High Blood Pressure: Utilizing Complementary Medicine to Minimize Drug Dependency and Working Toward Treatment Without Drugs If Possible

Paul Reller, L.Ac.

An article in the New York Times Business section, November 27, 2008, illustrates the growing concern among physicians that we are prescribing too many pharmaceuticals unnecessarily to treat common conditions of risk, and thereby unnecessarily increasing the incidence of side effects and health risks from medications. The article cites the lack of impact of the Allhat study findings of 2002, funded by the National Institute of Health (NIH) and its National Heart, Lung and Blood Institute. Allhat, which stands for Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial, enrolled more than 42,000 patients over age 55 from 1994 to 2001, randomly assigning the various pharmaceutical choices for hypertension, diuretic (chlorthalidone), ACE inhibitor (lisinopril), calcium channel blocker (Norvasc), and alpha adrenergic blocker (doxazosin/Cardura). The findings showed that a simple diuretic alone outperformed all the other protocols, cost about 4 cents per day, and had much fewer side effects and health risks associated.

The chairman of the steering committee of this study, Dr. Curt D. Furberg, a public health sciences professor at Wake Forest University, is very dismayed at the lack of change in prescription of antihypertensives since this study was published. He states that he expected prescription of a simple diuretic protocol to more than double, but that six years later it rose only about 5%, and that prescription of more profitable medications has grown faster than the prescription of generic diuretics. Experts in public health point to a number of disturbing facts that have dampened expectations. The pharmaceuticals have, of course, paid for studies that criticized the government study, heavily promoted their more expensive drugs, and paid huge consulting fees to key members of the government steering committe that continues to oversee published analysis of the government's public health recommendations based on this study. These facts are outlined in the article, which is accessible by clicking on the address at the end of this article.

There is also some evidence that prescribing doctors are concerned about the research into long-term risks and side effects of anti-hypertensives, as well as the concern of patients that frequently research these drugs. Angiotensin receptor antagonists are increasingly prescribed to alleviate concerns about the side effects of chronic use of ACE inhibitors and beta-blockers. Unfortunately, a study in 2010 (reported in a New York Times article cited below) found that this class of drugs increases cancer risk by 11% and lung cancer risk by 25%. Over 11% of men taking beta-blockers complain of significant loss of libido, or sex drive, and a high percentage of patients taking ACE inhibitors are bothered by dry cough, dizziness and fatique. There is growing concern about the incidence of kidney impairment with ACE inhibitors as well, and the combination of ACE inhibitor with a diuretic, coupled with chronic NSAID use, has resulted in a high incidence of kidney impairment over time.

To alleviate concerns about chronic effects of angiotensin receptor antagonists and ACE inhibitors, a new class of drug was introduced in 2007 called a direct renin inhibitor. Experts were concerned that even when effective in controlling blood pressure, the ACE inhibitors and angiotensin receptor antagonists did not actually lower circulating renin levels, and that high renin levels due to adrenal stress syndrome could contribute to cardiovascular damage even when blood pressure was controlled. In fact, a concern is voiced by experts that chronic use of the ACE inhibitors and angiotensin receptor antagonists would stimulate increased renin production to counter the effects of the drugs. The direct renin inhibitor drug was approved by the FDA in 2007, but doubts about the efficacy of the drug were immediately voiced by Dr. John Laragh, editor of American Journal of Hypertension and his wife, Dr. Jean Sealey, a hypertension researcher at Cornell University. The concern was that this new drug was no more effective than prior drugs, and that its ability to lower blood pressure may be limited by reactive renin secretion as well (see a discussion below in additional information). Integrating treatment to treat the underlying health problems that stimulate excess renin secretion may be the most sensible approach to alleviating these concerns. This is where Complementary Medicine, especially acupuncture with Chinese herbal medicine, may play a significant role.

Individual patients are starting to question whether they could achieve better results with less medication, and turning to Complementary Medicine to help them in this endeavor. The primary goal of Complementary Medicine, and especially Traditional Chinese Medicine, in treatment of sustained high blood pressure, is not the immediate lowering of the blood pressure, but rather the elimination or correction of the underlying health problems that is the cause of a sustained high blood pressure, or hypertension, although a growing number of clinical studies are demonstrating the immediate effects of various herbal chemicals to reduce blood pressure as well. A growing number of Medical Doctors agree that this is a practical approach, and could be integrated into the standard treatment protocol without risk, potentially reducing the dependency on multiple drugs to control hypertension. Risk from hypertension occurs over long periods of time for almost all patients. Adjustment of the treatment protocol is thus safe, even with a transition period where blood pressure is less controlled, as long as this is monitored by your physician. To insure safety, the patient is encouraged to purchase a blood pressure monitoring device for home use, and this helps the patient to understand which parts of the Complementary protocol seem to work the best.

To offer the hypertension patients a more complete package of cardiovascular risk reduction, researchers have also shown that Chinese herbal formulas could improve the circadian hypertension profile, lowering night-time blood pressure, improve elasticity of major arteries, exert significant anti-inflammatory and antioxidant effects, improve lipid profiles, and reduce atherosclerotic plaque. A number of beneficial effects could be combined in a single Chinese herbal formula. While the blood pressure lowering effects of Chinese herbs may not be greater than pharmaceuticals, the overall benefits may address the underlying health concerns, and integrated with standard therapy, the potential for risk reduction is great. No clinical studies have shown actual negative drug interactions between these common Chinese antihypertensive formulas and standard phamaceuticals. As research progresses, more and more patients, and more and more medical doctors, are considering the integration of Chinese acupuncture and herbal medicine into the antihypertensive protocol.

Medical doctors are also alarmed at the statistics of the high percentage of patients that go off of the antihypertensive drug regimen against medical advice, and many medical doctors are thus open to trials of Complementary protocol and reduction in medication, as long as this is professionally monitored. A 2008 study at the Department of Family Medicine and Community Health, School of Medicine, University of Pennsylvania, found that Integrative Medicine was successful in achieving lower blood pressure and greater adherence to medication protocols in a study group of patients with both hypertension and clinical depression. Adherence to prescribed protocols increased from about 30% to 80% when an Integrated medical approach was utilized, and integrated interventions were recommended in future medical care. Part of this Integrative Medicine could involve the Licensed Acupuncturist and herbalist. When the patient takes a more proactive approach to their medical problems, greater success is sure to occur.

