High Blood Pressure / Hypertension

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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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 diuretic alone is as effective as any combination for most patients, 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. To first try a simple potassium sparing diuretic and short courses of evidence-based acupuncture and electroacupuncture to achieve a healthier blood pressure pattern is a conservative treatment option that spares patients the adverse effects of chronic long-term treatment with a combination of drugs. To address the underlying problems causing hypertension that lead to your body instituting a higher sustained blood pressure, with treatments of Complementary and Integrative Medicine (CIM) is also important. We now know that simply forcing a lowered blood pressure with drugs that block normal metabolic pathways does not actually address the important underlying health issues that are very important in assessing real cardiovascular risk.

With the failures of standard drug protocols for hypertension, standard medicine is looking for more allopathic approaches to simply stop the body from being able to raise the blood pressure. One new type of treatment for hypertension that was poorly controlled even by a prescription of 4 harsh drugs when tolerated, is the surgical procedure of burning specialized tissues in the kidney/adrenal gland. Renal denervation has become fairly popular in Europe, and approved in about 80 countries, yet not in the U.S.A. A 2014 clinical trial called UPDATE-2, published in the New England Journal of Medicine, and presented at the American College of Cardiology, was the first to actually test this procedure against a sham procedure. Unlike with acupuncture, sham or so-called placebo procedures are rarely used in clinical trials of other manual medicines. Acupuncture needle stimulation has been one of the only manual procedures held to this criteria of proof of efficacy. UPDATE-2, or SYMPLICITY HTN-3, with chief investigator Dr. Deepak Bhatt of Brigham and Women's Hospital in Boston, used a sham procedure to see if Renal denervation worked, and surprisingly, it did not perform better than the sham procedure, showing that its benefits were due to a strong placebo effect in the patients. Previous trials showed a significant lowering of systolic blood pressure, but not a significant lowering of the more important diastolic, or resting phase, of the arterial pressure. Dr. Bhatt stated that this trial shows that in fact a lot of medical devices that are highly touted probably do not work, and incorporating sham procedure into clinical trials would show little efficacy for these expensive procedures over placebo. Once again, addressing the number of factors underlying the sustained high blood pressure, or even the health of the blood vessels and heart, is rarely talked about in the treatment discussion. The importance of these strategies, and integration of Complementary Medicine, are still not given the consideration that they deserve.

All of these hypertension drugs and surgical procedures have side effects that may decrease the quality of life, and some present quite a financial burden to patients, while integrative Complementary Medicine (CIM/TCM) is very safe and relatively inexpensive, with the only side effects being better overall health and disease prevention. 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 link in Additional Information). 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. What has long been overlooked in standard medicine is the actual underlying health problems causing the body to elevate the blood pressure. Since the delivery to blood nutrients and hormones to tissues is all-important, a very complex system of feedback regulation determines blood pressure, both locally and systemically. The explanation for decades concerned atherosclerosis and hardening of the arteries, primarily in men, mainly driven by diet and lifestyle, but we seen in the last decade that this does not account for a majority of cases, and that women experience cardiovascular risk at levels equal to men, but for different reasons. A variety of health problems lead to the stresses that trigger the need for an elevated blood pressure. Without addressing these health problems in a holistic and integrated package of care, we have been ignoring perhaps the most important issues in true reduction of cardiovascular risk.

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, and links to the evidence supporting this is found in the section of this article entitled Additional Information and Links to Scientific Studies. In addition to this, these therapies offer means to also correct the underlying health problems while achieving a healthy control of blood pressure, 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 considering the big picture, the goal of reducing dependence on problematic drugs and procedures by incorporating the healthy treatments in Traditional Chinese Medicine (TCM), seems very practical. Often, short courses of more frequent acupuncture and electroacupuncture, combined with a simple potassium sparing diuretic, will achieve a sustained healthy blood pressure that is individualized with considerations of cardiovascular risk. Other health problems should also be addressed during this same course of therapy, providing a simple and inexpensive treatment option.

When a complete package of holistic 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 in CIM/TCM, the patient is also able to learn the simple routines that will keep the blood pressure at a healthy level. Such therapy potentially prevents an array of future health problems, even beyond cardiovascular disease.

