Hypertension (Part 2)
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Hypertension (Part 2)
In Part 1 of Hypertension, we defined what hypertension, high blood pressure, is and we discussed dietary changes that can help to lower blood pressure. In this article, Hypertension Part 2, we will cover supplements and lifestyle changes that will lower blood pressure.
What Supplements can you take to reduce and manage your BP?
Potassium has been found to lower blood pressure (1). This is particularly true if the patient has a high sodium intake, is not on anti-hypertensive medication or has a low potassium intake (1). ‘Salt sensitive’ hypertension responds particularly well to increased potassium intake because the potassium increases the excretion of sodium (through urine) from the body (2). It takes about 4 weeks of potassium supplementation before the reduction in BP appears (2). Potassium should be part of any natural approach to treating hypertension (3). The typical American diet provides 2,620 mg of potassium per day (4). There is no RDI (Recommended Daily Intake) for potassium, however people with hypertension can benefit greatly from a daily dose of at least 4,700m mg (5). We recommend to eat potassium-rich foods, as per our article Hypertension Part 1, and to supplement potassium to manage your blood pressure. If you are going to supplement with potassium, we recommend you do so under the guidance of a skilled functional medicine practitioner. In our clinic, we primarily recommend potassium citrate powder as a preferred form to be taken with meals. With professional guidance, doses can be as high as 3,000 mg per day in divided doses. However, on your own, it is best to try to get all your potassium needs met from food.
A calcium-rich diet (of >1,000mg/ day) is recommended to manage hypertension. Supplementation has not been found to bring any significant benefits (6, 7). The RDA (Recommended Daily Allowance) for calcium varies depending on age and gender. Adults between 51 and 70 years are recommended to get 1,000- 1,200 mg per day. We think getting this from calcium-rich foods should be adequate.
Taking 500-1,000 mg of magnesium per day can decrease blood pressure (8). Furthermore, the combination of increased intake of magnesium and potassium with reduced sodium intake is more effective in reducing BP than taking a single mineral and is often as effective as one anti-hypertensive drug in treating hypertension (8).
Evidence indicates that garlic can lower BP in people with high blood pressure and should be a part of an anti-hypertensive therapy (9, 10).
Low levels of vitamin D are associated with a higher risk of hypertension (11). One small study gave 800 IU per day of oral vitamin D for 6 weeks to vitamin D–deficient elderly women. This dose of D lowered systolic blood pressure by 9.3% (12). Other studies have shown seasonal variations within the same population, with blood pressure peaking in winter and falling in summer (13, 14). A large dose of 50,000 IU of vitamin D per week has been shown to reduce hypertension in 8 weeks (15).
A review of nine studies on probiotics and hypertension found a significant decrease in both systolic and diastolic BP in patients who consumed a daily dose of 109 CFU (or 1 billion Colony Forming Units) of probiotics (16). CFU is the unit of measurement for probiotics and represents how many bacteria in probiotics are capable of dividing and forming colonies. A CFU is basically one distinct bacterium.
The results of this study indicate that probiotic consumption with daily doses from 109 to 1012 CFU (1 billion to 1 trillion Colony Forming Units) for 3 to 9 weeks may improve BP (16). The degree of improvement in BP is greater among people with hypertension who took a daily dose of 1.5 billion CFUs of probiotics (16). Success in lowering BP was improved if probiotics were taken for longer than 8 weeks (16). The study also suggests a greater effect from consuming multiple strains, rather than a single species (of bacteria) of probiotics (16).
The typical recommended dose of probiotics per day is 1 to 100 billion CFUs. If you are already hypertensive, then a higher dose (up to 350 billion CFUs) may be useful (16). Taking probiotics to prevent the onset of high blood pressure (and ensure good gut health) is recommended for everyone including those with normal to low blood pressure.
What Lifestyle changes can you make to reduce and manage your BP?
The standard advice for lowering blood pressure includes some very important tips, which are also advisable for general good health. These include:
- Manage stress: It is well-documented that stress is a contributing factor for hypertension (17). It is important to work on stress reduction and, more importantly, stress management if you want to reduce hypertension or avoid it developing in the future.
- Ensure that you are at a normal weight: As hypertension is involved in metabolic syndrome, as is obesity, it is well-known that losing weight, if necessary, will aid in lowering BP. Just losing 5% of your body weight can significantly reduce hypertension, while gaining weight increases the likelihood of hypertension (18).
