins like collagen and elastin Shearing Force Systolic pressure Activates Nitric oxide Vessel dilates

7 Endothelium Nitric Oxide (NO) NO Effects Vasodilator Supports Healthy Blood Flow to Tissues Marker of Endothelial Cell Health Mechanism of Action Relaxes Smooth Muscle Cells EC damage Decreases NO Rigid arterial walls Atherosclerosis

8 Part 2 What is High Blood Pressure?

9 Definition of High Blood Pressure Prehypertension Average SBP and/or DBP are greater than or equal to the 90 th percentile Hypertension Average SBP and/or DBP are greater than or equal to the 95% percentile Risk Begins 115/75 mmhg Risk Increases Each increment of 20/10 mmhg National High Blood Pressure Education Program 2011

10 Causes of High Blood Pressure Primary Unknown cause 50 million Americans Increased risk for vascular diseases No.1 independent risk factor for heart disease?? Secondary Sleep Apnea Drug-induced Chronic Kidney Disease Primary Aldosteronism Chronic Steroid Use Cushing s Syndrome Pheochromocytoma Thyroid Disease Coarctation of Aorta

11 TheoreticalCauses of High Blood Pressure Too much blood Injured blood vessel

12 Injured Blood Vessel Theory High Shearing Forces Over Time High Shearing Force Damages Endothelium Less NO produced Vessel becomes rigid Pressure increases More EC damage Vicious cycle develops

13 Goals of Managing Pressure Minimize Systolic Forward Pressure Limit the Shearing Force Improve NO Production Protect & Repair Endothelium

14 Blood Pressure Chart Conventional Medicine Ranges Life Extension Optimal Ranges

15 Part 3 What are the Consequences?

17 Middle Age High Blood Pressure 61,585 participants Men who developed high blood pressure in middle age had a 70% risk of having a heart attack or stroke Women who developed high blood pressure had almost a 50% risk of a heart attack or stroke Maintain or reduce blood pressure to normal levels by age 55 has the lowest risk for a heart attack or a stroke Northwestern University School of Medicine Cardiovascular Lifetime Risk Pooling Project

18 Benefits of Lowering BP Disease Consequence Average Risk Reduction Stroke 35-40% Heart attack 20-25% Heart Failure 50% Achieving a sustained 12 mmhg reduction in SBP over 10 years will prevent 1 death for every 11 patients treated. That s approximately 4.5 million lives saved in 10 years. 7 th Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-7)

19 Part 4 Lifestyle Modifications

20 Lifestyle Modifications Blood Pressure Reductions Modification Weight Loss Dash Diet Plan Exercise Reduce Sodium Intake Reduce Alcohol Consumption Approximate SBP reduction 5-20 mmhg/10 kg weight loss 8-14 mmhg 4-9 mmhg 2-8 mmhg 2-4 mmhg 7 th Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-7)

21 Dash Diet Plan Dietary potassium Dietary magnesium & calcium Fiber (15 g/day) and protein Alcohol (2 drinks for men & 1 for women) Salt (2.4 grams sodium) DASH diet can reduce systolic BP by 8-14 mm Hg 21 MellenPB, et al. Deteriorating dietary habits among adults with hypertension. DASH dietary accordance, NHANES Arch Intern Med. 2008;168:

22 Dash Diet Plan Nutrient Potassium 250 mg/serving (RDA =3500 mg) Magnesium 100 mg/serving (RDA = 400 mg) Fiber 5 to 10 g/serving (RDA = 25 grams) DASH Rich Foods Food Sources Asparagus Beets Eggplant Raisins Halibut Black Beans Seeds/Nuts Mixed, Whole Grains Sprouted Breads Legumes Seeds/Nuts

23 Dash Diet Plan Soluble Fiber Reduction of the glycemic index of foods and the attenuation of insulin response. Soluble fibers increase mineral absorption of calcium, magnesium and potassium by several mechanisms. A review found an average reduction in systolic pressure of 6 mmhg and diastolic blood pressure of 4 mmhgin patients with hypertension. J Hypertens Mar;23(3):

24 Dash Diet Plan Total Protein Protein increases sodium excretion, increases blood arginine and improves insulin sensitivity by replacing carbohydrates in the diet. 46 studies demonstrated that for every 11 grams of protein: 2 mmhg reduction in systolic blood pressure 1 mmhg reduction in diastolic blood pressure Blood pressure lowering effect was stronger in middle-aged and hypertensive people. J Hypertens Mar;23(3):

25 Part 5 Nutrients that Lower Blood Pressure

26 Goals of Managing Pressure Minimize Systolic Forward Pressure Limit the Shearing Force Improve NO Production Protect & Repair Endothelium

27 Cardiocontrol Blood Volume Cardiocontrol Vasodilators Antioxidants Work Horses

28 #1 Cardiovascular Control Magnesium Drinking water high in magnesium and other minerals is associated with lower cardiovascular mortality. Observational studies demonstrated the following: Magnesium intake lower blood pressure People with hypertension lower intakes of magnesium 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 PGE1. J Hum Hypertens Jul;12(7): J Clin Hypertens(Greenwich) Jul;10:3-11. Review.

