Review finds effectiveness for non-drug therapies in hypertension
A review published online on August 25, 2011 in the Journal of Clinical Hypertension concludes that lifestyle interventions such as the Dietary Approaches to Stop Hypertension (DASH) diet, as well as nutritional supplements including coenzyme Q10 (CoQ10) and potassium, are viable alternatives to drugs prescribed to help lower blood pressure.
"The treatment of hypertension is no longer limited to the simple prescription of pharmaceuticals," write Kevin J. Woolf, MD and John D. Bisognano, MD, PhD of the University of Rochester Medical Center in their introduction to the article. "For many patients, maximal medical therapy is insufficient to adequately treat refractory hypertension. In addition, some patients may prefer to explore therapies that do not involve drugs as an initial step."
Drs Woolf and Bisognano discuss the value of the low-sodium DASH diet, which provides greater amounts of fruit, vegetables and fiber and less fat than the average Western diet. Adherence to the DASH diet has been shown to lower systolic blood pressure by an average of 11.4 mmHg in hypertensive patients. This reduction is increased with the addition of weight loss counseling and an exercise program. Limiting smoking and alcohol consumption may also help reduce high blood pressure.
Possible antihypertensive dietary supplements mentioned in the review included potassium, calcium, vitamin D, folate, CoQ10, soy protein, flavonoids, fish oil and garlic. Dr Woolf noted that "Coenzyme Q10 has a pretty profound effect on blood pressure," an observation that reflects the findings of a recent meta-analysis.
Herbal supplements discussed included forskolin, mistletoe and hawthorn. The authors also described devices such as the implantable Rheos device, the Symplicity catheter, the RESPeRATE device and the Zona Plus dynamometer, all of which have resulted in a significant reduction in systolic pressure when used by hypertensive patients.
"Right now we're seeing a cultural shift where an increasing number of people want to avoid standard pharmaceuticals," noted Dr Bisognano, who is the director of Outpatient Cardiology at the University of Rochester Medical Center. "We're also seeing a growing number of patients who require a large number of drugs to control their blood pressure and are looking for something else to help manage it."
"Patients have different backgrounds and different approaches to living their lives," added Dr Woolf. "This is where the art of medicine comes in; getting to know patients and what they will and will not embrace can help physicians identify different therapies that suit their patients' habits and that will hopefully make a difference for them."
Blood pressure is a measurement of the force exerted upon blood vessel walls by blood as it flows through the arteries. High blood pressure occurs when there is an increase of force against the arterial wall, with potentially damaging consequences.
Since the heart has distinct "beats", the pressure of oxygenated blood in the arteries is not continuous, but varies between two values, one when the heart is contracting, and one when the heart is relaxing. As the heart contracts, blood is expelled from the left ventricle under the greatest force; this upper pressure limit is the systolic blood pressure.
Following contraction of the heart, the aortic valve closes, which prevents blood from flowing backward into the heart, and helps to maintain the pressure in the arteries. This allows the heart muscle to relax and fill with blood. Unlike all other organs, which receive blood flow when the heart "beats" or contracts, the heart itself is unique in that it receives blood supply between heartbeats. As the heart contracts to pump blood to the rest of the body, circulation to the heart itself is impeded. Blood pressure during the heart's "resting" period between contractions, called diastole, must be sufficient to deliver an adequate supply of oxygenated blood to cardiac tissue.
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/day 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/day) 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).
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