Around-the-Clock Blood-Pressure ControlMarch 2018
By Michael Downey
On November 13, 2017, 30 million Americans who previously thought their blood pressure was in a safe range suddenly became clinically hypertensive.1
On that day, the American Heart Association and the American College of Cardiology changed the definition of hypertension, lowering it from 140/90 mmHg down to 130/80 mmHg.2,3 They also redefined “elevated blood pressure” as anything over 120/80.
These new guidelines vindicate Life Extension®’s longtime stance that ideal systolic blood pressure should be below 120 mmHg—and closer to 115 mmHg for most people.
In addition to being lower, blood-pressure control needs to occur around the clock to avoid the dangers of artery-damaging spikes.
In healthy individuals, blood pressure tends to dip at night. But if you’re one of the individuals whose blood pressure does not dip at night—as it should—that means unnecessary damage is occurring to your blood vessels and organs.4
The exciting news is that researchers have identified several nutritional compounds that not only help lower blood pressure but also keep it down at night, for around-the-clock protection.
These nutritional approaches can be added to existing blood pressure-control programs, or used alone, to achieve improved benefits in conjunction with physician supervision.
New Hypertension Guidelines
In November 2017, the American Heart Association and the American College of Cardiology issued the following new blood-pressure guidelines:2
|Blood Pressure Category||Systolic||Diastolic|
|Normal||<120 mmHg||and||<80 mmHg|
|Stage I||130—139 mmHg||or||80—89 mmHg|
|Stage II||≥140 mmHg||or||≥90 mmHg|
These new numbers validate Life Extension®’s longtime stance that the ideal systolic blood pressure for most people should be below 120 mmHg—and closer to 115 mmHg.
Now that mainstream medicine has redefined full-blown high blood pressure as a reading of 130/80 mmHg or above, a startling 103 million Americans will now be advised to address this critical health issue.2,3
The Silent Dangers of Hypertension
The damage from hypertension impacts your entire body. High blood pressure pounds organs and blood vessels with each heartbeat, hour after hour, day after day.
Because the symptoms of high blood pressure are often silent or invisible, most people are unaware of the damage that is occurring. But over the years, the effects of this relentless trauma begin to show.
In addition to increasing the risk of cardiac events, high blood pressure contributes to other conditions including retinopathy, kidney failure, vascular dementia, and diabetes.5-8
In the kidneys, the ability to filter the body’s waste products and separate excess fluid from the blood weakens.7
In the brain, the relentless pounding damages delicate capillary beds leading to reduced cerebral perfusion (blood flow). Higher-than-optimal blood pressure can lead to multi-infarct dementia that arises from many mini-strokes.
Women who develop high blood pressure in their 40s are 73% more likely to develop dementia than women who maintain healthy blood pressure.9
Some people with high blood pressure face an extra risk at night.
Daily variations in blood-pressure patterns are tremendously important, especially in older adults.10,11 Blood pressure dips somewhat at night, providing temporary relief from the pounding damage.4
But in about 35% of adults with hypertension, their blood pressure does not fall at night. In these “non-dippers,” the damage may continue around the clock,4 exposing these individuals to a significantly higher risk of cardiovascular disease and death compared to “normal dippers”—even when both have the same blood pressure during the day.4
For these individuals, preventing high blood pressure—or aggressively treating it at an early stage—is even more important for preventing the relentless damage.
When it comes to lowering blood pressure, at-home monitoring is essential to ensure that optimal 24-hour protection is achieved. The availability of low-cost and reliable at-home blood-pressure monitors makes this easy.
Lifestyle changes such as losing weight and increasing cardiovascular fitness through exercise can help support healthy blood-pressure levels.
The older drug classes of medication often have side effects that patients find frustrating and bothersome. Side effects can include nighttime urinary frequency with the use of diuretics, or cold hands/feet and sexual dysfunction with the use of beta-blockers.
Newer classes of antihypertensive drugs like angiotensin II receptor blockers are usually better tolerated by patients in comparison with older medications like diuretics and beta-blockers.
Some people may only need to take one angiotensin II receptor blocker like telmisartan (40 mg to 80 mg a day) to achieve good results. This drug has additional benefits for vascular health.12-17
For others, the best strategy for hypertension control is the use of low doses of several different classes (different mechanisms of action) of medications.
Solutions for High Blood Pressure
Despite billions of dollars spent on drugs to lower blood pressure,18 the condition continues to threaten millions of Americans each year. Statistics show that about a quarter of those with hypertension cannot reduce their readings even when taking three different blood-pressure medications!19
For many people, blood-pressure drugs can have uncomfortable—and sometimes dangerous—side effects.