- Exercise: All types of exercise reduce blood pressure (19). Do whatever kind of exercise you prefer. HIIT (High Intensity Interval Training) is more effective at lowering hypertension and requires less time commitment (20), which may make it preferable for some people.
- Sleep: Too little sleep and poor quality sleep are associated with hypertension (21). Be sure to get 7-8 hours of sleep per night.
- Monitor your BP at home: Self-monitoring of blood pressure appears to reduce BP in hypertension (22). It is most effective when done with lifestyle modifications. This then leads to clinically significant BP reduction which persists for at least 12 months (22). Speak to us if you would like more info or assistance in how to go about monitoring your own blood pressure at home.
Newer, more modern, advice based on recent research on lowering BP recommends the following for hypertension:
- Heal the Gut: Evidence links gut dysbiosis (higher level of bad bacteria vs. good bacteria in the gut) with hypertension (23). Certain gut microbial strains may play either a pathogenic or a protective role in the development of hypertension (23). As mentioned above under supplements, probiotics can therefore help as part of a hypertension treatment plan (23). Whilst still a new concept requiring more research, it has been shown that eating lots of fruit and vegetables is associated with reduced blood pressure and lower cardiovascular mortality (24). The relationship between diet and the types of gut bacteria in your gut microbiome is well known and growing evidence supports the role of the gut microbiota in the regulation of blood pressure (24). This is a new approach to treating hypertension with diet and probiotics (25). The best way to heal the gut is to work with a skilled functional medicine practitioner who can test for issues like Small Intestinal Bacterial Overgrowth (SIBO), yeast overgrowth, parasites, worms, etc. Getting a comprehensive stool test together with a SIBO lactulose breath test and then treating issues that were identified on those tests is optimal to address the gut in a much more thorough way than probiotics and diet alone. This is a good preventive measure even if you do not notice any gut symptoms. Blood pressure issues, blood sugar imbalance, skin problems, autoimmune disease, and many more have been connected with gut function regardless of whether there are symptoms related to digestion.
- Avoid plastics: A study done in 2014 tested the impact of drinking from BPA-lined cans and the impact on blood pressure (26). BPA is bisphenol A, a chemical very commonly used in cans and plastic food and drink containers. It disrupts hormone function, raises blood pressure and can impact cardiovascular health over time. The study subjects drank 2 drinks from cans with BPA (26). Two hours later, BPA was found in their urine and their blood pressure was higher than before they consumed the drinks with BPA (26). Based on this evidence, it is strongly recommended to avoid canned and plastic food and drink containers. This is for general health and specifically for managing hypertension.
- Relaxation techniques such as Meditation, Tai Chi, Music, Deep Breathing: Many forms of relaxation techniques have a positive impact on blood pressure. Studies have found that all forms of meditation are associated with controlling and improving blood pressure (27). Twenty-two studies have reported reductions in BP with Tai Chi and no adverse effects were reported (28). Music has been shown to improve systolic blood pressure and should be used in treatment of hypertensive patients (29). Device-guided slow breathing can significantly lower BP with no known contraindications from the use of the device, and no adverse effects (30). 15-minute sessions of device-guided slow breathing performed at least 3 to 4 times per week reduce BP and more frequent use may lead to further decreases in BP (30). Other forms of regulated breathing such as pranayama were not compared. So it is not known if paced slow breathing can be taught and effectively used to lower BP over the long term without the use of a device (30).
- Sunlight: Exposure to sunlight can help to lower BP. As discussed above, research has found that a vitamin D deficiency is associated with higher BP which can be remedied with exposure to the sun. Other research has found that sunlight changes the levels of nitric oxide in the skin, which significantly lowers BP (31, 32). Spending about half the time it would take your skin to turn pink from the sun between the hours of 11am – 3pm with arms and/or legs exposed to the sun without sunscreen on those areas for 5 days per week can provide an optimal level of Vitamin D in many individuals. For fair skin individuals, usually 15-20 minutes is sufficient. The darker your skin, the longer it will take. It is best to avoid sunburn so please limit the unprotected sun exposure to an amount of time that will not lead to sunburn.
