~Hypertension, Part 6 - Functional Medicine

~Hypertension, Part 6 - Functional Medicine
Functional Medicine
  • Definition
  • Change in Lifestyle and Eating Habits
  • Aging and the Circulatory System
Definition

Functional medicine is science-based and advocates the principles of biochemical individuality, patient-care over disease-care, balance and interconnectivity between all of the physiological systems, positive vitality, and promotion of organ reserve. It emphasizes definable processes for integrating knowledge that focuses on functionality at multiple levels; not simply one disease, one cure.

Several basic concepts are often ignored despite being relevant to the treatment of hypertensive patients and associated cardiovascular disease. Although people often consider hypertension as a disease, it is a symptom. It is one sign of a developing or existing disease. It is a warning of the manifestation of a disease. Approximately 90% of the time, the underlying cause(s) of hypertension are unknown and, thus, the condition is named as essential hypertension. Commonly, physicians are told that by eliminating the hypertension, that is, by merely reducing blood pressure, the increased risk and mortality associated with underlying cardiovascular disease will be reversed. Unfortunately, the cumulative experience of over two decades of worldwide clinical trials indicates that getting rid of only one aspect of hypertensive disease, the elevated blood pressure, reduces only part of the cardiovascular risk associated with hypertension.

We must appreciate that what we call "hypertension" is a powerful indicator of disease in other body systems, such as left ventricular hypertrophy associated with congestive heart failure, that may exist prior to and progress independently of the hypertension. Thus, the disease we call "hypertension" is not just about pharmacologically lowering blood pressure using potent and foreign drugs that act on the cardiovascular system. We must consider the treatment of any and all associated disease to successfully treat hypertension.

Ultimately the goal would be to identify underlying disease, not only the elevations of blood pressure, but the other multi-systemic aspects of hypertensive cardiovascular disease and then implement an integrated medical approach. Focusing on such underlying factors would allow treatment of the disease process itself, rather than just the symptom of elevated blood pressure.

A second concept often overlooked but quite obvious is that people are different. The same elevation of blood pressure that leads to the diagnosis of "essential" hypertension may result from many different "primary" causes. They just happen to have hypertension as one shared clinical manifestation. This immediately implies that when we ask, "Is this drug or integrated therapy good, or preferred for hypertension?" the answer should be, "It depends." For example, the salt-sensitive hypertensive patient sometimes responds to dietary salt recommendations and to certain drug classes differently from an individual who is not salt sensitive.

Therefore, it is worthwhile to consider the associated underlying cardiovascular disease when considering the treatment protocols present in the cardiovascular section of this book. The treatment of hypertension is facilitated by understanding an individual's unique response to various conventional and integrated therapies. Working closely with your physician, monitor your individual response to integrated therapies.

Change in Lifestyle and Eating Habits
  • Guidelines for Hypertension
  • Measuring Blood Pressure
  • Life Style Changes
Guidelines for Hypertension

The American Medical Association (AMA) continues to discount new research in the anti-aging field. Only when faced with overwhelming evidence (as in the case of homocysteine's role in cardiovascular disease) does the AMA concede there is some merit in alternative and supplemental approaches. When respected mainstream medical organizations dismiss the importance of new findings, a majority of physicians and their patients also ignore these potentially useful findings as well. This can cost people their health or even their lives.

Government health guidelines, also based on older more rigorously established research largely follow the same guidelines advocated by mainstream medicine. These guidelines concern "optimal" levels of blood pressure. Yet high blood pressure (hypertension) continues to affect over 50 million Americans and contributes to the death of almost a quarter million people per year (Calvert 2001). Hypertension, "the silent killer", has devastating health effects that progress insidiously over decades, affecting men and women. Two million new cases of hypertension will be diagnosed each year.

The problem with these guidelines is that what was considered high "normal" (i.e., 139/89) and even normal (130/85) is too high for optimal health. Life Extension magazine has been informing its readers that failure to keep their blood pressures below 120/85 could result in serious health problems such as strokes and heart disease (Stamler 1993, 1999). Newly published government guidelines state that blood pressure should be considered normal only if it is at or below 119/79 (Chobanian et al. 2003). People with blood pressures of 120/80 to 140/90 are "prehypertensive" and encouraged to take immediate measures to decrease blood pressure including daily exercise, decreasing dietary salt, and consuming no more than two alcoholic drinks per day. Over 50 million Americans had high blood pressure before the new guideline. Now, millions more have high blood pressure.