The National Heart, Lung, and Blood Institute of the National Institutes of Medicine (NIH) has conducted much research and recommended that patients with mild to moderate hypertension try to control their blood pressure without medication. The DASH dietary protocol (Dietary Approaches to Stop Hypertension) has been very successful in this regard. Much study has proven that a significant reduction in high blood pressure is achieved for most patients with a diet that is rich in fresh vegetables, whole grains, beans and legumes, and includes small daily portions of fresh fruit, nuts, seeds, and healthy dairy products. The DASH diet limits meat, poultry and fish to just one or two small portions per day, and restricts the consumption of sugar sweetended beverages and foods, as well as salty snacks and fast food. A variety of DASH books, with menus and recipes, have been created, and the NIH study found that adherence to this plan produced an average reduction in systolic blood pressure of 6 mm Hg, and diastolic of 3 mm Hg in normal patients, and 11 mm Hg systolic and 6 mm Hg diastolic in patients with moderate to severe hypertension. Other studies have demonstrated similar benefits from daily short aerobic excercise routines. With the addition of Complementary Medicine into this protocol, a great number of patients are finding success in controlling hypertension and creating better overall health and reducing future health problems and health risks. These types of studies and protocols show that experts in the field, and the most respected health organizations find that it is important to try to control high blood pressure without chronic dependency on medications that have been proven to be less effective that we need them to be, and come with considerable long term side effects and risks themselves.

Treating both consistently sustained high blood pressure and the underlying causes and individualized risk factors of cardiovascular disease is important. Complementary and Integrative Medicine provides many treatment tools to help achieve these goals in the healthiest manner possible. Standard drug medications to control high blood pressure do nothing to resolve the underlying health problems that caused the hypertension. Ignoring these underlying health problems may be the reason that yearly deaths from cardiovascular disease remain high, and why the number of deaths from heart failure have remained constant from their peak in 1993 to today, despite the large rise in the prescription of anti-hyptertensive drugs.

Understanding high blood pressure and hypertension

Hypertension is defined as blood pressure that is consistently elevated above what is considered an increased risk for an individual patient, or type of patient, over a considerable length of time. There is disagreement on the exact number for the definition of high blood pressure, but recent studies have set the figure at 140/90 mm Hg for patients that present with a 10-year risk of cardiovascular disease that is 20% or higher. For patients without significant cardiovascular risk assessment, the safe sustained blood pressure is higher than 140/90. Some considerations of adjustment of this standard apply to common variations in blood pressure for different age groups, as blood pressure is generally lower in the teenager, and higher in the aging patient population, which should be taken into consideration. The key to a diagnosis of hypertension is not whether the blood pressure is high at one moment or moments, but whether it is consistently higher than what is acceptable for each individual in relation to their degree of cardiovascular risk. If your medical doctor does not determine that your blood pressure is consistently high outside of the doctor's office, and does not make a thoughtful analysis of your cardiovascular risk, he or she is not doing their job. Prescription of hypertension medications should follow logical diagnostic guidelines and be individually tailored to the patient. Thoughtful patients are starting to question this process, understand their medications, and seek both the right course of drug protocol for themselves, as well as a therapeutic protocol to correct the underlying health problems that have led to the consistently sustained high blood pressure. Patients that are determined by analysis to be at risk are also looking for ways to reduce risk. This is where Complementary Medicine comes into play.

Because of the failures of standard drug medication protocols to significantly reduce incidence of cardiovascular accidents or to reduce the deaths from heart failure, cardiologists have adopted an attitude that even mild hypertension may need to be heavily medicated to improve overall statistics. The research concerning the use of a multidrug protocol for patients with mild hypertension and no significant risk of cardiovascular disease, though, does not produce clear evidence that this drug protocol delivers significant benefits. The significant long-term side effects and risks from these medications has become a cause of concern in public health. The actual risk versus benefit assessment perhaps is being ignored in a desperate attempt to improve the statistical benefits from current medical protocol. The National Heart Lung and Blood Institute of the NIH states that a 2003-2006 national survey showed only about 45 percent of hypertensive patients (BP greater than 140/90 or on antihypertensive medications) had their condition under control. This has resulted in a push to medicate patients with lower blood pressures to achieve statistical goals, but has still not resulted in a significant drive to integrate Complementary Medicine into standard treatment protocol, despite the evidence of benefit.

By 2010, standard guidelines often indicated that an optimal blood pressure included a systolic pressure no greater than 120. There is now a prevalent question of whether medication risks and side effects are enough to warrant this treatment to achieve an optimal blood pressure. Systolic blood pressure (the top number in the standard ratio) is the pressure that your heart is pumping at any given moment. The diastolic pressure is the pressure in the arteries at rest. Systolic pressure can vary considerably depending on the amount of stimulation, including anxiety, illness, and activity. A study summary in 2010 of a large group of patients from a 2003-6 survey of adults with no prior history of hypertension (cited below), showed that a daily dose of high-fructose corn syrup almost doubled the risk of sustained systolic pressure over 160, so even diet may cause a higher systolic pressure. A large percentage of patients have an elevated systolic blood pressure whenever they are in a doctor's office (white coat syndrome). Studies have shown that 40-50% of patients had elevated blood pressure when in the doctor's office, but not at home. In addition, the prevalent use of a blood pressure cuff that is too small will show an elevated systolic pressure that is not accurate, and taking the pressure on the left arm (nearer the heart) will also likely result in a higher blood pressure for some patients. One study showed that 96% of primary care physicians habitually use a cuff size too small (Pickering T, 1994, Lancet 334(8914). In addition, primary physicians often choose the left arm. It is also well known from decades of study that systolic pressure is expected to be higher in the aging population. All of these considerations create a situation in which most patients as they age could be considered for anti-hyptertensive drugs, and most of these patients may not have true hypertension, much less a cardiovascular risk profile.

For some patients, the risks and side effects of medication are not a consideration when trying to control blood pressure, even when the sustained blood pressure is borderline or varies, and even when there is a low risk assessment for cardiovascular events. For an increasing percentage of patients, though, there is a desire to avoid these medication risks and side effects when possible by adopting a more conservative medical approach. It is highly recommended that the patient with a diagnosis of hypertension purchase a quality blood pressure monitor and make a record of the daily blood pressure when relaxed at home. In the past, the diastolic blood pressure was considered the primary indicator of cardiovascular risk when sustained consistently for at least 6 months in a patient with indicators of high risk. The emergent popularity of the prescription of beta-blockers and calcium channel blockers, which control spiking of systolic blood pressure, is considered a primary reason why these new standards that focus on systolic pressure are frequently discussed. A realistic assessment of risk, accurate record of blood pressure variance, and elimination of potential causes of high blood pressure before starting medication, are all essential components of a healthy approach to this problem of cardiovascular risk. When one starts medication to control blood pressure, adoption of a thorough and holistic approach to correcting the underlying causes of hypertension, and working to reduce cardiovascular risk, are ways to insure that greater protection from strokes and heart attacks in the future is achieved. In addition, Complementary Medicine can help protect the patient from the side effects and risks of the medications, and with sufficient improvement in health, the patient and their prescribing physician may decide to see if less medication can achieve sufficient results.

