High Blood Pressure

Synopsis:

Background
Risk Factors
Dietary & Lifestyle Approaches to Managing High Blood Pressure
Nutrients to Support Healthy Blood Pressure Levels
Suggested Supplementation
References

 

High blood pressure is a silent epidemic that threatens the lives of one in every three adults. Of those taking blood pressure medications, control rates vary between less than half to only two-thirds (Lloyd-Jones 2009; Lloyd-Jones 2005). This means that the majority of those diagnosed with hypertension spend most of their day with blood pressure levels that are dangerously elevated. Since increased blood pressure is a major risk factor for heart disease, stroke, congestive heart failure, and kidney disease, it acts as an accomplice in millions of additional deaths each year (Roger 2011).

Mainstream medicine has fallen short of relieving high blood pressure. A major problem is that mainstream medicine’s definition of what constitutes acceptable blood pressure levels is far too high. Researchers have found that blood pressure levels ranging from 120-129 mmHg systolic/ 80-84 mmHg diastolic were associated with an 81% higher risk of cardiovascular disease compared to levels of less than 120/80 mmHg. Moreover, blood pressure levels of 130-139/85-89 mmHg were associated with a frightening 133% greater risk of cardiovascular disease compared to levels below 120/80 (Kshirsagar 2006). Worse yet, most people do not get treated until levels exceed 160/90 mmHg, a level that dramatically increases the risk of disease and death (Hyman 2002).

Studies have estimated that reducing blood pressure by 10/5 mmHg, to no lower than 115/75, can reduce the risk of death due to stroke by 40% and the risk of death due to heart disease or other vascular causes by 30% (Lewington 2002). In individuals 40 to 70 years old, each 20/10 mmHg increment over 115/75 doubles the risk of heart attack, heart failure, stroke, or kidney disease (Lewington 2002; Chobanian 2003). Based on this and other data, a target blood pressure of 115/75 mmHg is the best (Chobanian 2003).

The development and progression of high blood pressure is complex and multifactorial. Thus, effective management requires a broad-based approach, including lifestyle modification, nutritional components, medication(s), and regular self-monitoring. 

 

BACKGROUND

Blood pressure is a measurement of the force exerted upon blood vessel walls by blood as it flows through the arteries. High blood pressure occurs when there is an increase of force against the arterial wall, with potentially damaging consequences.

Since the heart has distinct “beats”, the pressure of oxygenated blood in the arteries is not continuous, but varies between two values, one when the heart is contracting, and one when the heart is relaxing. As the heart contracts, blood is expelled from the left ventricle under the greatest force; this upper pressure limit is the systolic blood pressure.

Blood pressure during the heart’s “resting” period between contractions, called diastole, must be sufficient to deliver an adequate supply of oxygenated blood to cardiac tissue. The diastolic blood pressure should be close to 75 mmHg for optimal health.

The alternation between systolic and diastolic blood pressure occurs with every heartbeat, about 60-80 times per minute in the average adult at rest. Clinically, blood pressure measurements are expressed, in millimeters of mercury (mmHg), as the ratio of systolic pressure over diastolic pressure (e.g., 120/80 mmHg).

For most aging individuals, an optimal blood pressure goal of 115/75 mmHg is better. 

 

How Is Blood Pressure Regulated?

Blood pressure in the circulatory system is controlled in three ways:

1. Force and rate at which blood leaves the heart (cardiac output)

• During exercise or when responding to stress, our body increases its heart beats and the force at which blood leaves the heart, resulting in a greater flow of blood and an increase in pressure.

2. Diameter and flexibility of the blood vessels though which blood flows (peripheral resistance)

• Peripheral resistance describes the increase in blood pressure caused by blood vessels themselves. Arteries actively modulate their resistance by constriction, which decreases the diameter of the vessel (vasoconstriction) and increases blood pressure, or dilation (vasodilation), which lowers resistance and blood pressure. Vasoconstriction and vasodilation are also short-term mechanisms to regulate blood pressure, and are under the control of several hormones. Aging causes arteries to lose their elasticity, which explains why the majority of aging people have above optimal blood pressure readings.