- Filippini T, Violi F, D’Amico R, Vinceti M. 2017. The effect of potassium supplementation on blood pressure in hypertensive subjects: A systematic review and meta-analysis. Int J Cardiol.2017 Mar 1;230:127-135. doi: 10.1016/j.ijcard.2016.12.048.
- Haddy FJ, Vanhoutte PM, Feletou M. 2006. Role of potassium in regulating blood flow and blood pressure. Am J Physiol Regul Integr Comp Physiol.2006 Mar;290(3):R546-52.
- Cappuccio FP, MacGregor GA. 1991. Does potassium supplementation lower blood pressure? A meta-analysis of published trials. J Hypertens.1991 May;9(5):465-73.
- US Department of Agriculture, Agricultural Research Service. Data tables: results from USDA’s 1994-96 Continuing Survey of Food Intakes by Individuals and 1994-96 Diet and Health Knowledge Survey. ARS Food Surveys Research Group, https://www.barc.usda.gov/bhnrc/foodsurvey/home.htm(accessed 21 March 2019).
- Loren CordainS Boyd Eaton Anthony Sebastian Neil Mann Staffan LindebergBruce A Watkins James H O’Keefe Janette Brand-Miller. 2005. Origins and evolution of the Western diet: health implications for the 21st The Amer. J. of Clncl. Nutr., Volume 81, Issue 2, February 2005, Pages 341-354. https://doi.org/10.1093/ajcn.81.2.341.
- Simonetti G, Mohaupt M. 2007. Calcium and blood pressure. Ther Umsch.2007 May;64(5):249-52.
- Zemel MB. 2001. Calcium modulation of hypertension and obesity: mechanisms and implications. J Am Coll Nutr.2001 Oct;20(5 Suppl):428S-435S.
- Houston M. 2011. The role of magnesium in hypertension and cardiovascular disease. J Clin Hypertens (Greenwich). 2011 Nov;13(11):843-7. doi: 10.1111/j.1751-7176.2011.00538.x.
- X J Xiong, P Q Wang, S J Li, X K Li, Y Q Zhang, J Wang. 2015. Garlic for hypertension: A systematic review and meta-analysis of randomized controlled trials. Phytomedicine. 2015 Mar 15 ;22(3):352-61.
- Karin Ried. 2016. Garlic Lowers Blood Pressure in Hypertensive Individuals, Regulates Serum Cholesterol, and Stimulates Immunity: An Updated Meta-analysis and Review. J Nutr. 2016 Feb ;146(2):389S-96S.
- John P. Forman, Edward Giovannucci, Michelle D. Holmes, Heike A. Bischoff-Ferrari, Shelley S. Tworoger, Walter C. Willett, Gary C. Curhan. 2007. Plasma 25-Hydroxyvitamin D Levels and Risk of Incident Hypertension. 2007;49:1063–1069. doi:10.1161/HYPERTENSIONAHA.107.087288
- Pfeifer M, Begerow B, Minne HW, Nachtigall D, Hansen C. Effects of a short-term vitamin D(3) and calcium supplementation on blood pressure and parathyroid hormone levels in elderly women. J Clin Endocrinol Metab. 2001; 86: 1633–1637.
- Kunes J, Tremblay J, Bellavance F, Hamet P. Influence of environmental temperature on the blood pressure of hypertensive patients in Montreal. Am J Hypertens. 1991; 4: 422–426.
- Woodhouse PR, Khaw KT, Plummer M. Seasonal variation of blood pressure and its relationship to ambient temperature in an elderly population. J Hypertens. 1993; 11: 1267–1274.
- Mozaffari-Khosravi H, Loloei S, Mirjalili MR, Barzegar K. 2015. The effect of vitamin D supplementation on blood pressure in patients with elevated blood pressure and vitamin D deficiency: a randomized, double-blind, placebo-controlled trial. Blood Press Monit.2015 Apr;20(2):83-91. doi: 10.1097/MBP.0000000000000091.
- Khalesi S, Sun J, Buys N, Jayasinghe R. 2014. Effects of probiotics on blood pressure: a systematic review and meta-analysis of randomized, controlled trials. Hypertension. 2014 Oct;64(4):897-903. doi: 10.1161/HYPERTENSIONAHA.114.03469.
- Steptoe A, Kivimäki M, Lowe G, Rumley A, Hamer M. 2016. Blood Pressure and Fibrinogen Response to Mental Stress as Predictors of Incident Hypertension over an 8-Year Period. Ann Behav Med.2016 Dec;50(6):898-906.