The American Society of Hypertension (ASH) recommended in 2005 that overall risk assessment is very important in diagnosis and treatment protocol. If you are prescribed hypertensive medication without evidence of sustained high blood pressure meeting the above criteria (repeated measurement at the clinic and at home over several months), and are prescribed medication without a thorough risk assessment, these experts agree that your doctor is not doing his or her job. These risk factors include age, gender, high-density lipoprotein cholesterol count (HDL), history of smoking, diabetes, level of C-reactive protein (CRP), laboratory analysis of proteinuria and hyperuricemia, as well as glutathione metabolism (and circulating homocysteine levels). In evaluating age as a risk factor, it is important to note that blood pressure is normally higher in the aging population, and age alone does not present significant risk. Other important risk factors to consider include evidence of atherosclerosis, history of transitory ischemic attacks, and evidence of genetic predisposition. Any or all of these risk factors can be treated with a holistic approach. The patient may take blood pressure medications while treating these risk factors, and when sufficient progress is made, try going off of the blood pressure medications while monitored by the prescribing physician. Since the standard medication protocol does not address underlying health problems and dysfunctions, addition of Complementary protocols to address these concerns is sensible, and may eventually reverse the progression of cardiovascular disease. Since rebound effects may happen with some of these medications, decreasing dosage slowly is often recommended.

Often the Complementary Medicine protocol will address individual risk factors with individually tailored treatment, thus helping to control high blood pressure indirectly as well as directly. The degree of knowledge of the Complementary and Integrative Medicine physician, such as the Licensed Acupuncturist and herbalist, is very important in designing the right individual protocol. There may be a significant difference in approach between one Licensed Acupuncturist and another, and the individual patient may try another practitioner if results are not as good as expected, or if individual risk factors are not sufficiently addressed. Family history of cardiovascular disease and a personal history of stroke, heart attack or atherosclerosis, are important risk factors, as well as Kidney disease, and certain medications may also increase your risk of cardiovascular disease significantly, as well as a history of diabetes or metabolic syndrome. Hormonal changes, such as menopause may pose a significant risk of cardiovascular disease and hypertension. We have found that most types of essential hypertension are not directly inherited, but have a multifactorial cause, although genetic propensity is a significant and complicated factor in your assessment. When you work with your Complementary Medicine physician, such as a Licensed Acupuncturista and herbalist, it is important that you bring knowledge of your individual cardiovascular risk to the physician so that treatment and preventitive medicine can be applied more efficiently. There is no one-size-fits-all approach to hypertension and the underlying causes.

Evidence-based protocols in the treatment of Hypertension

Published clinical studies are now widely available via the internet and national and international databases of published research. This type of research evidence has helped Licensed Acupuncturists and herbalists immensely in choosing the most effective protocols. Both the centuries of empirical documentation of treatment protocols and modern research are useful to the modern acupuncturist and herbalist. In the realm of high blood pressure, a subject that was not addressed until the invention of simple modern devices to measure and monitor blood pressure, the evidence-based protocols are very important. Research is demonstrating, though, that a number of classic protocols in Traditional Chinese Medicine are proving to be very effective with modern research. Besides acupuncture, the array of therapies traditionally used, such as breathing techniques, dietary strategies, cognitive stress reduction, herbal medicines, and neuromuscular retraining, are all proving to be effective in scientific study. The most amazing studies of acupuncture have been conducted at the University of California, Irvine campus, throught the Susan-Samueli Center for Integrative Medicine. Here, the research initiated by the inventor of the PET scan and fMRI has recorded the amazing affects of specific acupuncture stimulation on the brain and central nervous system, and revealed how acupuncture stimulates a neurohormonal cascade of physiological events that improves hypothalamic function, visceral reflexes, improved regulation of the autonomic nervous system, and modulation of a number of chemicals that are key to blood pressure homeostasis. Acupuncture in these studies improved levels of glutamate, acetylcholine, endogenous opioids (endorphins and dynorphins), neurotransmitters such as serotonin and GABA, nociceptin, and endocannabinoids, all of which contribute to improved cardiovascular function. A summary of these studies is available in information resources below with a link to the NIH database. Other studies at the University of California, and in China and South Korea, have measured local vascular chemical changes with acupuncture stimulation that also improve cardiovascular function and correct dysfunctions. Such study not only confirms the efficacy of acupuncture in the overall treatment strategy, but helps modern evidence-based practitioners choose the right acupuncture points and modes of stimulation.

Studies at the Mayo Clinic confirmed that one of the most effective ways to reduce blood pressure involves a simple breathing exercise. Expensive monitors are now marketed to help the patient practice this technique, but for the same amount of money as this expensive monitor, you can combine a number of therapeutic techniques into a complete package of therapy that will not only lower your blood pressure but also benefit clogged arteries, help your body function better, improve your cholesterol metabolism, help regulate inflammation and calm the nervous system. A TCM protocol with a Licensed Acupuncturist can deliver a package of care that incorporates specific evidence-based protocols into this package of care. In this article, we see evidence that dietary changes reduce blood pressure, excercise routines reduce blood pressure, simple diaphragmatic breathing exercises reduce blood pressure, acupuncture protocols reduce blood pressure, and herbal/nutrient therapies reduce blood pressure. The key in holistic medicine is to find an individually tailored protocol that works, restores health, and does not require chronic dependence on therapy.

TCM practitioners have long utilized slow diaphragmatic breathing with soothing acupuncture sessions to lower the blood pressure. TCM physicians with knowledge of the slow diaphragmatic breathing protocol researched at the Mayo Clinic can help train the patient in this technique. Combining this therapy with the latest findings in nutritherapies and herbal medicine, and sound advice on what you can do with your diet to prevent stroke and heart attacks gives a complete package of care that will result in a greater chance of sustaining a healthy blood pressure for the rest of your life without constant treatment. University of California researchers have recently found that low frequency electrical stimulation at certain acupuncture points can consistently reduce blood pressure and benefit the cardiovascular system. Research proves that these acupuncture protocols produce both a repeated temporary reduction in blood pressure and improvement in the underlying health dysfunction. Multiple goals are achieved in therapy, as well as a neuromuscular retraining that allows the patient to restore a healthy control of blood pressure. So we see that there is evidence, supported by standard research, that acupuncture and various modalities under the scope of the acupuncture license can reduce blood pressure directly. What is more important, though, is a complete treatment protocol to target the underlying causes of the sustained high blood pressure, and achieve a number of simultaneous treatment goals.

In recent years more and more randomized clinical trials have been conducted to show the efficacy of acupuncture in sustaining lowered blood pressure. Some of these studies are cited below with links to study summaries in information resources. A discussion of the problems of study design with acupuncture is also included below to elucidate this subject for the patient.

"A course of 2 sessions per week of acupuncture with training in the correct breathing technique for 4 weeks, combined with nutritional supplements, herbal formulas and dietary/lifestyle advice may work wonders in achieving sustained normalization of blood pressure with less dependency on chronic drug therapies."

