An Integrated Approach to Manage Hypertension

What is Essential Hypertension?

Essential hypertension is the condition normally known as high blood pressure in adults where there’s no identifiable cause of high blood pressure.  Such a condition develops over a long period of time. Essential hypertension accounts for 95% of all cases of hypertension. Some people have high blood pressure caused by an underlying condition, such as kidney problems, adrenal gland tumors, thyroid problems, congenital defects or due to effects of certain types of medications like cold remedies, decongestants, alcohol abuse or drugs like cocaine or amphetamines(1)http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/basics/causes/con-20019580. This type of high blood pressure is called secondary hypertension and tends to appear suddenly.

Complications of high blood pressure (from Wikimedia Commons)

Complications of high blood pressure (from Wikimedia Commons)

In industrialized societies, the risk of becoming hypertensive (blood pressure >140/90 mm Hg) during a lifetime exceeds 90%. According to the National Heart, Lung and Blood Institute, hypertension (high blood pressure) usually neither causes pains nor causes complaints(2)http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/signs#However, modern medicine has discovered that hypertension was found as the preceding condition in cardiovascular events like heart attack, stroke, embolism, kidney failure and more. Therefore, medical research was directed to search for medication that forced the body to lower its blood pressure.

Body’s natural response

It must be first understood that high blood pressure is a logical response of our body’s intelligent control system. A reduction of blood flow (due to narrowed blood vessels and/or increased viscosity of blood) will lead to a deficiency of oxygen and energy to the cells and organs. To overcome this, our body elevates the blood pressure to maintain a sufficient supply of oxygen and energy to the cells and organs of the body. Drugs that are used to reduce the blood pressure do not overcome the circumstances that are causing the higher resistance to the flow of blood. On the contrary, they work against the efforts of our body to maintain a sufficient supply of oxygen and energy, in spite of harder circumstances. That’s why one feels worse when taking those pills. The pills can’t cure your high blood pressure. But they do cause the so-called “side-effects”, namely, dizziness, headache, fatigue, depression, throbbing of the heart, lack of energy, lack of concentration, impotency, frigidity and more.

Overdiagnosis and Overmedication?

Let us consider some facts. Sixty percent of ALL the most prescribed medications are for hypertension, high cholesterol levels, and diabetes(3)Herper M: America’s most popular drugs: a narcotic painkiller tops Forbes’ list of the most prescribed medicines. ForbesMay 11, 2010. What could be the possible reasons that explain such a dramatic rise in the diagnosis and treatment of these chronic conditions? One important factor is the pronounced lowering of diagnostic thresholds for diabetes and hypertension. As a result of lowering the bar, millions of people previously defined as healthy now are classified as needing treatment(4)Welch HG, Schwartz LM, & Woloshin S: Overdiagnosed: Making People Sick in the Pursuit of HealthBoston, MA: Beacon Press; 2011:171–172.. Lower diagnostic thresholds have resulted in large increases in the number of candidates for treatment, with an estimated 22 million additional people in the US alone being treated for hypertension(5)Yoon SS, Ostchega Y, & Louis T: Recent trends in the prevalence of high blood pressure and its treatment and control, 1999–2008. NCHS Data Brief. 2010;Oct(48):1–8.. Till the year 1992, for non-diabetic persons, the threshold for hypertension diagnosis was accepted as 160/95 mmHg. In the year 1993 this limit was reduced to 140/90 mmHg(6)Hunt LM, Kreiner M, & Howard Brody H: The Changing Face of Chronic Illness Management in Primary Care: A Qualitative Study of Underlying Influences and Unintended Outcomes, Annals of Family Medicine, September/October 2012 vol. 10 no. 5 452-460 .

According to the American Heart Association, “There is no specific level of BP where cardiovascular and renal complications start to occur; thus the definition of hypertension is arbitrary, but needed for practical reasons in patient assessment and treatment”(7) Carretero OA, MD & Oparil S: Clinical Cardiology, Essential Hypertension, American Heart Association publication – Circulation.2000; 101: 329-335.

Understanding the physiology in the search for drugs

Physiology of blood pressure regulation

Physiology of blood pressure regulation (From Wikimedia Commons)

The study of the physiology of blood pressure control and regulation can be both illuminating as well as frustratingly confusing. It is illuminating because it reveals that blood pressure regulation is not simply a complicated homeostatic control loop. It is frustratingly confusing because it is a complex responsive process that involves pressure receptors working with parts of the brain that act on the autonomous nervous system; the liver-kidney-adrenal-lung complex that involves various hormones and enzyme reactions that affect the blood vessels, heart output, water/ sodium excretion, calcium and potassium balance and a host of other mechanisms that are till today poorly understood.