- Earnest CP, Church TS. 2016. Evaluation of a Voluntary Work Site Weight Loss Program on Hypertension. J Occup Environ Med.2016 Dec;58(12):1207-1211.
- Cornelissen VA, Smart NA. 2013. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc.2013 Feb 1;2(1):e004473. doi: 10.1161/JAHA.112.004473.
- Boutcher YN, Boutcher SH. 2017. Exercise intensity and hypertension: what’s new?. J Hum Hypertens.2017 Mar;31(3):157-164. doi: 10.1038/jhh.2016.62
- Mayer J, Becker H, Brandenburg U, Penzel T, Peter JH, von Wichert P. 1991. Blood pressure and sleep apnea: results of long term nasal continuous positive airway pressure therapy. 1991;79(2):84-92.
- Tucker KL, Sheppard JP, Stevens R, Bosworth HB, Bove A, Bray EP, Earle K, George J, Godwin M, Green BB, Hebert P, Hobbs FDR, Kantola I, Kerry SM, Leiva A, Magid DJ, Mant J, Margolis KL, McKinstry B, McLaughlin MA, Omboni S, Ogedegbe O, Parati G, Qamar N, Tabaei BP, Varis J, Verberk WJ, Wakefield BJ, McManus RJ. 2017. Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis. PLoS Med.2017 Sep 19;14(9):e1002389. doi: 10.1371/journal.pmed.1002389.
- Yongbo Kang, Yue Cai. 2018. Gut microbiota and hypertension: From pathogenesis to new therapeutic strategies. Clincs and Rsch in Hepatology and Gastroenterology. Volume 42, Issue 2, April 2018, Pages 110-117. doi: 10.1016/j.clinre.2017.09.006
- Marques FZ, Mackay CR, Kaye DM. 2018. Beyond gut feelings: how the gut microbiota regulates blood pressure. Nat Rev Cardiol.2018 Jan;15(1):20-32. doi: 10.1038/nrcardio.2017.120.
- Honour JW. 2015. Historical perspective: gut dysbiosis and hypertension. Physiology. 01 OCT 2015. org/10.1152/physiolgenomics.00063.2015
- Bae S, YC Hong. 2014. Exposure to Bisphenol A From Drinking Canned Beverages Increases Blood Pressure. 2014;65:313–319. doi:10.1161/HYPERTENSIONAHA.114.04261.
- Koike MK, Cardoso R. 2014. Meditation can produce beneficial effects to prevent cardiovascular disease. Horm Mol Biol Clin Investig.2014 Jun;18(3):137-43. doi: 10.1515/hmbci-2013-0056.
- Yeh GY, Wang C, Wayne PM, Phillips RS. 2008. The effect of tai chi exercise on blood pressure: a systematic review. Prev Cardiol.2008 Spring;11(2):82-9.
- do Amaral MA, Neto MG, de Queiroz JG, Martins-Filho PR, Saquetto MB, Oliveira Carvalho V. 2016. Effect of music therapy on blood pressure of individuals with hypertension: A systematic review and meta-analysis. Int J Cardiol.2016 Jul 1;214:461-4. doi: 10.1016/j.ijcard.2016.03.197.
- Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, Fuchs FD, Hughes JW, Lackland DT, Staffileno BA, Townsend RR, Rajagopalan S; American Heart Association Professional Education Committee of the Council for High Blood Pressure Research, Council on Cardiovascular and Stroke Nursing, Council on Epidemiology and Prevention, and Council on Nutrition, Physical Activity. 2013. Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the American Heart Association. Hypertension.2013 Jun;61(6):1360-83. doi: 10.1161/HYP.0b013e318293645f.
- Liu D, Fernandez BO, Hamilton A, Lang NN, Gallagher JMC, Newby DE, Feelisch M, Weller RB. 2014. UVA irradiation of human skin vasodilates arterial vasculature and lowers blood pressure independently of nitric oxide synthase. J Invest Dermatol.2014 Jul;134(7):1839-1846. doi: 10.1038/jid.2014.27.
- Science Daily. 2014. Here comes the sun to lower your blood pressure. https://www.sciencedaily.com/releases/2014/01/140117090139.htm. Accessed April 2 2019.
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