Scientific study has shown that there are a number of causes of hypertension and a correct diagnosis is needed to effectively cure this symptom of imbalance in the body. Sustained stress inducing the angiotensin enzyme in the kidney/adrenal system is the most common cause, but atherosclerosis, poor venous return, vascular inflammation, hormone medications, chronic decongestant use, and excess consumption of alcohol or stimulants have also been found to cause hypertension. Most cases have no single cause and develop slowly, with imbalance of the sympathetic nervous system stimulating the sustained high pressure. Because of the multifactorial underlying cause of almost all cases of hypertension, a comprehensive and holistic treatment regimen is necessary to actually address these underlying causes and effect a cure.

Oxidative stress is perhaps the most important type of physiological stress inducing hypertension. Oxidative stress is integral to atherosclerotic plaque, hardening of arteries, degeneration of organ tissues, and poor function of the regulatory centers in the brain, as well as poor liver function. One example of oxidative stress that creates hypertension is accumulation of lead toxin. Lead pollution has been highly studied for many years in the United States. The Environmental Protection Agency has studied lead pollutants since the 1960s, and the harms to public health. Most lead toxins are carbon and lead molecules in the air that wind up in our waters, and subsequently in our food. While lead-based paints are highly publicized as a lead threat, these lead based chemicals are difficult to digest and unlikely to incorporate into your body. On the other hand, since we are carbon based life forms, lead carbon molecules, most of which are created by burning carbon fuels that contain lead, such as coal, are now ubiquitous in our air, water and food. You might go to the article on lead and mercury pollution on this website to read the EPA reports.

Scientific study has long identified hypertension as a direct public health threat from lead pollution. Chronic exposure to low levels of lead (not just the single episodes of ingesting lead paint particles or eating tuna), which occurs for most of the population due to poorly regulated coal firing power plants and smelters, causes sustained arterial hypertension that persists indefinately even after the cessation of lead exposure in humans, and in experimental animals studied. You can go to a link below, in additional information, to see a comprehensive report on this subject from the University of California at Irvine. There are ways to help your body reduce the accumulated lead toxicity, and other heavy metal toxicties as well, with safe and effective chelation methods, herbs and nutrional medicine. Complementary Medicine has made great strides in this treatment protocol, and a professional Complementary Medicine physician can help guide you through a periodic chelation and detoxification protocol.

The Pathophysiology of Hypertension

Almost all cases of hypertension fall under the category of idiopathic primary hypertension. Hypertension caused by another health problem, or secondary to another disease, indicates that the primary disease should be treated to cure the secondary hypertension. The term idiopathic means that the cause is unknown. To construct a treatment protocol that addresses the underlying health problems, though, requires us to look at the potential physiological causes of hypertension, and to work on these health problems, preferrably in an integrative manner, utilizing a complete package of care. Complementary Medicine offers various treatment modalities that are safe and without side effects. The first step is to make sure that your M.D. discusses what type of hypertension you have, and clarifies what is known about your individual underlying pathology.

One of the most respected experts on pathophysiology is Dr. Arthur C. Guyton. Dr. Guyton finds that the role of altered sodium excretion by the kidney, which is largely controlled by the endocrine system and hypothalamus/pituitary regulation, and also by the renin/aldosterone response, which is tied to adrenal hormonal responses, is the central mechanism in the development of hypertension. When the body struggles to maintain a sodium and water homeostasis, the body ultimately develops responses that increase the blood pressure to compensate. Several factors may affect the health of the kidney and ultimately create injury of the renal tubules and epithelium. These include sympathetic nervous overstimulation, or autonomic imbalance, toxins, and the effects of aging. In more recent study, the role of insulin resistance and metabolic syndrome, with fluctuating excess of the insulin hormone, has been found to lead to increased sympathetic autonomic nerve response and subsequent high blood pressure. This is also associated with sleep apnea, often the result of excess tissue growth in the airway due to metabolic syndrome, causing airway obstruction. This too may result in sympathetic overstimulation and chronic activation of the renin angiotensin response. Although we have these various pathophysiological explanations, there is still no clear single explanation for most cases of hypertension, only a multifactorial presentation involving these various systems.

The more proactive and intelligent patient understands that to correct this pathology of hypertension, that restoration of a healthy homeostatic function needs to be achieved. This requires some work to reduce physiological stress, improve kidney and liver health and function, achieve a balance hormonal response, and possibly correct metabolic disorder and insulin resistance. While each individual presents with a unique set of these problems, for some, the taks might seem complicated. The good news is that by working on these various underlying problems, general health and well being will be restored as the blood pressure is normalized. For most patients, hypertension is still in a mild stage, and for most, there is no history of cardiovascular risk. These patients may be diagnosed with hypertension, but have no immediate threat to the health from mild high blood pressure. There is usually time to resolve the underlying health problems before going on a harsh medication protocol. For those on medication, correction of the uderlying problems and restoration of health will lead to the ability to reduce or eliminate these medications. Your cardiologist will agree that this is the most desirable outcome.

Antioxidants and the importance of oxidative stress in Hypertension

Oxidative stress is a term used to describe chronic physiological degeneration of tissues from free radical damage. Excess oxidants are created when the body has to work too hard to maintain healthy tissues and cells, and when the body does not produce enough antioxdiant chemicals, tissue degeneration occurs. Oxidative stress can injure the arteries, heart muscle, liver cells, kidney cells, and brain tissues and cells, and all of these can contribute to hypertension. The main problem with keeping up with oxidative stress in the body, is that these free radical oxidants are created when the body tries to repair tissues and cells, such as with inflammatory mechanisms. This is why many of us need outside help to boost antioxidant activity to effectively repair damaged or degnerated tissues and cells and correct underlying causes of Hypertension. The subject of antioxidant therapy is complex, and the number of antioxidants utilized by our bodies is fairly large. You may go to a separate article on this website to better understand the complexities and choices in antioxidant therapy.

The failures of standardized treatment and the need for an integrative and more comprehensive approach to treatment of Hypertension

The reason that hypertension drugs are prescribed in combinations is that studies have shown very limited effectiveness with any one type. There are 4 basic types of drugs administered to decrease blood pressure: 1) diuretics to decrease the fluid pressure in the arteries, 2) angiotensin converting enzyme inhibitors (ACE inhibitors) to block nervous constriction of the arteries, and 3) beta-adrenergic blockers to prevent the heart from pumping with too much pressure. Calcium antagonists (4) are sometimes prescribed also to prevent the heart muscle from being able to pump with too much pressure. Three other categories have been introduced in an attempt to provide drugs with less drastic side effects. These include angiotensin receptor antagonists, with the advantage over ACE inhibitors, which do not block angiotensin II nonclassical pathways. These drugs purportedly reduce the high incidence of sexual dysfunction seen with chronic use of antihypertensive medications.