The response of the pharmaceutical industry has been to produce a class of drugs to address the parts that constitute the whole picture. The most commonly used drugs for hypertension include the thiazide diuretics, beta-blockers, ACE inhibitors, angiotensin II receptors antagonists, calcium channel blockers, alpha-adrenoceptor blockers, combined α- and β-blockers, direct vasodilators, and some centrally acting drugs such as α2-adrenoceptor agonists and imidazoline I1 receptor agonists. This piecemeal approach leaves the patient with as many as five or more prescriptions to keep the numbers low. Medical researchers admit that “Hypertension is one common disease that can be challenging to treat in the elderly due to the body’s physiologic changes, potential risks for side effects, medication interactions, and decreased medication adherence.(8)Cooney D, Pascuzzi K: Polypharmacy in the elderly: focus on drug interactions and adherence in hypertension. Clin Geriatr Med. 2009 May;25(2):221-33. doi: 10.1016/j.cger.2009.01.005

Have the drugs helped?

One would be led to believe that with the detailed knowledge of the mechanics of our body and the billions spent on development of drugs, we are in a better situation today than the late US President Woodrow Wilson was, when he supposedly died due to the effects of severe hypertension at a time when there were no medicines available for controlling high BP.

A recent research published by Cochrane reviewed 8,912 participants with mildly elevated blood pressures (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg), but no previous cardiovascular events and who were under treatment for 4 to 5 years with anti-hypertensive drugs. The startling truth they revealed was that compared to the results obtained with placebo, the drugs did not reduce total mortality. In 7,080 participants treatment with antihypertensive drugs as compared to placebo did not reduce coronary heart disease, stroke or total cardiovascular events. In fact withdrawals due to adverse effects were increased by drug therapy and absolute risk increase was 9%(9)Diao D, Wright JM, Cundiff DK, Gueyffier F: Intervention Review – Pharmacotherapy for mild hypertension,  The Cochrane Collaboration published in The Cochrane Library 2012, Issue 8.

The 2014 report from the Eighth Joint National Committee for Evidence-Based Guideline Management of High Blood Pressure in Adults has defined new limits for defining hypertension(10)Journal of the American Medical Association: JAMA 2014;311(5):507-520. doi:10.1001/jama.2013.284427.  Accordingly, non-diabetic persons and persons not suffering from chronic kidney disease aged 60 years or older a BP goal of less than 150/90 mm Hg is recommended (previously it was 140/90 mmHg for this population). They also mentioned that lifestyle treatments have the potential to improve BP control and reduce medication needs.

An integrative approach can help

Hippocrates had written that disease was both pathos (suffering) and ponos (toil), as the body worked to restore normalcy. The reason modern medicine has only concentrated on the toil is because fever, BP, sugar levels are measureable, while suffering is individual and internal. Raising blood pressure is the natural, intelligent, function of the body to cope with circumstances. But what could cause a permanent reset of the regulation system to a higher value of regulate blood pressure as it happens in essential hypertension? Why would the body move away from the best value for blood pressure?

Perhaps the answer can be found in the work of Dr. Hans Selye. Selye postulated that sickness was an adaptive response. For example, a fever that raises the core body temperature by 1 degree Celsius, costs the body an additional 13% energy. Suppressing a fever may save this additional expenditure, but the organism will fail in fighting off infection and may eventually die. However, to conserve this additional burden the body brings about behavioral changes such as huddling, making postural changes and seeking shelter. These are the subjective symptoms which are of little value in allopathic practice.

Selye coined the term syndrome of being sick to describe this stage of coping. This is the closest that one can come to explain the importance Homeopathy places on symptoms and sensations described by the patient. They go beyond the objective signs that laboratory tests will ever reveal. A practitioner of Homeopathy and Bach Flower Therapy is looking for these subjective symptoms to find a remedy. In the example given above, the fever is the objective symptom – the ponos described by Hippocrates. The description of pain, the amelioration caused by postural adjustment, the craving for warm drinks and aversions to cold drafts of air are part of pathos. How can we ever expect to find a remedy without taking pathos and ponos into account together?

Lifestyle is the key

Nearly 200 years before the dawn of the “New Age”, Dr. Samuel Hahnemann, the founder of Homeopathy, emphasized that life-style modification is the first step in the treatment of any disease or disorder. His instructions were strict – no spices, salt, tea, coffee, or alcohol and he advocated pure food grown as close to nature as possible. He stressed on the importance of moderate exercise, but most of all it was the removal of stressful factors and getting adequate rest that was necessary.

It has taken two centuries for modern medicine acknowledge that more than medicine, “A reduced fat, low cholesterol diet that emphasizes fruits, vegetables and low fat dairy products, and maintains an adequate intake of potassium, magnesium and calcium, should be followed; salt intake should be restricted; and stress management should be considered as an intervention”(11) Touyz RM, Campbell N, Logan A, Gledhill N, Petrella R, Padwal R: The 2004 Canadian recommendations for the management of hypertension: Part III–Lifestyle modifications to prevent and control hypertension, The Canadian Journal of Cardiology [2004, 20(1):55-59].

An eighteen month randomized clinical trial(12)Wang YF , Yancy Jr WS, Yu D ,  Champagne C , Appel LJ and Lin PH: The relationship between dietary protein intake and blood pressure: results from the PREMIER study – Journal of Human Hypertension (2008) 22, 745–754 and an epidemiological study with a 8-year follow-up(13)Stamler J, Liu K, Ruth KJ, Pryer J, Greenland P. Eight-year blood pressure change in middle-aged men: relationship to multiple nutrients.Hypertension 2002; 39: 1000–1006 confirmed that an increased intake of plant protein may be useful as a means to prevent and treat hypertension.