29 #1 Cardiovascular Control Magnesium 12 controlled trials with over 500 patients showed that supplemental magnesium for 8 to 26 weeks led to an average decrease in systolic pressure of 4 mmhg and diastolic blood pressure of 2.2 mmhg. 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. Cochrane Database Syst Rev Jul 19;(3):CD Review Magnes Res Mar;23(1):27-40

30 #1 Cardiovascular Control Hawthorn Berries Hawthorn exhibits mild blood pressure lowering activity by multiple mechanisms dilation of coronary and peripheral blood vessels inhibition of ACE anti-oxidative and anti-inflammatory effects mild diuretic activity improves cardiac oxygen consumption Eur J Heart Fail Dec;10(12): Cochrane Database Syst Rev Jan 23;(1):CD

31 #1 Cardiovascular Control 92 patients were randomized to take hawthorn or placebo 3 times daily for 4 months. Hawthorn demonstrated a significant decrease in both systolic and diastolic blood pressure. It has a time-dependent antihypertensive effect. Hawthorn Berries Drugs Exp Clin Res. 2004;30(5-6): patients with type 2 diabetes on blood pressure and/or blood sugar lowering drugs. Test participants receiving 1,200 mg hawthorn extract daily for 16 weeks. An average of 3-4 mmhg drop in diastolic blood pressure, while the control group saw no change. Br J Gen Pract Jun;56(527):

32 Cardiocontrol Blood Volume Blood Vasodilators Volume Antioxidants Work Horses

33 #2 Blood Volume Increasing Sodium Excretion Potassium Reduces blood volume and sensitivity of blood vessels to vasoconstriction by the Renin system. Decreases systolic blood pressure mmhgand diastolic blood pressure of mmhg J Hypertens Suppl Dec;9(6):S JAMA May 28;277(20): J Hum Hypertens Jul;17(7): Cochrane Database Syst Rev Jul 19;(3):CD Calcium Balances the concentrations of magnesium and potassium. Controls activity of smooth muscle cells. Decreases systolic blood pressure 2.6 mmhg and diastolic blood pressure of 1.3 mmhg. J Nutr Feb;125(2 Suppl):311S-400S. Diabetes Care Jun;14(6): J Hum Hypertens Aug;20(8):571-80

34 #2 Blood Volume Whey Protein Peptides Angiotensinogen Renin Blood Pressure Renin Angiotensin System Angiotensin I ACE Angiotensin II Increases sodium retention Increases blood volume Vasoconstricts Blood Pressure

35 #2 Blood Volume Whey Protein Peptides Whey protein is digested into smaller protein units called peptides. These milk peptides inhibit the angiotensin-converting enzyme (ACE). Human studies of whey-enriched milk products demonstrate convincing reductionsin blood pressure compared with placebo supplemented patients. Other studies suggest that active milk peptides also inhibit the release of other vasoconstriction molecules such as endothelin-1. Meded Rijksuniv Gent Fak Landbouwkd Toegep Biol Wet. 2002;67(4): J Food Prot Sep;66(9): Atherosclerosis Sep;212(1):

36 Cardiocontrol Blood Volume Vasodilators Antioxidants Work Horses

37 #3 Vasodilators Grape Seed Extract Procyanidinssupport vasodilation through an increase in nitric oxide production and ACE inhibition. Two 4-week studies of standardized grape seed extract (150 mg and 300 mg) in 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. Metabolism Dec;58(12):

38 #3 Vasodilators Pomegranate Extract Pomegranate polyphenols function as Nitric oxide producers 25% increase. They also act as ACE inhibitors. Reductions in ACE activity by 36% have been demonstrated. Pomegranate antioxidants have been associated with decreases in systolic blood pressure of8 mmhgin a 2 week clinical study and21 mmhgin a 1 year study. Atherosclerosis Sep;158(1): Clin Nutr Jun;23(3):

39 #3 Vasodilators Arginine Precursor to nitric oxide. Low cellular levels of L-arginine and nitric oxide are evident in individuals genetically predisposed to hypertension. Test diets rich in arginine-containing foods, or supplemented with arginine pills or powders, demonstrated decreases in blood pressure 6.2 mmhg systolic, mmhg diastolic when compared to control diets in a short term human study. Reductions in blood pressure were also observed in a pilot trial where kidney transplant patients were supplemented with 18 g daily of arginine, as well as in a small controlled trial with diabetic patients. Circulation Dec 14;110(24): Am J Hypertens May;13(5 Pt 1): Diabetes Care May;31(5):940-4.