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. The knowledgeable Licensed Acupuncturist and herbalist is able to provide short courses of therapy and continuing individualized guidance with evidence-based herbal and nutrient protocols and diet and lifestyle guidance. As research reveals the many health factors that contribute to hypertension, and the differences between men and women in cardiovacular disease risk, the obvious need for an expanded approach to care increases yearly.

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. Here is just a sample of the sound herbal research, with more links to scientific study presented below in additional information. These examples show that the proper quality and dosage is important to the effects.

The overall treatment protocol in TCM would utilize a broader effect than just one herbal chemical, though, supplying an array of effective therapeutic protocols to address both the symptom and the underlying causes specific to the individual with individualized course of holistic protocol, combining herbal formulas, short courses of acupuncture, expert advice on diet and lifestyle, researched nutrient medicines individually tailored to each patient, and even stress reducing therapeutic techniques. For example, a 2013 study at the China Academy of Chinese Medical Sciences, in Beijing, China, performed a meta-review of all medical databases for the efficacy of a common Chinese herbal formula prescribed for patients with essential hypertension and Liver Yang Hyperactivity, or stress-induced high blood pressure. Nine randomized controlled human clinical trials showed that this formula significantly improved the super oxide dismutase (SOD) levels in red blood cells, a key marker of cardiovascular risk in this type of patient. The decrease in systolic and diastolic blood pressure was equal to that of the control group, which involved patients prescribed anti-hypertensive drugs (PMID: 23596806). The implication by experts in China, was that such formulas, individually prescribed, provide an array of benefits that do in fact help resolve the underlying causes of hypertension, are inexpensive, and can be safely integrated with standard care. As always, the goal of the Licensed Acupuncturist and herbalist should be to help the patient find a complete set of therapeutic measures that quickly achieves the goal of maintaining a normalized blood pressure and reducing cardiovascular risk without the need for extended clinical therapy. Dependence on herbs and acupuncture is not the goal, restoring natural homeostatic mechanisms and guiding health changes in diet and lifestyle to achieve normal healthy blood pressure and reduce cardiovascular risk holistically is the goal.

Let me present just one example of the way that modern scientific research is helping the TCM physician better understand and refine treatment protocols for hypertension. To review more scientific research, scroll further to Additional Information and Links to Scientific Studies to access more proof of herbal efficacy as part of a comprehensive holistic treatment.

  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. While this herb alone may not achieve the desired goals, such therapy is always part of a larger holistic protocol in TCM therapy: 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 benefited 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 benefited 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

A 2015 study by the National Taiwan University of Public Health, in Taipei, Taiwan, showed that such research has changed the prescribing habits and patient choices in Asia in recent years, and that in a study of 154,083 patients in Taiwan, that by 2015 approximately 80 percent of patients now reported integrating TCM and Chinese Herbal Medicine into their treatment protocol for hypertension, with Dan shen and the formula Tian Ma Gou Teng Yin the most frequently prescribed by Medical Doctors (PMID: 26048045). This study should show that the obvious satisfaction and evidence-based confidence in CIM/TCM is high, and hopefully, integration in the U.S. will also increase soon. The actual treatment by TCM physicians, or Licensed Acupuncturists and herbalists, would of course by more individualized, holistic and varied than this use of just Dan shen and Tian Ma Gou Teng Yin, and would incorporate short courses of evidence-based acupuncture and electroacupuncture protocols.

Of course, with any evidence of benefit for single therapeutic protocols in CIM/TCM, there will always be studies designed and funded to discount the degree of effect in total. The problem concerns a system of evaluation that was designed to study the adverse risks of single pharmaceutical drugs, and is difficult to apply to a more complex holistic protocol. What must be considered is the fact that these low dose herbal and nutrient medicines, and acupuncture, come with no adverse effects that are noteworthy. The evaluation of combined therapies in actual clinical protocol is not able to be achieved in the standard model, by design. Nevertheless, attempts to reform this system of research and clinical trials continues, and each year produces more and more valuable evidence of benefit. For instance, in 2015, a meta-review of all published scientific studies of Chinese Herbal Medicine integrated with standard care, performed by the Beijing University of Chines Medicine, in Beijing, China, found 13 high-quality randomized controlled human clinical trials that demonstrated that Chinese Herbal Medicine "was safe and showed beneficial effects on BPV (blood pressure variability) in hypertension patients." This aspect of blood pressure control, especially in relation to female hypertension, is very important, and improved variability regulation, or homeostasis, could help many patients reduce the level of pharmaceutical medication and dosage, and thus adverse health effects, as well as improve the overall outcomes and prevention disease. To see this study, click here: http://www.ncbi.nlm.nih.gov/pubmed/26089943

