What is behind the new guidelines for treatment of high blood pressure?

In case you missed it, last week new classifications of high blood pressure and guidelines for treatment were released by the National Heart, Lung, and Blood Institute (NHLBI). When I read the newspaper accounts the changes seemed reasonable, but I was totally disgusted when I read the actual article in JAMA the Journal of the American Medical Association.1 Let me first explain the recommendations and then explain why I am convinced the move is simply designed to put more people on drugs.

For more than 3 decades the NHLBI has coordinated a coalition of major professional organizations and federal agencies to increase awareness, prevention, treatment, and control of high blood pressure. The latest report, "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" (JNC 7) was deemed necessary based the publication of many new clinical trials since the sixth version was released 6 years ago.

High blood pressure is a major risk factor for heart disease and the chief risk factor for stroke and heart failure, and also can lead to kidney damage. It affects about 50 million Americans - about one in four adults and roughly half of the people over 65 years old. With the new classification of "prehypertension" level another 45 million persons are candidates for drug therapy - but, there is a better way.

While I agree 100% with the rationale behind the new classification and the importance of an optimal blood pressure below 120/80, what I am totally against are the practical guidelines that overstress the use of drugs rather than focus on diet, lifestyle, and appropriate supplementation. Giving people drugs to lower blood pressure is not the best first step at all. Diet, lifestyle modification, and proper supplementation should be the first steps. If they are unsuccessful, then drugs should definitely be used.

Essential hypertension is a ridiculous term

Most people with high blood pressure will be told by their physician that they have "essential" hypertension. The term "essential" is used to designate that the origin or cause of a particular disease is unknown. Essentially, I think that the term essential hypertension is utterly ridiculous. High blood pressure is clearly the result of factors that lead to hardened, less compliant arteries or factors that disrupt the kidneys ability to regulate fluid volume.

When the arteries become hard due to the build-up of plaque containing cholesterol, blood pressure rises. Therefore, it is very important to prevent atherosclerosis (hardening of the arteries). Just like other degenerative diseases including atherosclerosis, the development of high blood pressure is closely related to lifestyle and dietary factors. Some of the important lifestyle factors which may cause high blood pressure include stress, lack of exercise, and smoking. Some of the dietary factors include: obesity; high sodium to potassium ratio; low fiber, high sugar diet; high saturated fat and low omega-3 fatty acid intake; and a diet low in calcium, magnesium and vitamin C. These same factors are known to also impact the ability of the kidneys to regulate fluid volume and control blood pressure.

Diet in the treatment of hypertension

The "Dietary Approaches to Stop Hypertension" (DASH) clinical studies were funded by the NHLBI to fully evaluate the efficacy of a system of dietary recommendations in the treatment of hypertension. The DASH diet is rich in fruits, vegetables, and low fat dairy foods, and low in saturated and total fat. It also is low in cholesterol, high in dietary fiber, potassium, calcium, and magnesium, and moderately high in protein.

The first study showed that a diet rich in fruits, vegetables, and low-fat dairy products can reduce blood pressure in the general population and people with hypertension.2 The original DASH diet did not require either sodium restriction or weight loss--the two traditional dietary tools to control blood pressure--to be effective.3 The second study from the DASH research group found that coupling the original DASH diet with sodium restriction is more effective than either dietary manipulation alone.31 In the first trial, the DASH diet produced a net blood pressure reduction of 11.4 and 5.5 mmHg systolic and diastolic, respectively, in patients with hypertension. In the second trial, sodium intake was also quantified at a "higher" intake of 3,300 milligrams per day; an "intermediate" intake of 2,400 milligrams per day; and a "lower" intake of 1,500 milligrams per day. Compared to the control diet, the DASH diet was associated with a significantly lower systolic blood pressure at each sodium level. The DASH diet with the lower sodium level led to a mean systolic blood pressure that was 7.1 mmHg lower in participants without hypertension, and 11.5 mmHg lower in participants with hypertension. These results are clinically significant and indicate that a sodium intake below the recommended level of 2,400 mg daily can significantly and quickly lower blood pressure.