3. Total volume of blood in the circulatory system

• Increasing the amount of water in the blood increases volume and the pressure it exerts. Reducing water content lowers blood pressure. Changes in blood volume are long-term mechanisms for blood pressure control.
• Much of blood pressure control is performed by the kidneys. By controlling the balance of water and salt, the kidneys influence blood volume, lending long-term blood pressure control. The kidneys also produce hormones that act remotely to increase blood pressure through vasoconstriction of arteries. Kidney function can become impaired as people age, which is another reason why blood pressure may increase as we grow older. A major reason for kidney impairment is hypertension. Excess blood glucose is another major cause of kidney damage.

 

Hypertension is classified as Primary and Secondary based on underlying cause.

• Primary hypertension – the most frequent and preventable type, arises from a number of underlying contributing factors (Chiong 2008; Carretero 2000). Inadequate intake of nutrients including potassium, magnesium, vitamin D and vitamin K may also play a role.
• Secondary hypertension – represents only about 5-10% of hypertension cases, and results from an underlying condition, usually associated with diseases of the kidneys, endocrine, vascular, or central nervous system.

Stage 1 Hypertension (140-159/90-99 mmHg) and Stage 2 Hypertension (greater than 160/100 mmHg) differ in their conventional medical treatments, with stage 2 hypertensive patients usually requiring the most aggressive intervention using combinations of medications.

 

Hypertension, Endothelial Dysfunction & Disease Risk

High blood pressure can damage arteries at a basic level—the endothelium. Arteries are made up of 3 layers. The inner layer, or endothelium, is composed of a thin layer of cells that protects the integrity of the artery. It promotes blood clotting in case of injury, and helps prevent damaging molecules such as low-density lipoproteins (LDLs) and triglycerides from penetrating the wall of the artery. When the endothelial layer is damaged, the result can be a thickened arterial wall and the abnormal aggregation of white blood cells that ultimately leads to an atherosclerotic plaque (Versari 2009; Rocha 2010).

 

While increases in blood pressure are expected under certain conditions such as excitement, stress or physical exertion, a prolonged elevation in blood pressure can be detrimental. Prolonged high blood pressure elevates the risk of several diseases, including arteriosclerosis, stroke, chronic kidney disease/failure, peripheral arterial disease (PAD), aneurysm, and vision loss.

 

 

Advancing age, gender, family history and genetic predisposition can contribute to the development of high blood pressure. However, we cannot modify these factors.  There are other risk factors that can be addressed through preventive action. These include:

1. High sodium intake – excess sodium alters the balance between excitatory and inhibitory adrenergic receptors in such a way that favors vasoconstriction, leading to increased blood pressure (Gavras 2012). Eating too much salt also increases the risk for stroke, kidney disease, and cardiovascular disease (He 2010; Demarin 2010). Sodium intake should be limited to 2.4 grams of sodium, or 6 grams of sodium chloride (table salt) daily (Chobanian 2003).
2. Low potassium intake – Adequate potassium intake helps balance the hypertensive effects of sodium. The suggested potassium intake for adults is 4.7 grams daily, but most people consume far less.
3. Obesity and Insulin Resistance – Body weight gain accounts for as much as 75% of the risk for high blood pressure (Marion 2004). As body fat mass increases, blood volume increases as well, which contributes to increased blood pressure. Insulin resistance, which often occurs in tandem with obesity, contributes to vascular resistance and increased blood pressure (Reisin 2009).
4. Stress – Stressful situations cause the release of hypertensive hormones, such as asepinephrine. 
5. Sedentary lifestyle, smoking, and too much alcohol can all increase the risk for high blood pressure.

Two important but overlooked contributors that may play a significant role in blood pressure regulation are vitamin K and vitamin D.

• Low Vitamin D intake – Insufficient intakes of this hormone-like vitamin are implicated in the pathology of high blood pressure along with numerous other diseases (Pillz 2010).
• Low Vitamin K intake – Vitamin K is required to maintain soft and pliable arterial walls. Inadequate vitamin K intake can result in an accumulation of calcium in the arterial wall, leading to hardening of the arteries and increased peripheral resistance (Schurgers 2007). Ensuring adequate vitamin K intake allows for proper allocation of calcium into the bones to maintain skeletal integrity and away from the arterial wall.