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

By 2013, acupuncture and Complementary and Integrative Medicine (CIM) was shown to be supported by even some of the most conservative medical organizations concerned with cardiovascular risk and high blood pressure, yet a bias against CIM is still strongly expressed. This presents a very confusing situations for patients who are just trying to do what their physicians tell them to do to prevent the leading cause of death and disability with aging. For instance, a 2013 American Heart Association committee recommended in their annual revised guidelines for professionals that Complementary Medicine should be integrated into treatment for hypertension, and gave supportive evidence-based ratings, with acupuncture and guided breathing techniques receiving a level B support from scientific evidence, and of course, healthy diet and lifestyle advice and changes heavily supported, yet these are still derided as a so-called "alternative", and written about with disparaging language. This strong bias has been entrenched in standard medicine despite decades of clinical proof that such therapeutic regiments are healthy and inexpensive, and have no adverse effects. Acupuncture itself has had to overcome incredible hurdles proving efficacy not with clinical effectiveness and proof of specific biological effects in study animals, and humans, but unlike almost all other manual medicines, proof against a so-called placebo, when we must realize that there is no placebo sticking a person with a needle and eliciting a response. This research study design, for pharmaceutical safety, presents a strong design bias that still continues despite this acknowledgement. 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 acupuncture 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 (Stop Hypertension with Acupuncture Research Program), conducted by a number of different medical schools and institutes, including Harvard Medical School and the Massachusetts General Hospital. 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, especially if the diastolic blood pressure was already mildly elevated to a sustained 98 mm Hg. 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. Real and individualized acupuncture treatment, combined with this holistic package of care, is sure to achieve even better results in real clinical practice, and this is the way such therapy is normally designed in TCM.

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 prove 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, and intelligent patients can see that there was significant benefit, and could expect better sustained results from a more holistic treatment protocol with real needle stimulation. What is evident is that the study design doesn't work.

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 anti-hypertensive 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 integrated treatment designed to minimize the use of pharmaceuticals. With the documented history of failure of standard therapy to work for a high percentage of patients, this inexpensive course of therapy, with no possibility of adverse effects, would seem like something to promote, but it still isn't promoted in standard medicine.

As time goes on, more and more sound clinical studies and human clinical trials of high quality are being conducted and published, and you can access some of these in the section entitled Additional Information. In the long run, though, 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, and assess the problems of study design. 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.

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, or excess of reactive oxygen species (ROS). 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 endogenous antioxidant chemicals to clear reactive oxygen species in times of stress. In this situation tissue degeneration occurs, and chronic inflammatory imbalance leads to atherosclerotic plaques, hardening of the arteries, poor heart function, and difficulty in regulating the blood pressure to deliver nutrients to maintain tissues. 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, or reactive oxygen species, are created when the body tries to repair tissues and cells, such as with inflammatory mechanisms, but lacks the normal ability to do so. This is why many of us need outside help to boost antioxidant activity to effectively repair damaged or degenerated 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.