One could surmise that with all of the evidence showing limited effectiveness of any one type of hypertension medication, the large percentage of noncompliance, and the SHARP study, finding that diruetic alone is as effective as any combination, that there would be some disappointment in the pharmacological treatment protocol. There is, and a growing number of physicians in Europe are utilizing Complementary Medicine as part of their practice. Medical doctors in the United States are slower to integrate Complementary Medicine into their practice, but a growing number of medical doctors are studying this field of scientific research, and often looking for integration with Complementary Medicine physicians, such as Licensed Acupuncturists, to expand treatment options in a patient-centered practice.

All of these hypertension drugs have side effects that may decrease the quality of life, and some present quite a financial burden to patients. Beta blockers and diuretics are frequently prescribed together in recent years, and research shows a significant increase in risk of new onset diabetes with chronic use, as well as a link to increased inflammation, cardiovascular disease and asthma (see study cited below). Modern research has found herbal and supplement alternatives without side effects that perform these same effects in the body. These herbal and nutrient chemicals may not be quite as effective as their pharmaceutical counterparts, but inclusion in a healthy comprehensive protocol may achieve the same results without side effects and long-term adverse effects on overall health.

So we see from the mounting research that herbal medicines, nutritional therapy, and acupuncture can achieve many of the goals of standard pharmaceutical with less drug risk and side effects over time. In addition to this, these therapies offer means to also correct the underlying health problems, which is a big part of holistic therapy in relation to hypertension. Added to this is advice to the patient, based on both modern research and a long history of empirical knowledge, related to changes in diet and lifestyle, that could be very important to correct underlying causes of hypertension and achieve a healthier life.

When a complete package of care and lifestyle changes is adopted, future success with less medication, or without medications, is very successful for almost all patients. By going through a course of treatments, the patient is able to learn the simple routines that will keep the blood pressure at a healthy level.

Your M.D. will often advise patients to first try diet and lifestyle changes before starting a lifelong dependency on pharmaceutical antihypertensives. The problem is the lack of professional guidance and thorough treatment protocol tailored to the individual patient in these circumstances, and so the patient will often fail to achieve desired results. By utilizing a Complementary Physician to guide your conservative therapeutic protocol, your chances of success are multiplied greatly.

Treatment protocol in Complementary and Integrative Medicine

When considering treatment protocol for hypertension with acupuncture, herbs, nutrient medicines, and therapeutic changes in lifestyle and diet, the patient does not have to give up standard pharmaceutical therapy. The goal of this approach should be to improve health, address underlying causes of hypertension, and work with the prescribing M.D. to see if lowered blood pressure can be sustained without pharmaceutical dependence. For most patients, adjustment off of pharmaceutical therapy for a short period of time should present no immediate threat to health. Monitoring blood pressure at home is advisable. Fluctuations in blood pressure are common, even for the healthy patient without hypertension, and the patient needs to work toward a goal of reasonably sustained normal blood pressure for his or her individual physiology. Of course, proper risk assessment is very important in determining what is acceptable levels for blood pressure. It must be kept in mind that single spikes in blood pressure that return to normal do not pose a significant threat to health in all but the most extreme cases.

Some of the herbal and nutrient therapies available in therapy are listed here as an example. Individual herbs and formulas are well studied and are specific for correcting the individual problem. Unlike pharmaceuticals, the herbs and nutrient medicines work to resolve the cause of high blood pressure, and do not force the reduction of blood pressure, so that the herbal and nutrient therapy does not need to be taken forever like the pharmaceutical. While this approach may be more complicated for a short while product-wise, it is a temporary treatment that should produce long-lasting effects, and is also relatively inexpensive. Since mild herbs and nutrients that are studied and found to be helpful often do not have a dramatic potential by themselves, a combination of herbs and nutrients is the answer in therapy, and this course of therapy should be administered and prescribed by a professional to suit the individual in treatment. The list below represents just some of the evidence-based therapies available in clinic:

1. Sea Ace: peptides from the bonito fish have been proven to work exactly like ACE inhibitors, but need to be taken for a few months to achieve effect. A comprehensive package of care could correct underlying mechanisms of cause of hypertension and the patient should be able to avoid the need to take this supplement in time.
2. EPAQ: krill oil is a potent source of beneficial essential fatty acids to prevent stroke and heart attack and regulate inflammation. Improved cardiovascular maintenance helps to normalize blood pressure indirectly.
3. Astra Garlic formula: aged garlic extract and other Chinese herbs are very effective in reducing atherosclerotic plaque and benefiting arterial health; a professional herbal formula from Health Concerns insures quality and effectiveness; see below for examples of scientific verification of benefits in reduction of atherosclerotic plaque with herbs. The University of Maryland Medical Center and other websites now cite numerous studies of the cardiovascular benefits of aged garlic (a fermented herb); to access click here: http://www.umm.edu/altmed/articles/garlic-000245.htm:
4. CoEnzyme Q10: a potent antioxidant useful to benefit heart and vascular tissues; expensive but one only needs to use this for a short time. Once again, a combination of direct treatment of high blood pressure and indirect care with cardiovascular maintenance works to achieve normal blood pressure without dependency on drugs, herbs or supplements in the future. A combination of CoQ10, B2 riboflavin, and magnesium is now available from Vitamin Research (Flavitrex or NeuroFlavin).
5. riboflavin Vitamin B2, and magnesium supplement have shown mild but significant benefit in study. According to the National Health and Nutrition Examination Survey (NHANES) over 65% of the population 19 years old and over has inadequate intake of magnesium. A study published in the American Journal of Hypertension, 2009, July 16, online, concluded that ’This study suggests that oral magnesium supplementation is associated with a small but consistent ambulatory blood pressure reduction in patients with mild hypertension.‘ Small reductions were consistently noted in the study population in both systolic and diastolic pressure, both day and night. Other nutrient supplements may be helpful and should be prescribed as needed for the individual. There are no miracle cures or wonder pills. Often the various nutrient medicines and key herbs are combined in nutrient formulas for convenience. Magnesium is a key ingredient in a number of Chinese herbs, as well, such as oyster shell extract, and other mineral herbs, which are often found in Chinese herbal formulas designed for heart health and lowering blood pressure. Studies in China have noted increases in blood magnesium levels as a result of acupuncture stimulation as well.
6. Lower BP: a formula of Chinese herbs used in hospitals for HTN is formulated in Dr. Kang's Formulas, a quality professional source. These herbs have little immediate effect, but have proven long-term sustained effects, and address common underlying causes of hypertension. The herb Luo bu ma, or Apocynum venetum, is now well studied for its beneficial effects to lower blood pressure and reduce atherosclerosis, and is included in this formula.