• Weight management & increased physical activity. Body Mass Index (BMI) between 18.5 and 24.9 carries the lowest risk of hypertension. Reductions of systolic blood pressure by 5-20 mmHg per 10 kg (22 pounds) of weight loss have been observed in several studies (The Trials of Hypertension Prevention Collaborative Research Group 1997; He 2000). Regular exercise has been associated with average reductions in blood pressure of 3.2 mmHg (systolic) and 3.5 mmHg (diastolic) in thousands of subjects across many studies (Cornelissen 2005; Kelley 2000; Xin 2001).

• Limitation of alcohol consumption – this can further reduce systolic blood pressure (Xin 2001).

• Sodium restricted diet (< 1.5 grams/day) can significantly reduce blood pressure.

• Fiber. Possible mechanisms include a reduction of the glycemic index of foods and the attenuation of insulin response (insulin plays a role in blood pressure regulation). Soluble fibers may also increase mineral absorption (such as calcium, magnesium, and potassium) by several mechanisms (Greger 1999).

• Protein. Results from a comprehensive review of hypertension studies indicate an association between low dietary protein intake and elevated blood pressure (Myers 2007). A recent review of 46 studies demonstrated the effects of plant protein on reductions in blood pressure. The mechanism for the blood pressure lowering effect of protein is unclear. It may increase sodium (and water) excretion from the kidneys, increase blood concentration(s) of arginine (the precursor to nitric oxide), or improve insulin sensitivity (especially if it replaces carbohydrates in the diet) (Myers 2007).

• Caloric restriction (CR) is the chronic reduction of dietary calories (typically 30%), without malnutrition (Lane 1998). Restriction in energy intake slows down the body’s growth processes, causing a focus on protective repair mechanisms. The overall effect is an improvement in several measures of health. Reductions of systolic blood pressure (5-10 mmHg) and diastolic blood pressure (4-6 mmHg) have been observed in studies of individuals with normal and high blood pressure that adopted a caloric-restricted regimen (Fontana 2007; Lefevre 2009; Riordan 2008; Bloomer 2010).

 

 

Cardioinhibitory & Cardiotonic nutraceuticals

Magnesium 

Dozens of observational studies have demonstrated that magnesium intake is associated with lower blood pressure, and hypertensive individuals have lower intakes of magnesium than those with normal blood pressure (Mizushima 1998). Magnesium may lower blood pressure both by acting like a natural calcium channel blocker and serving as a cofactor for the production of the vasodilator prostaglandin E1 (Houston 2008).

Daily supplementation with 300 to 500 mg of elemental magnesium is vital for those taking diuretic drugs. Absorption of magnesium into the bloodstream is not particularly effective. Higher blood magnesium levels may be achieved by taking 2,000 mg of magnesium threonate daily, even though its elemental magnesium is relatively low (Slutsky 2010).

 

Hawthorn (Crataegus laevigata; Crataegus monogyna; Crataegus oxyacantha)

Hawthorn is a traditional cardiovascular tonic that has been in use since the Middle Ages. Hawthorn extracts are believed to exhibit mild blood pressure lowering activity by multiple mechanisms, including the dilation of coronary and peripheral blood vessels, inhibition of ACE, anti-oxidative and anti-inflammatory effects, and mild diuretic activity (Graham 1939; Furey 2008). It also improves cardiac oxygen consumption (Pittler 2008).

In a study, test participants receiving 1,200 mg hawthorn extract daily for 16 weeks saw a 2.6 mmHg drop in diastolic blood pressure from baseline values, while the control group saw no change (Walker 2006).

 

Regulation of blood volume

Potassium

Potassium is one of the most abundant electrolytes in the body. Due to their antagonistic roles in metabolism, the balance of sodium and potassium plays a critical role in blood pressure regulation. Potassium increases excretion of sodium from the kidneys (reducing blood volume) and reduces the sensitivity of blood vessels to vasoconstriction by angiotensin II (Krishna 1993).

