Q: Answer the following for how they may apply to you:

1. Do you laugh a lot?
2. Do you have road rage?
3. Do you consider yourself to have a dynamic personality?
4. Have you ever been told that you seem too competitive? or too anxious?
5. Are frustration and resentment common feelings for you?
6. Do you struggle with aggressive impulses or hostile tendencies?
7. Do little things frequently bug you?
8. Do you get chronic headaches towards the end of the day?
9. Can you ever feel your heart pounding in your chest just thinking about being confronted or challenged?
10. Do you get hot and bothered when other people try to manage your schedule or activities?
11. Are you a woman on hormone replacement therapy or using the pill?
12. Do you regularly eat dairy products or red meat?

A: If you answered “no” to the first question or “yes” to more than one of the other questions, you MAY have or be at risk for elevated blood pressure. If you haven’t had a basic physical exam in over a year, do it soon. Or, check your local drug stores for public blood pressure cuffs — almost always free. If you BP measures 140/90 or more, see a physician immediately.

Hypertension is defined as a repeated blood pressure (BP) reading of greater than 140/90 mm Hg (mercury). The upper number, called the systolic reading, relates basically to the strength and contractility of the heart muscle and represents the heart working. The lower number, the diastolic reading, is measured when the heart is resting, and gives information about peripheral resistance — in other words the condition of the arteries, the capillaries and the venous return system. Oxygenated blood pumps out of the heart, through the muscular aortic artery on the left side. De-oxygenated blood comes back in through the major veins on the right side, then to the lungs to pick up oxygen, then to the left side of the heart. Amazing, isn’t it!

Many people with high blood pressure feel fine most of the time, so they they may not worry about the risks of uncontrolled hypertension. These risks include stroke, blindness, heart attack and kidney failure. Frequently hypertension is discovered during routine physical examination. Later signs and symptoms of hypertension may include:

• occipital headache
• dizziness
• palpitations
• blurred vision
• epistaxis (nosebleeds)
• hematuria (blood in the urine)

About 89% of cases of high blood pressure have no obvious cause that can be singled out as the culprit Many factors are implicated however, including family history, environment (family size, crowding, eating patterns, occupation, obesity), salt ingestion and sensitivity (there is controversy over whether the sodium or chloride part of the salt molecule is the principal factor), race (blacks have more hypertension than whites), high cholesterol, high homocysteine, smoking, and diet. Many drugs can elevate blood pressure, including oral contraceptives (Ceska Gynekologie, Apr 1994), NSAIDS (Br J of Clinical Pharmacology, May 1993) and tricyclic antidepressants (Amer J of Cardiology, Nov 1992).

Risk actors for hypertension and other forms of heart disease that you can control are cigarette smoking, high cholesterol and obesity. Your can also exercise. Start by assessing your cardiovascular fitness with a submaximal stress test. This is something typically done in a hospital or sports medicine setting, by a qualified exercise physiologist. Your aerobic condition is calculated, compared to normal for your age and other factors, and then an aerobic exercise program tailored to your needs can be designed. Typically heart patients need to work out in the range of around 40% of their maximum target heart rate, sometimes for only 10 minutes a day at first. Don’t overdo. Consistency, and slowly building up as your condition improves is the key. Severe hypertension patients may be advised to do NO aerobic exercise at first. Isometrics are strongly contraindicated because they can unduly stress the heart. A system of slow, standing Chinese exercise movements called Qi Gong have helped many people and are widely practiced in China not only as therapy but as treatment of many diseases, including cardiovascular problems.