Pharmaceutical companies have introduced many medications to combat hypertension. A significant portion of prescribed medications in the U.S. are anti-hypertensives. With drug costs rising at an annual rate of at least 12% per year since 1993, the majority of prescription drugs (including diuretics, calcium channel blockers and ACE inhibitors) have troublesome to potentially deadly side effects, including hyperglycemia (high blood glucose), tinnitus (ringing in the ears), kidney damage, and heart failure.

The Life Extension Foundation has warned people to not depend on once-daily dosing of antihypertensive drugs. Many of these drugs do not provide true 24-hour protection for everyone, although FDA-approved package inserts indicate that statistically significant numbers of people show statistically significant decreases in high blood pressure. One solution is to take a lower dose twice-daily, even though the FDA-approved package inserts indicate once-daily dosing is adequate.

Our apparent odds with drug company and FDA claims derive in part from our higher standard for healthy blood pressure control. We would prefer to see 120/80 levels rather than concede that pressures as high as 140/90, previously recommended by the government (Chobanian et al. 2003), are satisfactory during any portion of a dosing interval. Because drug approval is based upon statistical averages, this means that the recommended dosage schedules will not be adequate for a minority of the population. Failure to keep blood pressure below 120/80 still increases the risk of mortality even if the prescribed medications diminish the severity of hypertension. Maintaining levels below 120/80 confers longevity and greater protection against heart attack or stroke (Taddei et al. 1998; Siani et al. 2000).

Measuring Blood Pressure

Doctors record blood pressure as two pressures--the systolic pressure (the force of blood in blood vessels as the heart contracts) and the diastolic pressure (the force of blood in blood vessels as the heart relaxes between beats). Mainstream medicine guidelines define normal systolic blood pressure as 130 mmHg or less and diastolic pressure of 85 mmHg or less. High normal systolic/diastolic pressures are 131-139/86-89. Hypertension is defined as blood pressures above 139/89. Systolic pressure is often the more crucial assessment in the elderly, not diastolic, as previously considered for the normal population (Izzo J et al. 2000). Other sources suggest that diastolic blood pressures below 85 are considered normal; 85 to 89 are high normal; 90 to 104 is mild hypertension; 105 to 114 is moderate hypertension; 115 or greater is considered severe (Williams and Braunwald 1987).

"Blood pressure" can be defined as the pressure or force that is applied against the artery walls as blood is carried through the arterial circulatory system. It is recorded as a measurement of this force in relation to the heart's pumping activity, and is measured in millimeters of mercury (mmHg). The top number, or systolic pressure, is the measurement of the pressure that occurs when the heart contracts or beats. The bottom number, or diastolic pressure, is the measurement recorded between beats, while the heart is at rest. The systolic number is placed over the diastolic number. An example would be 110/70 (read as 110 over 70). The systolic number is always the higher of the two numbers.

Life Style Changes

Lifestyle modifications to diet, salt intake, weight loss, smoking, and exercise can reduce blood pressure in a significant number of people. Studies affirm the need for a population-wide effort for health promotion through lifestyle modification (Miura et al. 2001; Vasan, 2001; Vasan et al. 2001, 2002).

The Dietary Approaches to Stop Hypertension (DASH) diet is recommended by both mainstream and integrative medical practitioners as a first line approach to the management of hypertension (Appel et al. 1997; Maizes, 2002). The DASH diet is high in fruits, vegetables and other nutritious foods that are rich in potassium, calcium and magnesium. The diet encourages a reduction of saturated fats in favor of monounsaturated fats and omega-3 fatty acids as found in fish oil. Salt restriction to less than 2,400 mg (about one teaspoon) a day is also recommended for people with hypertension. People who follow the DASH diet can decrease their systolic/diastolic pressure by 11/6 points (Cushman et al. 1998).

The DASH diet decreases hypertension through emphasis on eating fruits and vegetables: foods high in potassium, calcium, and magnesium. These minerals are essential in controlling hypertension. Numerous studies show that diets high in these minerals (supplements) significantly control hypertension (Allender et al. 1996; McCarron, 1997, 1998; Witteman et al. 19 8 9 8 ). When 58,218 nurses aged 34-59 years supplemented their diets with these minerals over four years, only 3,275 developed hypertension. Advancing age, obesity, and excessive alcohol consumption were still the strongest predictors of hypertension. However, those women who consumed 800 mg of calcium and 300 mg of magnesium had less risk for developing hypertension (Witteman et al. 1989). A review of several large studies over 15 years concluded "it appears prudent for physicians and health care providers to ensure that patients who are either hypertensive or at risk of developing high blood pressure consume adequate calcium, potassium, and magnesium on a daily basis" (McCarron , 1997).