Evidence from observational studies and clinical trials consistently indicate that high levels of potassium are associated with lower blood pressure (Houston 2008). Four comprehensive reviews of potassium trials report average reductions in systolic blood pressure of 2.4-5.9 mmHg and diastolic blood pressure of 1.6-3.4 mmHg when supplementing with potassium for 2-8 weeks (Cappuccio 1991; Whelton 1997; Geleijnse 2003; Dickinson 2006). The degree of blood pressure lowering appears to be dose dependent.

The adequate intake (AI) of potassium is 4.7 g daily for adults. Most adults have a median dietary intake substantially lower than this (2.8 - 3.3 g daily in men and 2.2-2.4 g daily in women) (Food and Nutrition Board 2005).

Foods rich in potassium include the following:

• Beet Greens
• Legumes/Beans (e.g. lentils, soybeans)
• Sweet Potato
• Potatoes
• Spinach
• Avocado
• Bananas
• Yogurt

 

Calcium

In addition to magnesium and potassium, population-based studies suggest a role for calcium in the prevention of hypertension, possibly through its ability to promote sodium excretion, balance the concentrations of other minerals (particularly magnesium and potassium), and its role in the activity of smooth muscle cells in blood vessels (Hamet 1995; Resnick 1991). In a review of 40 randomized controlled trials, an average daily calcium dose of 1,200 mg was associated with a reduction in systolic (1.9 mmHg) and diastolic (1.0 mmHg) blood pressure. In persons with habitually low calcium intake (< 800 mg/day), the hypotensive effect was even greater (2.6/1.3 mm Hg) (van Mierlo 2006).

 

Antioxidants

Coenzyme Q10 (CoQ10)

As a critical component of mitochondrial function and energy production, CoQ10 has a central role in proper cardiac function (Adrash 2008). Within blood vessels, CoQ10 may directly contribute to the functionality of vascular smooth muscle cells, allowing them to properly dilate (Digiesi 1992). As a lipid-soluble antioxidant, CoQ10 may quench free radicals and spare levels of vasodilatory nitric oxide (Rosenfeldt 2007).

CoQ10 (at 200 mg daily) has also been shown to improve blood pressure and blood sugar control in type 2 diabetics when combined with the cholesterol-lowering drug fenofibrate (Chew 2008). CoQ10 may lead to modest reductions in diastolic blood pressure in chronic kidney disease patients when combined with fish oil (Mori 2009).

 

Carotenoids

Epidemiological evidence suggests that the risk of hypertension decreases as the concentration of four serum carotenoids (α- and β-carotene, lutein/zeaxanthin, and β-cryptoxanthin) increases (Hozawa 2009). In addition, lycopene (a carotenoid) has demonstrated hypotensive activity in a human intervention study. A small crossover study of 31 patients with stage 1 hypertension taking 250 mg of a lycopene-enriched tomato extract for 8 weeks demonstrated significant reductions in blood pressure (-10/-4 mmHg), while no changes in blood pressure were observed during the placebo period. Thiobarbituric acid–reactive substances (TBARS), a marker oxidative stress, also decreased during the test period (Engelhard 2006).

 

Chlorogenic acid

Chlorogenic acid from green coffee (unroasted coffee beans) is a hypotensive antioxidant that likely increases the availability of nitric oxide (for vasodilation) by inhibiting enzymes that form reactive oxygen free radicals (Chen 2009). The roasting of coffee reduces the effects of chlorogenic acid on blood pressure. Still, the activity of chlorogenic acid remaining in roasted coffee is enough to counteract some of the hypertensive effects of caffeine, explaining why coffee consumption raises blood pressure less than an equivalent amount of caffeine alone (Noordzij 2005). Green coffee bean extract supplements are available to provide standardized doses of chlorogenic acid with minimal amounts of caffeine.