Several nutritional compounds have been found to help reduce blood pressure both day and night. They work in ways similar to many prescription drugs—but without the side effects.
These compounds represent a novel approach to promoting healthy blood pressure and can provide critical around-the-clock management. For many people, this may provide an adequate maintenance program in consultation with their physician.
Three natural compounds have been found to help block the receptor for angiotensin II,20 which is a hormone that triggers the constriction (narrowing) of arteries.21 These flavonoid molecules—quercetin, myricitrin, and myricetin—are found in a wide variety of plant foods, but only in small amounts.22,23
Much like a finger over a garden hose, the narrowing of arteries raises pressure within them. Thus, blocking the angiotensin receptors is an effective way of bringing down blood pressure by helping to relax the arteries.
Experimental studies using assessment of receptor docking (i.e. the ability of a molecule to bind to a receptor) suggest that both quercetin and myricetin are effective at blocking angiotensin II receptors.20
A study conducted on rats showed that myricetin reduced systolic blood pressure by inhibiting the arterial-contracting response to angiotensin by 43%.24
These encouraging results led scientists to study the blood pressure-lowering effects of these flavonoid nutrients in placebo-controlled clinical trials—and the results did not disappoint.
Studies in adults showed that flavonoids like quercetin are effective at lowering blood pressure in healthy adults, in those with elevated blood pressure and hypertension (according to new guidelines), and in those with type II diabetes.
In both healthy adults and in those who were overweight or obese, 150 mg a day of quercetin reduced systolic blood pressure compared to placebo.25,26 In adults with elevated blood pressure and hypertension (according to new guidelines), 162 mg of quercetin daily reduced systolic blood pressure by 3.9 mmHg compared to a placebo.27
Higher amounts—730 mg of quercetin daily—reduced systolic blood pressure by 7 mmHg and diastolic blood pressure by 5 mmHg.28
In patients with type II diabetes—a population that has a higher risk of hypertension—researchers found both quercetin and myricitrin to be especially effective at lowering blood pressure:
In one study, 500 mg a day of quercetin lowered systolic pressure by 5.3 mmHg compared with a placebo.29
In another study, 600 mg a day of leaf powder from a myricitrin-containing extract produced an 11 mmHg decrease in systolic blood pressure.30
Calcium Channel-Blocking Stevioside
When intracellular calcium levels rise in smooth-muscle cells, it causes those cells to contract, which narrows arteries and increases blood pressure. Thus, blocking calcium channels is a distinct—and extremely effective—means of reducing blood pressure.
Scientists have found that a plant extract called stevioside mimics the activity of calcium channel-blocking drugs, effectively blocking calcium channels in the smooth-muscle cells of the arteries.31-33
Stevioside is derived from the leaves of Stevia rebaudiana that is often used in no-calorie sweeteners.34,35 A 2017 review found that stevia glycosides provide therapeutic effects against diseases such as cancer, diabetes mellitus, obesity, inflammation—and hypertension—without any toxicity.36
Calcium channel-blocking medications work well in combination with angiotensin II receptor-blocking medications. In the same way, stevioside can work well with the flavonoids quercetin, myricitrin, and myricetin to deliver a similar dual mechanism of action.
A recent meta-analysis included data on 788 patients taking between 750 mg and 1,500 mg of stevioside a day. Across all studies, stevioside demonstrated a 4.5 mmHg decrease in systolic blood pressure. And when stevioside was continued for a year or more, the mean decrease in systolic blood pressure was a substantial 11.9 mmHg!37
Around-the-Clock Protection With Melatonin
The hormone melatonin has numerous mechanisms of action that help lower blood pressure.
It dilates blood vessels38 and inhibits “fight-or-flight” signals from the sympathetic nervous system.38,39 It also helps regulate mitochondria—the energy-producing structures inside cells—to maintain a cardiovascular function.40 But what makes melatonin especially noteworthy is its impact on nighttime blood pressure.
Studies have shown that melatonin helps regulate circadian rhythms and reduces nighttime blood pressure.41-43 This is important for everyone with hypertension—but it is especially important for the 35% of non-dippers.
Not all types of melatonin have equally effective blood-pressure benefits. A meta-analysis compared 5 mg daily of immediate-release melatonin with 2-3 mg daily of controlled-release melatonin.
While immediate-release melatonin eked-out insignificant reductions of 0.3 mmHg systolic and 0.2 mmHg diastolic, the controlled-release melatonin slashed systolic readings by an average 6.1 mmHg and diastolic readings by 3.5 mmHg.43
Melatonin’s effects are so substantial that the author of a recent study concluded that, “[S]upplementation of melatonin…has been shown to be efficient in…the control of hypertension and metabolic syndrome.”44
As an added benefit, melatonin has also been shown to protect various organs from long-term hypertension.45-47
Life Extension has long maintained that the blood-pressure readings called normal by national guidelines were in fact much too high, lulling millions of people into a false sense of security while they are experiencing body-wide dangers.