40 #3 Vasodilators Olive Leaf Extract The leaves contain the active compoundsoleuropeinand ursolicacids which have been shown to act as: Vasodilators and ACE inhibitors Beta blocking and calcium channel-blocking agents 148 stage-1 hypertensive patients were randomized to captopril or olive leaf, 500 mg twice daily. After 8 weeks: SBP reductions were 11.5 for olive leaf vs mmhg for captopril DBP reductions were 4.8for olive leaf vs. 6.4 mmhg for captopril. 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%). J Ethnopharmacol Feb;84(2-3): J Ethnopharmacol Nov 20;120(2): Phytomedicine Feb 15;18(4):251-8.

41 Cardiocontrol Blood Volume Antioxidants Vasodilators Antioxidants Work Horses

42 #4 -Antioxidants CoQ10 12 studies with 328 patients showed improvements in blood pressure. 3 controlled trials of mg of CoQ10 for up to 8 weeks resulted in decreases in systolic pressure of 11 mmhg and diastolic pressure of 7 mmhg. CoQ10 may lead to modest reductions in diastolic blood pressure in chronic kidney disease patients when combined with fish oil. Cochrane Database Syst Rev Oct 7;(4):CD J Hum Hypertens Apr;21(4): J Hypertens Sep;27(9): Lycopene A small crossover study of patients with hypertension taking 250 mg of a lycopene-enriched tomato extract for 8 weeks resulted in a reduction of SBP by 10 points and DBPby 4 points. No changes in blood pressure were observed during the placebo period. Thiobarbituric acid, a marker oxidative stress, also decreased during the test period. Am Heart J Jan;151(1):100.

43 #4 -Antioxidants Green Coffee Extract 117 subjects randomized into 3 dosage of green coffee extract versus placebo once daily for 28 days. SBP reduced 5.6 mmhg for higher dose groups. DBP reduced by 3.9 mmhg Hypertens Res Sep;28(9): Vitamin C Higher blood levels of vitamin C are associated with lower blood pressure. Individuals with the highest blood concentrations had 4.66 mmhg lower systolic blood pressure and 6.04 mmhg lower diastolic blood pressure than those with the lowest concentrations. Several small studies have shown modest reductions in SBP ranging 1.8 to 4.5 mmhg and DBP ranging 2 to 2.8mm Hg blood pressure at doses of 500 mg to 2000 mg daily. J Hypertens Jul;16(7): Nutr J Dec 17;7:35.

44 Cardiocontrol Blood Volume Work Vasodilators Horses Antioxidants Work Horses

45 #5 The Work Horses Vitamin D Suppresses the production of angiotensin II. 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 increasein serum vitamin D. J Hypertens Apr;29(4):

46 #5 The Work Horses Garlic Extract Garlic s promotion of cardiovascular health has been substantiated by several human trials A recent review and analysis of 11 controlled human trials showed a mean decrease in systolic blood pressure of 8.4 mmhg and for diastolic pressure 7.3 mmhg for diastolic. BMC Cardiovasc Disord Jun 16;8:13.

47 Cardiocontrol Magnesium Hawthorn berries Blood Volume Potassium Calcium Whey protein peptides Vasodilators Antioxidants Grape seed extract Pomegranate Arginine Olive leaf extract CoQ10 Lycopene Green coffee extract Vitamin C Work Horses Vitamin D Garlic extract

48 Conventional Algorithm Dash Diet Plan Work Horse(s) Cardiocontrol(s) Dash Diet Plan Work Horses Cardiocontrol(s) Vasodilator(s) Dash Diet Plan Work Horses Cardiocontrol(s) Vasodilators Blood Volume(s) Antioxidant(s)

49 Thank You! Healthy Talk with Dr. Mike on RadioMD Thursdays 3-4PM ET

Role of Minerals in Hypertension

Role of Minerals in Hypertension Lecture objectives By the end of the lecture students will be able to Define primary and secondary hypertention and their risk factors. Relate role of minerals with hypertention.