Two randomized controlled trials investigated the effects of different doses of chlorogenic acid on volunteers with mild hypertension. In the first, 117 male volunteers were randomized into 3 dosage groups (46 mg, 93 mg, or 185 mg) of green coffee extract versus placebo once daily for 28 days. At study end, average reductions in systolic blood pressure from baseline (4.7 mmHg and 5.6 mmHg for the medium and high dose groups, respectively) varied significantly from placebo. Differences in diastolic blood pressure from the placebo group were also observed in the medium and high dose groups (-3.2 mmHg and- 3.9 mmHg, respectively) (Kozuma 2005). The second trial, with a similar design and duration, tested four doses of green coffee bean extract standardized to chlorogenic acid (0 mg, 82 mg, 172 mg, or 299 mg) in 203 pre- and stage 1 hypertensive volunteers (male and female). Green coffee bean extract had an anti-hypertensive effect on systolic blood pressure in a dose-dependent manner (ranging from -2.7 mmHg to -3.3 mmHg for the low and high doses, respectively). Diastolic blood pressure reduction was consistent across all dosages (approximately 3 mmHg) (Yamaguchi 2008).

 

Vitamin C

Vitamin C is an essential water-soluble antioxidant vitamin in humans. It is thought to exert hypotensive effects through an improvement in endothelial function, reduction in arterial stiffness, and its ability to bind the angiotensin receptor (thereby lowering its ability to bind angiotensin II) (Leclerc 2008). Higher plasma levels of vitamin C are associated with lower blood pressure (Bates 1998). In observational studies, individuals with the highest plasma ascorbic acid (vitamin C) concentrations had 4.66 mmHg lower systolic blood pressure and 6.04 mmHg lower diastolic blood pressure than those with the lowest concentrations (Block 2008).

Intervention studies with vitamin C in hypertensive adults have shown mixed results. Several small studies have shown modest reductions in systolic (1.8 to 4.5 mmHg) and diastolic (2.8mm Hg) blood pressure at doses of 500 mg to 2000 mg daily (Mahajan 2007; Sato 2006; Ward 2005; Duffy 1999; Fotherby 2000; Hajjar 2002), while others failed to reveal significant effects (Kim 2002; Ghosh 1994; Magen 2004).

 

Vasodilators

Grape Seed Extract

Grape seed extract contains oligomeric procyanidins (OPCs) that support vasodilation through an increase in nitric oxide production and ACE inhibition (Clouatre 2010). Two 4-week studies of standardized grape seed extract (150 mg or 300 mg) in pre-hypertensive patients with metabolic syndrome demonstrated a marked reduction in systolic and diastolic blood pressure. The reduction averaged -12/-7 mmHg between the two studies and did not significantly differ between the two dosages (Siva 2006; Sivaprakasapillai 2009).

 

Pomegranate

Pomegranate contains several bioactive antioxidant polyphenols, including punicalagins. Pomegranate juice consumption (50 ml [1.7 oz.] daily) has been associated with decreases in systolic blood pressure of 8 mmHg in a 2 week study (Aviram 2001), and 21 mmHg in a 1 year study (Aviram 2004).

In addition to its potent antioxidant activity (it has been shown to reduce LDL oxidation and increase levels of the cellular antioxidant glutathione) (Aviram 2004), pomegranate polyphenols also function as ACE inhibitors. Reductions in ACE activity by 36% have been demonstrated after 2 weeks of pomegranate juice consumption (Aviram 2001).

 

L-Arginine

L-arginine, an amino acid, serves as the main raw material for the production of the vasodilator nitric oxide. Low cellular levels of L-arginine and nitric oxide are evident in individuals genetically predisposed to hypertension, likely due to inefficient transport of L-arginine across the cellular membrane (Schlaich 2004). Test diets rich in arginine-containing foods, or supplemented with arginine, demonstrated decreases in blood pressure (6.2 mmHg systolic, 5.0-6.8 mmHg diastolic) when compared to control diets in a short term human study (Siani 2000). Reductions in systolic and diastolic blood pressure were also observed in a pilot trial where kidney transplant patients were supplemented with 18 g daily of arginine (Kelly 2001), as well as in a small controlled trial with diabetic patients (Martina 2008).

 

Soy isoflavones

Soy isoflavones have been suggested to increase arterial vasodilation, improve endothelial function, and decrease blood pressure, possibly by reducing oxidative stress and increasing the availability of nitric oxide (Mahn 2005). Two analyses of 25 randomized controlled trials confirm the effect of isoflavone intake on reductions in blood pressure. In the first analysis, 14 clinical trials with 789 participants (both with normal blood pressure and pre-hypertension) revealed that a daily ingestion of 25–375 mg of purified soy isoflavones for 2–24 weeks decreased systolic blood pressure by an average of 1.92 mmHg compared with placebo (Taku 2010). Decreases in systolic blood pressure were greater in studies of longer duration (3.45 mmHg in studies longer than 3 months).