Other Chinese formulas are useful to target specific health problems, such as cholesterol imbalance, nervousness, or problems with kidney diuresis or liver metabolism. Identification of the type of hyptertension, and possible underlying causes helps guide therapy with Traditional Chinese Medicine (TCM) and other Complementary and Integrative medical specialties. It is important to discuss these health problems with a cardiologist when diagnosed. Overall health is very important in control of blood pressure, as most cases are primary idiopathic hyptertension with a multifactorial cause. Since most cases of hypertension are considered mild to moderate, and occur in patients with little cardiovascular risk, the success of dietary and general health protocols have been very successful in controlling hypertension in many clinical trials, such as the DASH protocol, created by the U.S. National Institutes of Health (NIH) to help lower blood pressure without medication. TCM, with its various treatment modalities and wealth of patient advice, is an ideal form of medicine to improve overall health and achieve this NIH goal of controlling blood pressure without medication.

Specific herbs shown in studies to treat high blood pressure may also be combined for a short course of herbal therapy utilizing raw herbs or alcohol tinctures. The effects of specific herbs to effect vasodilation, modulate adrenergic stimulation or inhibit calcium influx, diurese, and improve autonomic nervous system balance are well documented, but often dose dependant. This type of treatment provides a stronger effect and more tailored treatment to the individual condition.

Prescription of nutrient supplement combinations to achieve specific results may also be effective in the overall treatment plan. This type of naturopathic approach is somewhat complicated in scope and best left to the professional to prescribe and guide therapy. Each individual may need different nutrient supplements to achieve different goals, and a professional evaluation and assessment helps guide the most effective individualized protocol.

Much research has demonstrated the abilities of specific herbal chemicals to achieve the same goals of therapy seen with pharmaceutical medications, and with no significant side effects or risks. These herbal medicines may be used to enhance current pharmaceutical therapy, or to replace or reduce it. Of course, this ideally requires that cardiologists are willing to objectively discuss integration of Complementary Medicine into the protocol. Unfortunately, this is slow to develop in the United States. In the European Union, which has mandated coverage for Complementary Medicine, this type of integration of health professionals and complementary therapies is now common, and many evidence-based herbal and nutrient medicines are now included in standard treatment guidelines.

Feel free to schedule a short consultation for free if you are interested in this type of integrative therapy and are unsure of how it will work with you.

Scientific studies revealing the efficacy of Chinese herbal chemistry in achieving the same or similar effects of standard pharmaceutical hypertensive medications

The number of sound scientific studies regarding the specific effects of Chinese herbs is now very large. This article attempts to present a small sampling of this research to assure the reader that the use of Chinese herbs in treatment of hypertension is evidence-based and sound. Due to the lack of funding, as well as the long process of step-by-step studies utilized with pharmaceuticals, many studies of Chinese herbal chemicals are still in the early stages of demonstrating specific beneficial effects in vivo with laboratory animals. Chinese herbs may be studied first with their history of clinical benefits, often stretching back centuries, then isolation of the most active chemicals in the plant, proceeding to studies in laboratory animals, then effects in humans, and lastly double-blinded placebo-controlled large clinical trials with actual patient populations. Of course, these controlled trials require funding, volunteers, and are difficult to design with placebo comparison. As the public increases their awareness of the safety and efficacy of integrating professional herbal medicine into their antihypertensive protocol, and support this medical practice, more and more of these final stage clinical trials will be performed.

1. A 2008 study at the Chinese University of Hong Kong found that a chemical in the Chinese herb Dan shen (Salvia miltiorrhiza), cryptotanshinone, exerted significant vasodilation effects on coronary arteries via inhibition of calcium channel influx, much like some standard pharmaceutical antihypertensives. The degree of specificity of research findings is apparent in this study summary: http://www.ncbi.nlm.nih.gov/pubmed/17961542
2. A 2006 study at the Chinese University of Hong Kong found that chemicals in the Chinese herb Dan shen (Salvia miltiorrhiza) also benefitted the relief of pain in the knee, and improved resolution of chronic knee arthroses, via vasorelaxant effects in knee joints. The study found that low dosage of dan shen extract significantly benefitted the knee pathology and repair without affecting blood pressure, but that a higher dosage of dan shen extract also lowered high blood pressure. Such research guides the dosage and formulation of professional Chinese herbal medicines: http://www.ncbi.nlm.nih.gov/pubmed/16266795

Scientific study of acupuncture and hyptertension therapy: the pitfalls and manipulation of current scientific study of manual medicines:

A more thorough review of the problems with acupuncture research is available elsewhere on this website, in the For Professionals, Research section, but a quick overview of current research and what it really reveals is presented here.

Scientific clinical study at this point in time was created to insure the safety and effectiveness of pharmaceutical drugs to protect the public. Applying this type of research, the double-blinded placebo study model, to manual medicine and acupuncture has presented quite a challenge, and has left the field of research, which is dominated by the big money of big pharmaceutical companies, open to manipulation of study findings. The field of acupuncture was challenged to prove that it worked about 30 years ago, so that governments could consider legally mandating its insurance and governmental coverage. By 1997, the NIH and WHO completed its meta-analysis of the accumulated study date by panels of medical doctors and researchers, and found that acupuncture was indeed proven effective for a wide variety of health problems, despite very low funding for research. The panels found that manual medicine is not proven effective in double-blind placebo studies in general, because of the difficulty of designing placebos for manual medicine, and because blinding the physician to the manual medicine presents quite the challenge. Nevertheless, small acupuncuture studies did strive to meet these almost ridiculous requirements. The large amount of scientific study from Asian countries, who largely rejected the double-blind placebo format as unrealistic, was rejected by the Western medical journals as unscientific.

When we look at current double-blind placebo studies of acupuncture, we find two remarkable aspects of these studies. One, the acupuncture treatments, which are very limited in scope in order to insure uniformity, almost always show significant benefit; and two, the acupuncture treatment selected, which is very limited in scope, is compared to a sham acupuncture manipulation, or to alternate so-called placebo acupuncture stimulation with real needles, which also shows significant benefit, albeit at a lower degree of measurable effectiveness. This latter method has been demanded by medical organizations to insure objective comparison to placebo in a study in which the treatment method is blinded to the administrator of the treatment. Of course, the only way to really insure that this method is utilized is to arbitrarily choose acupuncture points close to the actual points studied, so that the physicians performing acupuncture do not realize which are the studied points, and which are the points chosen as sham acupuncture. The problem here is that TCM literature has long concluded from observation, that stimulating a point close to the optimal location of the recommended point in the body will produce similar results, although not as effective as acupuncture at a more exact trigger point, and utilizing optimal technique of needle manipulation.