New official guidelines have finally validated Life Extension’s longstanding blood-pressure recommendations.
High blood pressure elevates the risk of disorders ranging from kidney disease to dementia because of the severe damage it does to blood vessels and the organs they serve.
A unique combination of five nutrients—quercetin, myricitrin, myricetin, stevioside, and melatonin—can work by multiple mechanisms to control blood pressure around the clock.
No one should ever assume a drug, supplement, or healthy lifestyle regimen is producing optimal blood pressure readings.
Use of an at-home blood-pressure monitor can enable people to better achieve 24-hour blood-pressure control.
If you have any questions on the scientific content of this article, please call a Life Extension® Wellness Specialist at 1-866-864-3027.
- Dyer O. New guideline will put 30 million more Americans in high BP group. BMJ. 2017;359:j5357.
- Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA 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. 2017.
- Available at: https://newsnetwork.mayoclinic.org/discussion/american-college-of-cardiology-and-american-heart-association-announce-new-blood-pressure-guidelines/. Accessed December 11, 2017.
- Verdecchia P, Schillaci G, Porcellati C. Dippers versus non-dippers. J Hypertens Suppl. 1991;9(8):S42-4.
- Cho NH, Kim KM, Choi SH, et al. High Blood Pressure and Its Association With Incident Diabetes Over 10 Years in the Korean Genome and Epidemiology Study (KoGES). Diabetes Care. 2015;38(7):1333-8.
- Long AN, Dagogo-Jack S. Comorbidities of diabetes and hypertension: mechanisms and approach to target organ protection. J Clin Hypertens (Greenwich). 2011;13(4):244-51.
- Schmieder RE. End organ damage in hypertension. Dtsch Arztebl Int. 2010;107(49):866-73.
- Available at: http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20045868. Accessed December 11, 2017.
- Gilsanz P, Mayeda ER, Glymour MM, et al. Female sex, early-onset hypertension, and risk of dementia. Neurology. 2017;89(18):1886-93.
- Elliott HL. 24-hour blood pressure control: its relevance to cardiovascular outcomes and the importance of long-acting antihypertensive drugs. J Hum Hypertens. 2004;18(8):539-43.
- Pierdomenico SD, Pierdomenico AM, Coccina F, et al. Circadian blood pressure changes and cardiovascular risk in elderly-treated hypertensive patients. Hypertens Res. 2016.
- Goyal SN, Bharti S, Bhatia J, et al. Telmisartan, a dual ARB/partial PPAR-gamma agonist, protects myocardium from ischaemic reperfusion injury in experimental diabetes. Diabetes Obes Metab. 2011;13(6):533-41.
- Iwai M, Inaba S, Tomono Y, et al. Attenuation of focal brain ischemia by telmisartan, an angiotensin II type 1 receptor blocker, in atherosclerotic apolipoprotein E-deficient mice. Hypertens Res. 2008;31(1):161-8.
- Iwanami J, Mogi M, Tsukuda K, et al. Low dose of telmisartan prevents ischemic brain damage with peroxisome proliferator-activated receptor-gamma activation in diabetic mice. J Hypertens. 2010;28(8):1730-7.
- Myojo M, Nagata D, Fujita D, et al. Telmisartan activates endothelial nitric oxide synthase via Ser1177 phosphorylation in vascular endothelial cells. PLoS One. 2014;9(5):e96948.
- Yuen CY, Wong WT, Tian XY, et al. Telmisartan inhibits vasoconstriction via PPARgamma-dependent expression and activation of endothelial nitric oxide synthase. Cardiovasc Res. 2011;90(1):122-9.
- Yusuf S, Teo K, Anderson C, et al. Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial. Lancet. 2008;372(9644):1174-83.
- Available at: https://meps.ahrq.gov/data_files/publications/st404/stat404.shtml. Accessed December 11, 2017.
- Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008;51(6):1403-19.
- Laskar MA, Choudhury MD. In silico screening of some plant based natural products as angiotensin receptor blockers against cardiovascular diseases. World Journal of Pharmacy and Pharmaceutical Science. 2015;4(1):1248-57.
- Taubman MB. Angiotensin II: a vasoactive hormone with ever-increasing biological roles. Circ Res. 2003;92(1):9-11.
- Hobbs CA, Swartz C, Maronpot R, et al. Genotoxicity evaluation of the flavonoid, myricitrin, and its aglycone, myricetin. Food Chem Toxicol. 2015;83:283-92.