A second analysis of 11 trials (with a total of 549 participants) looked at isoflavone intake from soy protein, revealing a similar average reduction of systolic (2.5 mmHg) and diastolic (1.5 mmHg) blood pressure when compared to placebo (Liu 2011). These trials used a narrower range of isoflavone dosage (65-153mg daily). Within the trials utilized in this analysis, the blood pressure lowering effects of soy isoflavones were greatest in hypertensive patients and in trials lasting longer than 3 months.

 

Olive leaf (Olea europaea)

Olive leaf has traditionally been used to treat high blood pressure,atherosclerosis, and diabetes (Janicke 2003). The leaves contain the active compounds oleuropein and oleacein, which may function as a vasodilator and ACE inhibitor, respectively (Somova 2003). They also contain ursolic and oleanic acids, two compounds shown to promote normal heart rhythm and lower cardiac output (acting as beta blockers) in rats (Somova 2004). Olive leaf extract has also shown calcium channel-blocking activity (Scheffler 2008).

Despite traditional usage, controlled human clinical trials on olive leaf extract have, until recently, been equivocal (Cherif 1996; Scheller 1955). Two recent studies using a standardized commercial extract, however, have produced promising results. The first was an open-label, controlled study using 20 pairs of identical twins with borderline hypertension. Supplementation with 1,000 mg of olive leaf extract over eight weeks resulted in a decrease of up to 19/10 mmHg within pairs. Within pairs of subjects, differences in blood pressure could be observed at a lower dosage of 500 mg (Perrinjaquet-Moccetti 2008). In the second study, 148 stage-1 hypertensive patients were randomized to captopril (a prescription ACE Inhibitor) or olive leaf, 500 mg twice daily. After 8 weeks, mean reductions from baseline were -11.5 and -13.7 mmHg (systolic) and -4.8 and -6.4 mmHg (diastolic) in the olive leaf and captopril groups, respectively, indicating that olive leaf extract was nearly as effective as the prescription drug for lowering blood pressure. The olive leaf extract group also demonstrated reductions in serum total cholesterol (2.8%) and triglycerides (7.8%), as well as a borderline statistically significant reduction in LDL-cholesterol (2.9%) (Susalit 2011).

 

Other Hypotensive Dietary Factors

Vitamin D

Vitamin D has several direct and indirect effects on cardiovascular health. It contributes to the maintenance of blood pressure by suppressing the production of renin in the kidneys (lowering angiotensin II production) (Li 2003). It can also suppress parathyroid hormone and pro-inflammatory cytokines, which are both associated with cardiovascular disease. The endothelial cells, which line the insides of blood vessels, have receptors for vitamin D, which suggests a direct effect of vitamin D on vascular metabolism. Several observational studies have revealed an increased risk for hypertension when comparing persons with the lowest and highest vitamin D intake. An analysis of 18 studies revealed a 16% reduction in the risk of hypertension for every 16 ng/ml increase in serum vitamin D (Burgaz 2011). According to data from the National Health and Nutrition Examination Survey (NHANES), nearly 75% of light-skinned, and up to 90% of dark-skinned Americans are vitamin D insufficient (Adams 2010).

Interventions using vitamin D have demonstrated modest results for lowering blood pressure. A review of 11 randomized, controlled vitamin D intervention trials (including over 700 subjects) demonstrated a small reduction in systolic (3.6 mmHg) and diastolic (3.1 mmHg) blood pressure at daily doses of 800-2,500 IU (Witham 2009).

It is recommended that all individuals maintain a blood 25-hydroxyvitamin D level of 50 – 80 ng/ml. Doing so often requires daily supplementation with 5,000 – 8,000 IU of vitamin D. Supplemental doses should always be based upon an individual’s blood test results.