Natural products to lower blood pressure

There is a new product that I hope will do as much good for people with high blood pressure as glucosamine sulfate did for people with osteoarthritis. The product is anti-ace peptides - a purified mixture of 9 small peptides (proteins) derived from muscle of the fish bonito (a member of the tuna family). I feature an article on this natural product on my website. Basically, anti-ACE peptides works to lower blood pressure by inhibiting ACE (angiotensin converting enzyme). This enzyme converts angiotensin I to angiotensin II - a compound that increases both the fluid volume and the degree of constriction of the blood vessels. If we use a garden hose model illustrate the pressure in your arteries, the formation of angiotensin II would be similar to pinching off the hose while turning up the faucet full blast. By inhibiting the formation of this compound, Anti-ACE Peptides relax the arterial walls and reduce fluid volume. Anti-ACE Peptides exert the strongest inhibition of ACE reported for any naturally occurring substance available.

Three clinical studies have shown Anti-ACE Peptides exert significant blood pressure lowering effects in people with high blood pressure (hypertension).4-6 The material appears to be effective in about two thirds of people with high blood pressure - about the same percentage as many prescription drugs. (NOTE: People who do not respond to Anti-ACE Peptides after a two month trial should try Celery Seed Extract). The degree of blood pressure reduction in these studies was quite significant, typically reducing the systolic by at least 10 mm Hg and the diastolic by 7 mm Hg in people with prehypertension and Stage 1 hypertension. Greater reductions will be seen in people with higher initial blood pressure readings.

Classification and Recommended Treatments For Stages of Hypertension

† Smoking, high cholesterol, age over 60, or family history of heart disease
†† Diabetes, stroke, retinopathy, peripheral arterial disease, nephropathy, or clinical signs of heart disease

Level 1 Support

• Foundational supplements (Natural Factors products)
  • MultiStart multiple vitamin and mineral formula
  • Enriching Greens - one serving daily
  • RxOmega-3 Factors - 2 capsules daily
• Potassium chloride 1,500 to 3,000 mg (use NuSalt or NoSalt salt substitutes to achieve dosage)
• Magnesium 150 to 400 mg three times daily
• ProMannan: 1,000 mg before meals three times daily
• Garlic: 4,000 mcg of allicin (I recommend Garlic Factors from Natural Factors)

  If after 2 months if there is no change add anti-ACE fish peptides: 1,500 mg daily. If after 2 months there is still no change, discontinue anti-ACE fish peptides and replace with celery seed extract: 150 mg daily.

Level 2 Support

• All of the above plus:
• Anti-ACE fish peptides: 1,500 mg daily

  If after 2 months if there is no change add celery seed extract: 150 mg daily. If there is still no change, add Coenzyme Q10: 100 mg daily. If the blood pressure has not dropped below 140/105, you will need to work with a physician to select the most appropriate medication. If a prescription drug is necessary, a diuretic alone is often the first recommendation

Consult a physician immediately. A drug may be necessary to achieve initial control calcium channel blockers or ACE inhibitors alone or in combination with a diuretic appear to be the safest when Level 3 Support is required. Follow the supplement recommendations given for Level 2 Support. When satisfactory control over the high blood pressure has been achieved, work with the physician to taper off the medication.

Key References:

1. 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. see http://jama.ama-assn.org/cgi/content/full/289.19.2560v12560.
2. Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 1997; 336:1117-24.
3. Moore TJ, Conlin PR, Ard J, Svetkey LP. DASH (Dietary Approaches to Stop Hypertension) diet is effective treatment for stage 1 isolated systolic hypertension. Hypertension 2001; 38:155-8.
4. Fujita H, Yamagami T, Ohshima K. Effect of an ace-inhibitory agent, katuobishi oligopeptide, in the spontaneously hypertensive rat and in borderline and mildly hypertensive subjects. Nutr Res 2001;21:1149-58.
5. Fujita H, Yasumoto R, Hasegawa M, Ohshima K. Antihypertensive activity of "Katsuobushi Oligopeptide" in hypertensive and borderline hypertensive subjects. Jpn Pharmacol Ther 1997;25:147-51.
6. Fujita H, Yasumoto R, Hasegawa M, Ohshima K. Antihypertensive activity of "Katsuobushi Oligopeptide" in hypertensive and borderline hypertensive subjects. Jpn Pharmacol Ther 1997;25:153-7.