Resources and Strategies

The Evidence-Informed Chiropractor

 

Week 6 - Hypertension

 

The most common primary diagnosis in the U.S. is hypertension. Due to the fact that hypertension is essentially a silent disorder, 30 percent of individuals are unaware s/he is hypertensive. Cardiovascular disease has been estimated to total more than $320 billion in health costs in the U.S. alone. Hypertension is a significant modifiable risk factor for cardiovascular disease.

Cherry DK, Woodwell DA. National Ambulatory Medical Care Survey: 2000 Summary. Advance Data 2002;328.

2000 Heart and Stroke Statistical Update. American Heart Association. Dallas, TX. American Heart Assoc., 1999.


   Of course, you won't find it if you don't look for it. So you must record blood pressure on every new patient.

Can conservative approaches compare to drug therapy?

 

It may surprise you that the same national committee that re-classified the different levels of hypertension also listed non-drug approaches to reducing blood pressure.

 

 Give your patient a handout with these scientifically-supported approaches and resources to support them.

Reduction in systolic blood pressure have been demonstrated with the following:

  • weight loss: 5-10 mm/Hg per 10 kg of weight loss
  • DASH Eating Plan: 8-14 mm/Hg
  • Sodium restriction: 2-4 mm/Hg
  • Physical activity: 4-9 mm/Hg
  • Moderate alcohol consumption: 2-4 mm/Hg
  •  

Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 2003;289(19):2560-2572.

       More recently, three additional approaches have been demonstrated effective

 

Slow breathing- Either by using a breathing device or self-monitoring, breathing at a rate of 10 breaths per minute for 15-20 minutes a day reduces BP by as much as 10-15 mm/Hg.

Rosenthal T, Alter A, Peleg E, Gavish B. Device-guided breathing exercises reduce blood pressure: ambulatory and home measurements. Am J Hypertension. Jan 2001;14(1):74-76.

Viskoper R, Shapira I, Priluck R, et al. Nonpharmacologic treatment of resistant hypertensives by device-guided slow breathing exercises. Am J Hypertension. Jun 2003;16(6):484-487.


Increase dietary potassium - The Institute of Medicine recommends 4.7 grams of potassium per day which is twice the U.S. average

The sources of potassium that have the greatest antihypertensive effect are fruits, vegetables, and other foods rather than supplementation. Societies who have a high potassium intake have almost no hypertension.

It has been shown that potassium supplementation also can dramatically reduce the need for antihypertension medication. In one study, 82% of individuals needed less than half of their medication dosage and 38% required no medication after a one-year follow-up.

He FJ, MacGregor GA. Fortnightly review: Beneficial effects of potassium. BMJ. Sep 1 2001;323(7311):497-501.

Siani A, Strazzullo P, Giacco A, Pacioni D, Celentano E, Mancini M. Increasing the dietary potassium intake reduces the need for antihypertensive medication. Ann Intern Med. Nov 15 1991;115(10):753-759.



 L-arginine- A study by Siani et al. indicates that a diet with foods containing L-arginine versus L-arginine supplementation had a beneficial effect on hyperlipidemia and hypertension.

Arginine is a precursor to nitric oxide which is a vasodilator. It is found in brown rice, chocolate, caffeine, nuts (e.g. walnuts, filberts, pecans, Brazil nuts, etc.), oatmeal, raisins, seeds, whole wheat bread.

The one concern is the balance between L-lysine and L-arginine especially with patients who have a viral infection (e.g. herpes).

Siani A, Pagano E, Iacone R, Iacoviello L, Scopacasa F, Strazzullo P. Blood pressure and metabolic changes during dietary L-arginine supplementation in humans. Am J Hypertension. May 2000;13(5 Pt 1):547-551.

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