Numerous studies have also confirmed that giving up smoking, and refraining from consumption of alcohol have major beneficial effects on reducing BP(14)Dickey RA, Janick JJ: Lifestyle Modifications In The Prevention And Treatment Of Hypertension, Endocrine Practice, Volume 7, Number 5/September/October 2001.

Regulation of blood pressure requires the pituitary-heart-lung­-kidney-adrenal mechanism to be kept in good working order. This can be best achieved by seeking a holistic, integrated approach.

Perhaps only homeopathy has remedies that address stress causing factors. For example there are remedies that will specifically take into account agitation, resentment, fear, anxiety, grief or anger if that forms part of the symptom portrait. When we combine meditation and creative visualization along with homeopathic treatment, your primary care physician will notice the steady improvement and that may result in reduced drug uptake. It must be mentioned though, Blood pressure can be more difficult to treat if drugs are used as well. Homeopathy works but it can take longer.

Practices to managing stress

Research in modern medicine now confirms that stress can cause hypertension through repeated blood pressure elevations as well as by stimulation of the nervous system to produce large amounts of vasoconstricting hormones that increase blood pressure. Factors affecting blood pressure through stress include white coat hypertension, job strain, race, social environment, and emotional distress. Furthermore, when one risk factor is coupled with other stress producing factors, the effect on blood pressure is multiplied.

A variety of non-pharmacologic treatments to manage stress have been found effective in reducing blood pressure and development of hypertension, examples of which are meditation, acupressure, biofeedback and music therapy. This all the more important in our age where people put in 70 hour work in a week, attend endless committee meetings, and respond constantly to cell phones, stress has become a prevalent part of people’s lives; therefore the effect of stress on blood pressure is of increasing relevance and importance.

Summary

Hypertension management and the possibility of cure requires an integrated approach. Both the medical care-givers and patients need to understand the limitations and pitfalls of current practice, and must remain open to supportive treatment. The role of meditation, mindfulness, exercise, diet and overcoming stress has been accepted by modern medicine. Professional bodies like American Heart Association accept that limits defining hypertension is quite arbitrary. New recommendations for people above the age of 60 and who are non-diabetic persons and who do not suffering from chronic kidney disease set the goal of 150/90 mmHg as the goal.

Further reading

Elaine Lewis on Hypertension: The High Blood Pressure Snow Job

References   [ + ]

1. http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/basics/causes/con-20019580
2. http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/signs#
3. Herper M: America’s most popular drugs: a narcotic painkiller tops Forbes’ list of the most prescribed medicines. ForbesMay 11, 2010
4. Welch HG, Schwartz LM, & Woloshin S: Overdiagnosed: Making People Sick in the Pursuit of HealthBoston, MA: Beacon Press; 2011:171–172.
5. Yoon SS, Ostchega Y, & Louis T: Recent trends in the prevalence of high blood pressure and its treatment and control, 1999–2008. NCHS Data Brief. 2010;Oct(48):1–8.
6. Hunt LM, Kreiner M, & Howard Brody H: The Changing Face of Chronic Illness Management in Primary Care: A Qualitative Study of Underlying Influences and Unintended Outcomes, Annals of Family Medicine, September/October 2012 vol. 10 no. 5 452-460
7. Carretero OA, MD & Oparil S: Clinical Cardiology, Essential Hypertension, American Heart Association publication – Circulation.2000; 101: 329-335
8. Cooney D, Pascuzzi K: Polypharmacy in the elderly: focus on drug interactions and adherence in hypertension. Clin Geriatr Med. 2009 May;25(2):221-33. doi: 10.1016/j.cger.2009.01.005
9. Diao D, Wright JM, Cundiff DK, Gueyffier F: Intervention Review – Pharmacotherapy for mild hypertension,  The Cochrane Collaboration published in The Cochrane Library 2012, Issue 8
10. Journal of the American Medical Association: JAMA 2014;311(5):507-520. doi:10.1001/jama.2013.284427
11. Touyz RM, Campbell N, Logan A, Gledhill N, Petrella R, Padwal R: The 2004 Canadian recommendations for the management of hypertension: Part III–Lifestyle modifications to prevent and control hypertension, The Canadian Journal of Cardiology [2004, 20(1):55-59]
12. Wang YF , Yancy Jr WS, Yu D ,  Champagne C , Appel LJ and Lin PH: The relationship between dietary protein intake and blood pressure: results from the PREMIER study – Journal of Human Hypertension (2008) 22, 745–754
13. Stamler J, Liu K, Ruth KJ, Pryer J, Greenland P. Eight-year blood pressure change in middle-aged men: relationship to multiple nutrients.Hypertension 2002; 39: 1000–1006
14. Dickey RA, Janick JJ: Lifestyle Modifications In The Prevention And Treatment Of Hypertension, Endocrine Practice, Volume 7, Number 5/September/October 2001

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