- Ross JA, Kasum CM. Dietary flavonoids: bioavailability, metabolic effects, and safety. Annu Rev Nutr. 2002;22:19-34.
- Godse S, Mohan M, Kasture V, et al. Effect of myricetin on blood pressure and metabolic alterations in fructose hypertensive rats. Pharm Biol. 2010;48(5):494-8.
- Egert S, Bosy-Westphal A, Seiberl J, et al. Quercetin reduces systolic blood pressure and plasma oxidised low-density lipoprotein concentrations in overweight subjects with a high-cardiovascular disease risk phenotype: a double-blinded, placebo-controlled cross-over study. Br J Nutr. 2009;102(7):1065-74.
- Pfeuffer M, Auinger A, Bley U, et al. Effect of quercetin on traits of the metabolic syndrome, endothelial function and inflammation in men with different APOE isoforms. Nutr Metab Cardiovasc Dis. 2013;23(5):403-9.
- Brull V, Burak C, Stoffel-Wagner B, et al. Effects of a quercetin-rich onion skin extract on 24 h ambulatory blood pressure and endothelial function in overweight-to-obese patients with (pre-)hypertension: a randomised double-blinded placebo-controlled cross-over trial. Br J Nutr. 2015;114(8):1263-77.
- Edwards RL, Lyon T, Litwin SE, et al. Quercetin reduces blood pressure in hypertensive subjects. J Nutr. 2007;137(11):2405-11.
- Zahedi M, Ghiasvand R, Feizi A, et al. Does Quercetin Improve Cardiovascular Risk factors and Inflammatory Biomarkers in Women with Type 2 Diabetes: A Double-blind Randomized Controlled Clinical Trial. Int J Prev Med. 2013;4(7):777-85.
- Sales DS, Carmona F, de Azevedo BC, et al. Eugenia punicifolia (Kunth) DC. as an adjuvant treatment for type-2 diabetes mellitus: a non-controlled, pilot study. Phytother Res. 2014;28(12):1816-21.
- Liu JC, Kao PK, Chan P, et al. Mechanism of the antihypertensive effect of stevioside in anesthetized dogs. Pharmacology. 2003;67(1):14-20.
- Melis MS. Influence of calcium on the blood pressure and renal effects of stevioside. Braz J Med Biol Res. 1992;25(9):943-9.
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- Gardana C, Simonetti P, Canzi E, et al. Metabolism of stevioside and rebaudioside A from Stevia rebaudiana extracts by human microflora. J Agric Food Chem. 2003;51(22):6618-22.
- Soejarto DD, Kinghorn AD, Farnsworth NR. Potential sweetening agents of plant origin. III. Organoleptic evaluation of Stevia leaf herbarium samples for sweetness. J Nat Prod. 1982;45(5):590-99.
- Momtazi-Borojeni AA, Esmaeili SA, Abdollahi E, et al. A Review on the Pharmacology and Toxicology of Steviol Glycosides Extracted from Stevia rebaudiana. Curr Pharm Des. 2017;23(11):1616-22.
- Onakpoya IJ, Heneghan CJ. Effect of the natural sweetener, steviol glycoside, on cardiovascular risk factors: a systematic review and meta-analysis of randomised clinical trials. Eur J Prev Cardiol. 2015;22(12):1575-87.
- Pechanova O, Paulis L, Simko F. Peripheral and central effects of melatonin on blood pressure regulation. Int J Mol Sci. 2014;15(10):17920-37.
- Mutoh T, Shibata S, Korf HW, et al. Melatonin modulates the light-induced sympathoexcitation and vagal suppression with participation of the suprachiasmatic nucleus in mice. J Physiol. 2003;547(Pt 1):317-32.
- Baltatu OC, Amaral FG, Campos LA, et al. Melatonin, mitochondria and hypertension. Cell Mol Life Sci. 2017;74(21):3955-64.
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- Gomes Domingos AL, Hermsdorff HHM, Bressan J. Melatonin intake and potential chronobiological effects on human health. Crit Rev Food Sci Nutr. 2017:1-8.
- Cano Barquilla P, Pagano ES, Jimenez-Ortega V, et al. Melatonin normalizes clinical and biochemical parameters of mild inflammation in diet-induced metabolic syndrome in rats. J Pineal Res. 2014;57(3):280-90.
- Leibowitz A, Volkov A, Voloshin K, et al. Melatonin prevents kidney injury in a high salt diet-induced hypertension model by decreasing oxidative stress. J Pineal Res. 2016;60(1):48-54.
- Qiao YF, Guo WJ, Li L, et al. Melatonin attenuates hypertension-induced renal injury partially through inhibiting oxidative stress in rats. Mol Med Rep. 2016;13(1):21-6.