Even the most respected textbooks used diagnostically by physicians (Williams 2001), support the DASH diet saying that "Nondrug therapeutic intervention is probably indicated in all patients with sustained hypertension and probably in most with labile hypertension. The general measures employed include (1) relief of stress, (2) dietary management, (3) regular aerobic exercise, (4) weight reduction (if needed), and (5) control of other risk factors...", "Dietary management has three aspects: [1.] Because of the documented efficacy of sodium restriction and volume contraction in lowing blood pressure [at least in some patients], mild…sodium restriction…significantly potentiates the efficacy of nearly all antihypertensive agents. It is quite clear that in some hypertensive patients, the level of sodium intake does influence blood pressure. Some studies have also reported a lowering of arterial pressure related to an increase in potassium and/or calcium intake…. A particularly useful approach is the DASH…diet, which uses natural foods that are high in potassium and low in saturated fat.", "[2.] Caloric restriction…for patient who are overweight…show…weight reduction (average [10 pounds ] } over 6 months) lowered blood pressure by 2.5 mmHg.", "[3.] A restriction in the intake of cholesterol and saturated fats…may diminish…Arteriosclerotic complications. Probably the most significant step could be…to convince the smoker to give up cigarettes. " (Williams 2001).

Cigarette use is a major contributing factor to hypertension. One cigarette can cause transient blood pressure increases over 10 points. Regular smoking raises blood pressure through the predominant action of nicotine (Verdecchia et al. 1995). Other known health risks associated with smoking include heart disease, diabetes and impotence.

Obesity is more problematical in Western civilizations and a contributor to modern diseases, including hypertension. Obesity increases risk of developing hypertension early and a more severe hypertension later. Weight loss can be controlled as revealed in a 7-year study of mildly hypertensive subjects on restricted salt intake and weight loss programs. Eighty percent had reductions in blood pressure that allowed them to completely stop their prescription blood pressure medication (Espeland , et al. 1999). Android obesity or male-pattern obesity is characterized by central abdominal obesity and an increased risk of hypertension, diabetes, hyperinsulinism, cardiovascular disease, and premature death (Sardesai 1998).

Exercise is helpful in reducing obesity by burning calories, but may have even more beneficial effects on hypertension via actions which raise testosterone levels. High intensity exercise and strength training keeps testosterone at optimal levels (Kraemer et al. 1999; Izquierdo et al. 2001). Protein consumption is vital to maintaining muscle mass and testosterone levels. Diets low in protein in men, 40-70 years old, lead to elevated serum hormone binding globulin (SHBG) levels and, therefore, decreased levels of 'free' testosterone (Longcope et al. 2000). EPA and DHA decrease levels of SHBG (Nagata et al. 2000). Men given 60 mg of zinc daily for 50 days had significantly increased levels of testosterone (Netter et al. 1981). Super MiraForte contains a mixture of plant extracts which effectively increase free testosterone levels (Kellis et al. 1984).

Aging and the Circulatory System

As we age, there is a general accumulation of scar tissue throughout the body that results from nonspecific free-radical attack secondary to the presence of oxygen, cell-death caused by infections or chemical insults, and programmed cell death (apoptosis). One of oldest theories of aging states that over time our organs and tissues accumulate enough scar tissue that blood pressure rises in order to adequately perfuse those tissues or organs. The damage that is done by hypertension eventually results in the fatal progression of some disease, typically related to the cardiovascular or renal system, which together really constitutes one system that interlinks a pump and a filter. The intervening vasculature becomes important not only as a participant in the blood pressure-mediated physiological decay, but when damaged, can also cause further morbidity through hemorrhage or clot formation.

Because the heart is working harder than normal with aging, high blood pressure further increases the risk of arteriosclerosis, atherosclerosis, coronary heart disease, heart attack, stroke, aneurysm, and kidney failure. When the heart works harder than normal over an extended period of time, it enlarges as a natural response to perform its function. High blood pressure also causes the arteries and arterioles to become scarred, hardened, and less elastic. This limits the amount of blood flowing to the organs and causes blood clots in the arteries.

Continued . . .


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