Besides taking the correct antioxidants in the diet, and supplements when necessary, correcting underlying causes of oxidative stress, and improving overall health and circulation, are very important. Once again, to address this important health subject, an holistic protocol is needed, and patient understanding and guidance. Not only heavily advertized antioxidant supplements, but improved diet and lifestyle, and utilization of acupuncture and deep tissue massage, or Tui na, is important. Deep tissue physiotherapies have been proven to do more than just relieve pain, and studies have shown that improvement in biochemical and neurohormonal health is achieved with these therapies of acupuncture and Tui na as well. Diurnal cortisol balance, decreases in vasopressin amd adrenal corticocotropin hormone (ACH), increases in oxytocin to benefit nighttime blood pressure regulation, and iincreased immune responsiveness were noted in a landmark 2010 study at Cedars-Sinai Medical Center in Los Angeles, California. Both improvements in circulation to deliver antioxidants and help clear excess reactive oxygen species and toxins, as well as improvement in homeostatic regulation of oxidant stress were achieved. In addition, many scientific studies of the effects of acupuncture stimulation point to mechanisms of reducing oxidant stress as one of the main physiological pathways of effect, such as upregulation of the expression of super oxide dismutase, improved glutathione metabolism, and downregulating of the malondialdehyde toxicity in cells.

Treatment protocol in Complementary and Integrative Medicine (CIM)

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.

Differences in subsets of the patient population demand different approaches in treatment and prevention strategies, and standard medicine provides a basic one-size-fits-all strategy that does not address different physiological needs between men and women, and between different age groups. Complementary and Integrative Medicine provides the protocols to achieve this individualized care. For instance, studies have shown that steroid hormone imbalances play a dramatic role in female hypertension, and that the estrogens, such as estradiol, estrone and estriol, play a large role in blood pressure homeostasis and the health of the arteries and heart. While synthetic estrogens in contraceptives and hormone replacement therapies (HRT) have been found to increase cardiovascular risk, the use of bioidentical natural estrogens have been shown to lower blood pressure in perimenopause and improve vascular health. While this has resulted in some shift to the use of Premarin, a naturally derived estrone from the urine of horses, bioidentical estriol topical creams present the patient with many of the same benefits without high dose and prolonged dependence. A knowledgeable TCM physician is able to include bioidentical hormonal creams, derived from plant sources, into a holistic protocol to achieve the desired results. To see a review of sex steroid hormones in relation to blood pressure and cardiovascular health, click here: http://cardiovascres.oxfordjournals.org/content/53/3/688

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 / Sea BP: 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 omega-3 essential fatty acids, especially EPA and DHA, to prevent stroke and heart attack and regulate inflammation. Improved cardiovascular maintenance helps to normalize blood pressure indirectly, and many clinical studies have shown benefit to heart function, blood pressure, lipid balance, vascular health, decrease in risk of thrombus and sclerotic inflammation, and an anti-oxidant effect. Of course, improving the intake of essential fatty acids in the diet is important when taking any essential fatty acid supplement, and an intelligent balance of the various types of what are called omega3,6,9 is most important.
  3. Astra Garlic formula: aged garlic extract, prepared properly, 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-H2, B2 riboflavin, and magnesium is now available from Vitamin Research (Flavitrex or NeuroFlavin).
  5. Riboflavin Vitamin B2, and magnesium potassium supplement have shown mild but significant benefit in study. According to the National Health and Nutrition Examination Survey (NHANES) over 65 percent of the population 19 years old and over has inadequate intake of magnesium due to depletion of the quality of our topsoil with modern farming techniques. The widespread use of Roundup glyphosate herbicide, a mineral chelator, has exacerbated this food deficiency. A study published in the American Journal of Hypertension, 2009, July 16, online, concluded: '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. In 2014, a large study by the Belgian Nutrition Society showing that Vitamin B2 Riboflavin lowers blood pressure in hypertension patients with the genotype MTHFR 677TT was published in the medical journal Archives of Public Health, showing that for specific subsets of patients, such nutrient therapy is proven effective. Other nutrient supplements may be helpful and should be prescribed as needed for the individual, as well. The availability in the body for magnesium depends upon the conjugated carrier chemical used, and a magnesium potassium aspartate is currently recommended. There are no miracle cures or wonder pills for blood pressure control, but a thorough holistic protocol of improved diet and daily exercise, individualized nutritional supplements, herbal medicine, and short courses of specific researched acupuncture and electroacupuncture protocols will easily achieve the goal and improve overall health. Magnesium plus B2 is just part of a total program. 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, showing how utilization and regulation of the mineral in the body is just as important as the amount taken in the diet. Magnesium is an electrolyte mineral associated with antiarrhythmic cardio effects, vascular tone, glucose and insulin homeostasis. Lowered magnesium levels are associated with oxidative stress, proinflammatory states, endothelial arterial dysfunction, platelet aggregation, insulin resistance, and hyperglycemia. While large human clinical trials have not yet been conducted to prove the efficacy of magnesium to lower blood pressure, this supplement may be an important adjunct in the holistic treatment protocol.
  6. Green coffee bean extract: this chlorogenic acid-rich supplement is used to aid in weight loss, but a human clinical trial in Japan, randomized and placebo-controlled, demonstrated significant effects in lowering both the systolic and diastolic blood pressure as well (see study link below). A combination of studied antioxidants that includes green coffee extract, grape seed extract, and pomegranate extract, combined with Vitamin K2 in the form of MK-7 (similar to nattokinase), perhaps affords a broader benefit (Circutrol BP).
  7. 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. Apocynum venetum is shown to exert inhibitory modulation of voltage-gated sodium and potassium cell channels. While there are no herbs that provide the same effect as pharmaceutical blood pressure medications, many Chinese herbs and formulas are proven to help correct the underlying physiological problems and eventually restore proper homeostatic control of the blood pressure. Patients must understand that their body has risen their blood pressure in response to underlying health problems to facilitate proper delivery of blood nutrients. Simply blocking some aspect of this feedback mechanism is not the most intelligent overall approach to health. Whether or not one takes pharmaceutical medications, a patient with chronically high blood pressure needs to address these underlying causes of hypertension, and Complementary Medicine, in the form of Traditional Chinese Medicine, or the profession of Acupuncture, provides an array of useful and healthy treatment protocols. Even if the blood pressure is controlled with pharmaceutical drugs, the underlying health problems are not resolved. These professional Chinese herbal formulas do not negatively interact with blood pressure medications, and can be taken concurrently. Since all of these medications come with eventual negative adverse side effects, Complementary Medicine can protect against these side effects, and perhaps help the patient achieve the goal of normalizing blood pressure mechanisms and going off of the medications. Stopping blood pressure medications should always be done gradually, and with the advice and guidance of the prescribing Medical Doctor, who is responsible for this aspect of the integrated medical treatment.