A case in point is the SHARP study of 2006 on acupuncture and high blood pressure. In this relatively large double-blinded placebo study, the results showed that 96% of the 188 participants, who received 12 treatments of a limited scope, meaning that the treatments were not individually tailored to the patient, but uniform in use of generalized point selection of 10 acupuncture points or less, showed a sustained decrease in diastolic blood pressure in follow-up at 10 weeks, of between 3.31 to 5.33 points. This was in a study population that had been weaned off hypertension medications and had shown that their diastolic blood pressure did not exceed 105 during the study period. We can see that a decrease of 4 points is very significant in this group. The so-called placebo acupuncture stimulation at points close to the studied points, showed a sustained decrease in diastolic blood pressure of 1.82 to 3.80 points. The conclusion of the researchers in the published summary of the trial was that this proved that acupuncture did not work. The intelligent patient may look at these same findings and observe that the acupuncture of limited scope of efficacy worked pretty well for almost 100% of patients, and thus choose for themselves to try incorporating a real acupuncture course into a total protocol of treatment that utilizes not only acupuncture, but herbal medicine, nutrient supplement prescription, dietary and lifestyle changes, and breathing techniques, to achieve a healthy and risk free sustained lowering of their blood pressure.

The study authors of the SHARP study concluded that there were significant problems in evaluating results in such a trial. They stated that the overall treatment environment normally utilized by acupuncturists was not allowed in the study design, and that the acupuncture stimulation at so-called placebo points was actually along lines considered off the normal meridians, and could not be themselves evaluated for efficacy. The authors also stated that the use of separate diagnosing and treating acupuncturists also presented a problem in effective treatment, which is usually tailored to the individual in TCM, and which relies on the treatment techniques of needling to be guided by the diagnostic considerations at each treatment. The choice of acupuncture points was limited to a selection from 10 points, but 10% of study participants received needling at 0-2 points, and 55% of study participants received needling at 6 of these points or less. The authors acknowledged that the results were much less than previous study and much less than reported effects measured in actual clinical settings. Even with these problems of study design acknowledged, though, the study summary merely stated that the trial did not definitively proove statistically significant benefit of acupuncture over placebo. When reading the summary, the implication is that the acupuncture protocol did not work. This was not really the case.

A prior double-blinded placebo study had utilized a placebo whereby the treating acupuncturists used a device to needle the patients where the placebo , or sham device, did not penetrate the skin, but gave a sensation similar to skin penetration. This type of placebo could not elicit physiological effects, and the study results showed a dramatic difference between the real acupuncture and the sham, despite the problems with inherent lack of ability to manipulate the needles effectively, or provide an optimally tailored treatment for the individual. This study, Yen et al, reported declines of diastolic blood pressure after 8 weeks of twice-weekly treatments, of between 8.7 to 14.8 mm Hg in the active acupuncture group and 2.9 to 4.0 mm Hg in the sham group (a true placebo effect). All of these study participants were currently being treated with antihypertensive medications and had lower mean body index (BMI) than the SHARP trial. In this study, the participants had not achieved sufficient lowering of blood pressure with the use of standard medication. This study would seem to indicate proof of efficacy of inclusion of acupuncture in an overall protocol of treatment designed to minimize the use of pharmaceuticals.

In the long run, it is too much to ask of the patients to critically read and analyze the study data on acupuncture clinical trials in the reduction of blood pressure. Patients must depend on medical advice. Standard medicine has been very critical of the acupuncture profession for decades, and the advice from M.D.s is tainted with this professional bias. Hopefully, as research reveals more and more positive data, this will change.