 

Vitamin K

Atherosclerosis is a leading cause of disability and death in civilized societies. Many factors are involved in the initiation and progression of atherosclerosis. Vascular assaults including homocysteine or oxidized low-density lipoprotein (LDL) can initially damage the inner arterial lining (the endothelium) (Mallika 2007). To repair this damage, the endothelium accumulates collagen that forms a cap over the injury site (Lafont 1999).

These endothelial collagen caps attract calcium that accumulates (calcifies) and forms a hard material resembling bone; this is why atherosclerosis is sometimes referred to as “hardening of the arteries.” Ultimately, this process suppresses vascular flexibility and causes narrowing of the passage through which blood must flow, leading to increased blood pressure. Calcification of the coronary arteries markedly increases heart attack risk as well (Bellasi 2007).

Studies reveal that vitamin K plays an indispensible role in the balance of calcium deposition as it relates to both skeletal and vascular health. Vitamin K ensures that adequate calcium remains in the bones for strength while keeping calcium out of the arteries to maintain flexibility (Schurgers 2001; Doherty 2003; Beulens 2008). A substantial volume of research shows that insufficient vitamin K2 accelerates arterial calcification (Beulens 2008). Animal models indicate that supplemental vitamin K is able to reverse arterial calcification (Schurgers 2007).

 

Garlic

Garlic’s promotion of cardiovascular health has been substantiated by several human trials, particularly its hypotensive activity and ability to induce favorable blood lipid profiles. Garlic also reduces systolic and diastolic blood pressure in hypertensive individuals, as well as systolic blood pressure in persons with normal blood pressure. A recent review and analysis of 11 controlled human trials showed a mean systolic decrease of 4.6 mmHg in the garlic group compared to placebo, while the mean decrease in hypertensive subjects was 8.4 mmHg for systolic and 7.3 mmHg for diastolic (Ried 2008).

 

Fish Oil

Fish oil is a source of the omega-3 fatty acids Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA). EPA and DHA are made to a very limited degree in the human body from alpha-linolenic acid, but are essential for several metabolic processes. Aside from reductions in the risk of cardiovascular mortality and non-fatal cardiovascular events (Marik 2008), fish oil fatty acids show reductions in blood pressure. In an analysis of 36 clinical trials on the effects of omega-3 supplementation in over 2,000 individuals with normal and high blood pressure, a median intake of 3.7 g daily of fish oil demonstrated an average blood pressure reduction of 2.1 mmHg (systolic) and 1.6 mmHg (diastolic) (Geleijnse 2002). The effects were greater in hypertensive individuals, with average reductions of 4 mmHg (systolic) and 2.73 mmHg (diastolic). Omega-3 fatty acids from fish oil have also demonstrated modest hypotensive activities in diabetic patients. A review and analysis of five small randomized controlled trials revealed a mean blood pressure reduction of 1.69/1.79 mmHg (Hartweg 2007).

Sesame lignans (including sesamin and sesamolin) are found in sesame seeds and present in sesame oil. Several animal studies have reported that sesame lignans suppress the development of hypertension (Matsumura 1998; Kita 1995; Nakano 2002). When used as a substitute for other types of cooking oil, sesame oil (about 35 g daily as part of meal preparation) exhibited significant reductions in systolic (20 mmHg) and diastolic (18 mmHg) blood pressure in 40 middle-aged, diabetic, hypertensive patients after a period of 45 days. These changes disappeared after switching back to groundnut or palm oil (Sankar 2006). A larger study of similar design (356 hypertensive patients on the calcium channel blocker nifedipine) produced similar reductions in systolic and diastolic blood pressure from baseline values. Sesame oil further increased the hypotensive efficacy of nifedipine (reducing blood pressures by an average of almost 15/10 mmHg over the drug alone) (Sankar 2005). A small randomized controlled trial of purified sesamin supplementation (30 mg, 2 times daily for 4 weeks) in 25 middle aged, pre-hypertensive subjects decreased systolic blood pressure by 3.5 mmHg and diastolic by 1.9 mmHg (Sankar 2005).

Sesame lignans may lower blood pressure due to their suppression of the vasoconstrictor 20-hydroxyeicosatetraenoic acid (20-HETE). A 30% reduction in 20-HETE levels has been observed in humans after 5 weeks of sesamin supplementation (39 mg daily) (Wu 2009). Sesame lignans may also lower blood pressure through antioxidant activity (sparing nitric oxide from oxidation) (Miyawaki 2009).