Integration of the specialty of Traditional Chinese Medicine in the overall care of the patient with chronic high blood pressure and cardiovascular risk offers and array of benefits. Other Chinese formulas are useful to target specific health problems related to chronic high blood pressure, such as cholesterol imbalance, nervousness, adrenal health, or problems with kidney diuresis or liver metabolism. Identification of the type of hypertension, 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, and become fully informed, as a proactive approach always results in better individualized benefits in medical care. Overall health is very important in control of blood pressure, as most cases are called primary idiopathic hypertension 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. In recent years we are seeing more and more of the best authorities in standard medicine recommend that these Complementary Medicine approaches be tried first with mild to moderate hypertension, instead of immediately taking an array of pharmaceuticals for the rest of your life. 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. In holistic medicine, such treatments are utilized in a complete protocol that always seeks to correct underlying causes so that there is no dependency on any herbal use.

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. For instance, if one is a cigarette smoker, research has revealed that the metabolism is affected, with measurable changes in adiponectin, brain-derived neurotrophic factor, leptin, C-reactive protein, and other metabolic factors related to cardiovascular health. These negative factors can be ameliorated with intelligent care in Complementary Medicine. Obesity, diabetes, Metabolic Syndrome, adrenal stress, insomnia, and other related health problems may all be individually addressed with nutrient medicine. The choice in what to take resides with the patient, but professional advice and prescription should be used to intelligently guide this choice.

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. The problems with such integration of Complementary Medicine is not one of danger of the Complementary therapies, as their is almost no record of adverse effects and malpractice in Complementary Medicine, but rather of optimum utilization of this very safe medical specialty.

Feel free to schedule a short consultation with myself or any knowledgeable Licensed Acupuncturist and herbalist in your local area, usually for free if you are interested in this type of integrative therapy and are unsure of how it will work with you. It does not hurt to discuss and research Complementary Medicine, and the eventual health effects are not adverse side effects, but improved overall health with TCM. Any commitment of time and money, even a single short course of therapy, is helpful in the integration of Complementary Medicine.