The importance of nutrition and diet cannot be overemphasized in disease control, and hypertension is no exception. In general, attempt to adhere to the following eating principles:

• drink PLENTY of water. If you are dehydrated, the blody will shunt blood into the major vessels, thus making it harder for the heart to pump blood into the smaller vessels. In the long run diuretics are COUNTERPRODUCTIVE in the treatment of hypertension, and should be avoided if possible.
• low sugar diet, especially avoiding refined, white sugar and products which contain it. (Ann Internal Medicine 98:838-41, 1983)
• low fat diet focusing on using only unsaturated fats — no more than 15% is optimal. Do try to avoid saturated fats (animal fat) altogether. (Preventive Medicine 14(5):573-84, 1985)
• your daily food intake should provide calories in the following percentages: 45-65% complex carbohydrates, 15-30% protein and 10-15% fat .
• high fiber, such as the good old apple a day, and whole grains (Ann Internal Medicine, editorial, May 1983)
• low cholesterol (avoid animal fat).
• low sodium/sodium-restricted diet . Take the salt shaker off the table. This is NOT a universal principle, but many people with hypertension will do better avoiding excess salt.
• 1-2 week watermelon fast, followed by a vegetarian diet .
• if overweight, reduce weight to normal range.
• avoid allergenic foods (including MSG), salt, salty foods (including pickles, chips, packaged meats), alcohol, sucrose, caffein, hydrogenated oils (margarine, vegetable shortenings, imitation butter spreads, most commercial peanut butters) and oxidized fats (deep fried foods, fast food, ghee, barbequed meats)

Supplements may be additionally helpful, because it is sometimes impossible to get therapeutic levels of certain nutrients through diet alone. Please contact a qualified health care provider for specific dosages.

• Vitamin A
• Vitamin B-complex
• Vitamin B3
• Vitamin C
• Vitamin D
• Calcium
• Magnesium
• Potassium
• Coenzyme Q10 (my favorite for heart conditions and the #1 supplement in Japan. This is a critical enzyme in the electron transport chain, allowing oxygenation of tissues at a cellular level thus lessening the burden on the heart muscle to deliver oxygen)
• omega-3 fatty acids
• omega-6 fatty acids, especially evening primrose oil (EPO)

While the low sugar, low fat, high fiber approach to controlling hypertension has been well established for over 20 years, a more recent study confirmed the importance of certain minerals as well. The so-called “DASH” (Dietary Approaches to Stopping Hypertension, NE Jour Med, 336:1117-24, April 1997) diet concedes that “a low-fat diet rich in fruits and vegetables had a surprisingly large impact on blood pressure” and also recommends more daily Calcium (1200 mg), Magnesium (484 mg) and Potassium (4566 mg) and less Sodium (3000 mg). The DASH diet specifies consuming at least 31 grams of fiber and a calorie intake distributed as 55% carbohydrates (complex), 18% protein (low fat) and no more than 27% fat (not saturated).

The world of plant medicine also has much to offer for controlling or even reducing chronic high blood pressure. Please consult with a qualified herbalist or naturopathic physician to find out about specific dosages for you, or the form in which to take the herbs. My favorite is Hawthorne berry (Crataegus oxycantha) which has emerged as the single most valuable plant remedy for the heart and circulation. Hawthorne is high in two groups of pigments which allow the heart to pump as vigorously as it needs without becoming enlarged. The first is the dark blue procyanidines which strengthen the inner lining of the major blood vessels, thus slowing the heart beat. The second group are the well-known flavonoids (like Vitamin C) which dilate the coronary and peripheral arteries. In China Hawthorne berries are used to help digest fatty foods, and lower cholesterol. There are no known contraindications for Hawthorne, and it can be taken long term without risk of dependency or reduced effectiveness. Hawthorne has proven to be an excellent remedy for angina, coronary artery disease and cardiac arrhythmias as well as for high blood pressure. A typical dose is 10-20 drops of tincture 3 times daily or 2-4 grams of solid extract daily.

My next favorite herbal heart tonic is good old garlic (Allium sativa). The earliest indications that garlic served as a medicinal plant come from the Stone Age. A garlic recipe written in cuneiform characters in about 3000 BC has been found. An ancient Egyptian papyrus dated 1600 BC described an uprising among the pyramids-builders because their daily food rations did not include enough garlic to keep them fit and strong for their work. In this century experiments in India show that eating garlic can significantly lower blood cholesterol and other fats. Research at George Washington University shows that garlic can reduce blood clotting (makes platelets less “sticky” and helps to “bust” clots) as well as lowering blood pressure in both animals and humans. Garlic contains many vitamins (including several B’s) and minerals (including iodine) but the clinical effects are probably mostly due to the detoxifying sulfur in the allicin, a volatile oil responsible for the garlic odor. Fresh garlic is by far the most potent form and 1 to 3 cloves daily will go a long way in keeping your heart healthy. Garlic capsules (which dissolve in the small intestine) are useful if you need to avoid the smell which tends to regurgitate back up from the stomach.