Information Resources

1. The New York Times article that addresses the Allhat study can be quickly found at http://www.nytimes.com/2008/11/28/business/28govtest.html?em
2. The NIH website concerning the Allhat study is indirect in dissemination of the study findings, but can be accessed at http://www.nhlbi.nih.gov/health/allhat/index.htm
3. A 2010 article in the New York Times reviews findings from the National Health and Nutrition Examination Survey of 2003-6 that found a strong association between consumption of high-fructose corn syrup (the prevalent industry sweetener) and high systolic blood pressure: http://www.nytimes.com/2010/07/06/health/research/06patterns.html
4. A 2010 article in the New York Times reveals that research confirms a significant cancer risk from the antihypertensive drugs called angiotensin receptor antagonists: http://www.nytimes.com/2010/06/22/health/research/22risk.html
5. A 2007 article concerning the direct renin inhibiting drug Aliskiren was published in THEHEART.org online publication HeartWire, where prominent hypertension researchers discussed the pros and cons of this new drug. The discussions reveal that 1/3 to 1/2 of patients treated with drugs do not get their high blood pressure controlled, that the renin-angiotensin drugs have a limited antihypertensive dose-response curve, that many patients have side effects from these drugs, and that patients respond differently to these various drugs. The researchers Drs. Sealey and Laragh found that data from the clinical trials of Aliskerin, involving more than 5000 patients, revealed that even when combining the drug with other antihypertensive drugs, that less than 50% of patients achieved blood pressure control: http://www.theheart.org/article/791131.do
6. For summary of Yin et al Korean study of acupuncture as adjunct treatment in essential hypertension mentioned in this article, to check the facts and opinions expressed in this article, go to: http://www.ncbi.nlm.nih.gov/pubmed/17359649
7. For details of the SHARP study to check the facts and opinions expressed in this article go to: http://hyper.ahajournals.org/cgi/content/full/48/5/838#R35-069898 NOTE: you may have to type the address into the server as this document from the publication Hypertension does not utilize a www address. You may also copy and paste the address to the Google search and then click the appropriate address or HTML selection to see the full report of the study.
8. In 2010, a clinical study by the Nanjing University of Chinese Medicine was conducted in Germany, comparing a standard antihypertensive drug to acupuncture with a randomized choice of hypertensive patients: http://www.ncbi.nlm.nih.gov/pubmed/21375023
9. In 2010, a clinical study by Shangxi College of TCM in Xianyang, China, showed that addition of acupuncture protocol to standard medication therapy delivered a measurable benefit in improvement of vascular endothelial function, reducing E-selectin, and nitric oxide synthase (a vascular constrictor) both in the arterial membrane (eNOS) and inside the cell cytosol (iNOS), and improved the degree of success in therapy: http://www.ncbi.nlm.nih.gov/pubmed/21246843
10. In 2010, a clinical study Kyung Hee University in Seoul, South Korea, demonstrated that a 7 day course of acupuncture with inclusion of stimulation of a specific acupuncture point (ST36) demonstrated improved endothelial function and flow-mediated dilation after this short course of therapy, demonstrating how short courses of acupuncture could prevent the progression of cardiovascular diseases in hypertension patients : http://www.ncbi.nlm.nih.gov/pubmed/20673141
11. In 2010, a clinical study at the University of California, Irvine, Susan-Samueli Center for Integrative Medicine, found that low frequency electroacupuncture stimulation at just 2 points (ST36 and P5-6) demonstrated measurable effects in the brain that improved blood pressure regulation with a long-lasting effect. These studies with fMRI and blood tests have become famous at this University, proving the remarkable ability of acupuncture to affect specific targeted sections of the brain and initiate a cascade of neurohormonal changes that are consistent with the classic literature of TCM : http://www.ncbi.nlm.nih.gov/pubmed/20444652
12. In 2010, a clinical study at Shandong University of TCM, in Jinan, China, found that a simple two point electroacupuncture protocol (LI11 and LV3) reduced both systolic and diastolic blood pressure as well as medication, and presented significant benefits in controlling types of blood pressure that varies in the diurnal cycle of day and night: http://www.ncbi.nlm.nih.gov/pubmed/20862935
13. A 2010 mega-analysis of randomized controlled trials of acupuncture in the treatment of hypertension, accessing all of the major scientific medical databases, conducted by the Far East University in Korea, found that acupuncture treatments effectively reduced blood pressure when individualized to patients utilizing standard syndrome differentiation, but not significantly when ignoring individualized syndrome differentiation in the selection of acupuncture points and treatment. Acupuncture also significantly reduced blood pressure when combined with standard medication therapy, compared to such combinations with sham acupuncture. The researchers did note that there was still a limited number of acupuncture clinical trials adhering to the rigorous standards of the pharmaceutical industry trials published in medical journals, and that more rigorously designed clinical trials needed to be conducted. This research again shows that study design is difficult with acupuncture, and that study designs that do not allow the acupuncture treatments to be individually applied in a syndrome differentiation, as occurs in actual clinical practice, result in poor outcomes, as could be expected from improper treatment. There is no one-size-fits-all approach in TCM for a reason: http://www.ncbi.nlm.nih.gov/pubmed/20232615
14. A 2008 Taiwan study found significant risk of new onset diabetes with patients taking beta blockers and diuretics for a prolonged course: http://www.ncbi.nlm.nih.gov/pubmed/18475020
15. A 2006 study found the pathophysiological link from beta-blockers to chronic inflammation, cardiovascular disease and asthma: http://www.springerlink.com/content/u087k72k7106nl04/
16. There are a variety of simple changes in diet and lifestyle that have been shown to reduce high blood pressure. A 1985 study by the American Society for Clinical Nutrition found that increasing calcium rich foods in the diet significantly lowered blood pressure, while reducing salt intake had no effect. Since calcium is a backbone for chloryphyll, increasing fresh green vegetables in the diet will help lower blood pressure: http://www.ajcn.org/cgi/content/abstract/
17. A 2010 study published in the Journal of the American College of Nutrition found that diets high in beneficial essential fatty acids ALA and LA (alpha linoleic and linolenic acids) significantly reduced diastolic blood pressure by 2-3 mm Hg, and total peripheral vascular resistance by up to 4%. Eating fresh walnuts and flax seeds daily were recommended. These essential fatty acids are found in many Chinese herbs, and plant-based diets rich in whole grains, beans, legumes and fresh green vegetables also supply these important nutrients for cardiovascular health: http://www.ncbi.nlm.nih.gov/pubmed/21677123
18. An example of the recent research confirming the efficacy of Chinese herbal medicine in high blood pressure is found on the NIH website PubMed: http://www.ncbi.nlm.nih.gov/pubmed/17966898
19. A 2007 study of the Chinese herb Danshen by UMDNJ New Jersey Medical School, published in the American Journal of Physiology and Heart Circulatory Physiology: http://http://www.ncbi.nlm.nih.gov/pubmed/17172272
20. A 2006 study found the pathophysiological mechanism of blood pressure reduction utilizing acupuncture; this study was also performed by the UMDNJ New Jersey Medical School, and published in Microcirculation. 2006 Oct-Nov;13:577-85: http://http://www.ncbi.nlm.nih.gov/pubmed/16990216
21. A 2006 randomised controlled trial to study the hypotensive effects of the herb hawthorn (Crataegus laevigata), used in formulas to help lower blood pressure, showed a significant reduction in diastolic pressure with 16 weeks of use. This study added hawthorn extract to hypertensive medications in diabetic patients, as is common in England, and showed that an integrative medical approach is effective and sensible. This outcome also shows that a properly prescribed formula utilizing a number of mild hypotensive herbs, including hawthorn, is effective and very safe: http://www.ncbi.nlm.nih.gov/pubmed/16762125
22. A 2005 study and the Chinese University of Hong Kong found that the common Chinese herb Scutellaria baicalensis (Huang qin) exhibited potent anti-thrombotic, anti-inflammatory, and antioxidant effects to act as a significatn adjunct in herbal formulas to treat hypertension and atherosclerosis: http://www.ncbi.nlm.nih.gov/pubmed/15853750
23. A 2003 study by the University of California at Irvine demonstrates that oxidative stress from environmental lead exposure is one of the potential causes of high blood pressure, and that the normal physiology does not produce enough antioxidants to counter this oxidative damage. A wide array of Chinese herbs contain potent antioxidant chemicals in combination with other chemicals that increase vasodilation by encouraging increased nitric oxide, inhibit calcium channel excess, modulate beta-adrenergic mechanisms, reduce vascular inflammation, reduced formation advanced glycation endproducts, and improve lipid profile: http://www.nature.com/ki/journal/v63/n1/full/4493411a.html
24. A 2010 randomized clinical study at the Institute of Integrated Traditional and Western Medicine at Central South Unversity in Changsha, China, compared a common formula to help with essential hypertension, Calming Liver and Restraining Yang Formula (Ping Gan Qiang Yang), to the pharmaceutical drug amiodipine (Norvasc, a calcium channel blocker). The study found that overall antihypertensive effects were statistically the same, but that the Chinese formula over time decreased night-time blood pressure better, provided an improved lipid profile, alleviated symptoms, and improved quality of life better than Norvasc: http://www.ncbi.nlm.nih.gov/pubmed/20545208
25. The 2010 randomized clinical study at the Institute of Integrated Traditional and Western Medicine at Central South Unversity in Changsha, China, mentioned above, concerning the common Chinese antihypertensive formula Ping Gan Qiang Yang, found that this herbal treatment may recover the circadian rhythm of blood pressure and improve the carotid elasticity to improve reduction of cardiovascular risk when combined with standard pharmacological treatment: http://www.ncbi.nlm.nih.gov/pubmed/21660675
26. The now popular website of Dr. Ray Sahelian, reviews the Chinese herb that is most specific for blood pressure reduction in Chinese formulas, Luo bu ma, or Apocynum venetum. He cites studies that show that chemicals in this herb increase nitric oxide to vasodilate, reduce the formation of advanced glycation endproducts, exert anxiety calming effects, and improved kidney function: http://www.raysahelian.com/apocynum.html

The information on this website is not intended to be used as a specific medical advice or cure. Please consult with the practitioner or an appropriate physician, such as a licensed acupuncturist, naturopath, or medical doctor, to discuss the proper application of the information contained on this website.