 

Whey protein peptides

Whey protein peptides have antioxidant potential and display blood pressure lowering properties (Chitapanarux 2009; Laviolette 2010; Marshall 2004). They also contribute to blood vessel relaxation and reduced “stiffness” (Pal 2010). The discovery that antioxidant status directly affects angiotensin availability further explains how whey proteins may fight elevated blood pressure (Zhou 2010). Human studies of whey-rich or whey-enriched milk products demonstrate convincing reductions in blood pressure compared with placebo- or casein-supplemented patients (Pal 2010; Kawase 2000; Pins 2006).

In recent years, scientists have found that whey proteins exert substantial direct angiotensin-converting enzyme (ACE)-inhibiting effects (Vermeirssen 2002; Manso 2003; Vermeirssen 2003). In the human stomach and intestine, some whey protein breaks down into very specific short amino acid chains (peptides) that function as efficient ACE-inhibitors (Abubakar 1998; Parrot 2003; Vermeirssen 2002). Laboratory studies consistently show that blood pressure is reduced in hypertensive animals given whey protein derivatives (Yamamoto 1999; Costa 2005). This effect is attributed, in part, to ACE inhibition. The ACE-inhibitory effect is substantially less powerful than those of prescription drugs. However, some people encounter side effects with those drugs (FitzGerald 2004). Whey protein derivatives, by contrast, can be used for long periods of time without adverse side effects. Other studies suggest that these active milk components also inhibit the release of other vessel-constricting molecules such as endothelin-1, offering a second pathway for blood Pressure Control (Maes 2004).

 

 

High blood pressure is very dangerous.  A multi-modal approach, combining dietary changes, increased exercise, nutritional supplements, and pharmaceutical drugs should be utilized to maintain blood pressure as close to 115/75 mmHg as possible for optimal protection.

While a number of nutrients have shown varying degrees of blood pressure lowering effects, many aging people will require at least one class of anti-hypertension prescription medication(s). Lifestyle modification and nutritional supplementation may enable a lower dose of anti-hypertensive drug(s) or elimination of medication if 24-hour blood pressure readings of 115/75 mmHg are achieved.

Cardioinhibitory And Cardiotonic Nutrients (Controlling the force at which the heart pumps)

• Magnesium: 350 – 1500 mg daily
• Hawthorn Berries: 2 – 3 g daily

Regulation of Blood Volume (Blood is mostly water, so its volume is dynamic – therefore interventions that help control water storage can modulate blood pressure as well)

• Potassium: 99 mg daily (or more) when instructed to do so by a health care professional, based on blood test results.
• Calcium: 1000 – 1200 mg daily

Antioxidants (Reducing oxidative stress helps maintain the ability of blood vessels to dilate, a critical step in blood pressure regulation)

• Coq10: 100 – 300 mg daily (ubiquinol form of coenzyme Q10)
• Lycopene: 15 – 30 mg daily
• Green Coffee: standardized extract: 400 – 1200 mg daily
• Vitamin C: 1000 – 2000 mg daily

Vasodilators (Compounds that enhance the production or activity of nitric oxide and help the blood vessels dilate, allowing for a reduction in blood pressure)

• Grape extract (containing seed and skin extracts): 150 mg daily
• Pomegranate extract: standardized to 30% punicalagins: 400 mg daily
• L-arginine: 1600 mg three times daily between meals
• Soy Isoflavones: 135 – 270 mg daily
• Olive Leaf Extract: 500 – 1500 mg daily

Other Hypotensive Dietary Factors

• Vitamin D: 5000 – 8000 IU daily (depending on blood test results)
• Vitamin K: 2100 mcg daily (as 1,000 mcg K1; 1000 mcg MK-4; and 100 mcg MK-7)
• Garlic; standardized extract: 1500 – 6000 mg daily
• Fish Oil (with sesame lignans and olive polyphenols): 2000 – 4000 mg daily

Whey Protein Peptides: 1700 – 3400 mg daily

 

 

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