Gingko biloba, while perhaps better known as a memory enhancing herbal remedy, is another important cardiac activator. The principle constituents are, like Hawthorn, flavonoid pigments. Ginkgo has received considerable study in the past decade in Germany and has been difinitively shown to produce vasodilation and thus increased blood flow, particularly in medium sized and small vessels. This is why blood flow to the head and brain are improved. A typical dose is 240 mg daily, in capsule or tincture form.

One more useful circulatory stimulant that must be mentioned is cayenne pepper, or Capsicum frutescens. Cayenne is the sweetish hot spice that can be sprinkled with delicious results on fish, rice, and most vegetable dishes. A wonderful warming drink of a pinch of cayenne in fresh lemonade sweetened with maple syrup will just about cure a cold instantly! The American herbalist Dr. T.J. Lyle wrote “cayenne is the most powerful and persistent heart stimulant known… its influence reaches every organ.” Like Hawthorne it is rich in Vitamin C. Take one capsule daily, or sprinkle it regularly on your food.

As with most diseases, hypertension is likely to have mental and emotional correlates. Hypertensive patient are like overreactive sounding boards and often display increased anxiety, inappropriate coping behaviors in socially distressing situations or exaggerated dependency needs. The heart represents your center of love and security. Heart problems are thus logically associated with long-standing emotional problems such as lack of joy or belief in strain and stress. Adding a psychospiritual component to your hypertension treatment protocol (counseling geared towards resolving residual anger, fear or frustration) will help minimize disease relapse.

Bibliography

• Rudolf Fritz Weiss, MD. Herbal Medicine, Beaconsfield Arcanum, Stuttgart, Germany, 1985
• Richard Mabey. The New Age Herbalist, Macmillan Publishing Company, New York, NY, USA, 1988
• Clive Couldwell, “What Doctors Don’t Tell You” Vol. 5, No 11, London, England, February 1995
• Melvyn R. Werbach, MD, “Nutritional Indluces on Illness,” Townsend Letter for Doctors & Patients, Port Townsend, WA, USA, December 1995

A few months after her hysterectomy, Jean, a pleasant, somewhat overweight woman in her mid forties, came to see me for medical advice. She had begun a regimen of hormone replacement therapy and noticed that she got out of breath quicker than before. A physical exam quickly revealed borderline hypertension (147/96) which made her sad, but didn’t surprise her. She told me her mother had developed hypertension as soon as she began conventional menopausal hormone therapy. Although Jean was unwilling to give up hormonal therapy altogether, she was willing to try a lower dose, and with plant-based hormones. By switching over to Tri-Est with Progesterone, and quiting dairy products, she lost 20 pounds in 3 months and her blood pressure dropped to 142/91. Definitely an improvement, but more could be done. I asked her to begin a daily prescription of a potassium supplement (99 mg daily) and also take 2 grams of Hawthorne berry extract in warm water. One of her post-hysterectomy complaints (and why she wanted to get onto hormones) was memory loss, so Gingko biloba was a natural choice for Jean. I started her on 240 mg daily for 6 weeks (standardized to contain 24% gingo heterosides), and CoQ10, 100 mg daily to start, reducing the dose to 30 mg daily after a few months. I also asked her to incorporate more garlic and onions into her cooking, to help the liver break down excess fats or other potential toxins. After 3 months on this protocol she checked in again. Her blood pressure had been consistently below 140/90 for 6 weeks, and she reported that in the past 3 weeks it had rarely gone above 130/84. What this great news really means is that with minimal effort she is likely to extend her healthy life 10 or even 20 years beyond what she could have expected with untreated hypertension. Oh, by the way, when she first discovered her hypertension she resumed regular yoga classes, a life practice which had lapsed. Currently she is teaching a weekly beginner’s class to enthusiastic students!