If you suffer from hypertension, several avenues of treatment are available to you. How do you choose what is best for your unique condition? In this blog, I’ll explore the approaches to hypertension offered by Western conventional medicine, Western herbal medicine, Traditional Chinese Medicine (TCM), and East Indian Ayurvedic medicine. Each of these has a well-respected track record backed up by practice and research.

Western conventional medical approach to hypertension

Western medicine considers hypertension (HTN, or high blood pressure,) as a cardiac condition where the arterial blood pressure, the blood pumped from the heart through the arterial conduits of the body, is abnormally elevated.  A measurement is taken using a blood pressure cuff to determine systolic blood pressure (BP) and diastolic blood pressure.

Systolic pressure measures the resistance of the artery when the blood is pumped from the heart while the diastolic measures what resistance remains on the artery between systolic ‘beats’ or episodes.  Averages differ with age and other activities such as exercise, stress, etc., but a systolic pressure (the top number) consistently over 140 is a high systolic BP while a diastolic pressure (the bottom number) consistently over 90 represents a high diastolic BP reading.  Differential analysis is based on whether the condition is ‘primary hypertension’ or ‘secondary hypertension.’ Primary hypertension accounts for over 90% of HTN and is defined as having no known medical cause. Secondary hypertension accounts for the remaining HTN cases and is caused by other conditions that affect the kidneys, heart or endocrine systems.

I consider it essential to purchase a good blood pressure cuff called a sphygmomanometer at your local drug store or online. Take your blood pressure four times daily, both resting and sitting up, noting the readings each time. This should be over the course of three or four days. Then try to find an average of all the readings.

All systems of medicine regard hypertension as one of the risk factors for stroke, myocardial infarction, heart failure and arterial aneurysm. It is also considered the leading cause of chronic kidney failure. Even moderate hypertension is a known cause of shortened life expectancy. All medical systems also recognize that certain dietary and lifestyle changes will decrease hypertension and its associated risks.

Western conventional drug-based medicine may need to be employed when herbal, dietary and lifestyle approaches yield unsatisfactory results. This is one reason why seeking the guidance of a qualified medical practitioner is important.

Diuretics aside, drugs in the antihypertensive class share a similar pharmacologic action.

Commonly used prescription drugs include:

• ACE inhibitors (e.g. captopril)
• Alpha blockers (e.g. prazosin)
• Angiotensin II receptor antagonists (e.g. losartan)
• Beta blockers (e.g. propranolol)
• Calcium channel blockers (e.g. verapamil)
• Diuretics (e.g. hydrochlorothazide)
• Direct rennin inhibitors (e.g. aliskiren)

All of the above drugs come with considerable risks versus benefits.

ACE (angiotension converting enzyme) inhibitors specifically regulate intercellular and extracellular fluid in the body and reduce arterial tension. It is a standard prescription for those suffering from congestive heart failure associated with excessive fluid buildup in the system which puts an extra burden on the heart to circulate it throughout the body.

ACE inhibitors have relatively few side effects. Most are caused by low blood pressure with one of the most common being dizziness, especially upon waking, with more extreme cases accompanied with fainting spells. Other side effects can include kidney problems and persistent cough.

Combinations of an ACE inhibitor, a diuretic and a NSAID (non steroidal anti-inflammatory drug) like ibuprofen should be avoided as this has been known to cause renal failure or what in the Australian health industry is called a ‘triple whammy.’

Calcium channel blockers decrease the force of contraction of the myocardium (heart muscle), which in turn lowers the heart rate.

Besides decreasing the heart’s muscular contraction, they also slow down the electrical conduction within the heart. Calcium channel blockers should be avoided or used with extreme caution in individuals suffering from weakness of the heart muscle (cardiomyopathy).

The number of various calcium channel blocker drugs are too numerous to mention here, however they all lower what in TCM terms would be called Heart Qi, which causes the common complaint of extra tiredness and exhaustion by those taking these drugs.

Adverse symptoms from taking calcium channel blockers are generally more serious than ACE inhibitors and are divided into non-life threatening and serious.

Relatively non life-threatening include:

• Abdominal pain
• Constipation
• Drowsiness
• Fatigue
• Heart palpitations
• Flushing or hot flashes
• Nausea
• Headaches
• Sore throat
• Swelling or water retention in the extremities

The following serious or life-threatening side effects make me wonder why anyone suffering from hypertension would ever want to take such drugs, especially when more natural lifestyle, dietary and herbal alternatives could work for them.

• Chest pain
• Heart attack
• Serious low blood pressure symptoms such as dizziness, lightheadedness and fainting
• Severe water retention with difficulty breathing which can be signs of heart failure
• Depression
• Paranoia
• Breast enlargement in men (gynecomastia)
• Temporary blindness
• Various allergic reactions such as an unexplained rash, hives, itching, swelling, difficulty breathing, wheezing or swallowing

ACE inhibitors and calcium channel blockers are the two main weapons in a medical doctor’s armamentarium for the treatment of hypertension heart failure. Most doctors prescribe a combination of both in order to broaden the effect of treatment.

Western herbal approach to the treatment of hypertension

Western herbalists usually prescribe hawthorn berries and leaf as well as garlic for the treatment of hypertension. Several studies have been generated around the successful use of these herbs.

Hawthorn

Researchers in Reading, UK conducted one such trial on 79 patients with type 2 diabetes. They were randomized to receive either 1200 mg of hawthorn extract daily or placebo for 16 weeks. Medication for high blood pressure was used by 71% of the patients. At the end of 16 weeks, those taking the hawthorn supplement had a significant reduction in mean diastolic blood pressure (2.6 mm Hg) with no herb or herb drug side effects or interactions.

From a traditional Western herbal perspective, hawthorn increases blood circulation, relieves nervousness and anxiety, and from Traditional Chinese Medicine (TCM) perspective, it promotes the digestion of protein and fats. Clearly the aim here is to treat the cause rather than just the symptoms of high blood pressure. I imagine with the above study what might be achieved with a somewhat higher dose of hawthorn taken over a longer period of time than a mere 16 weeks. The same would be true for the other herbs and supplements which I will describe as follows.

Garlic

For centuries, both Mediterranean and Chinese people have used garlic to prevent and treat cardiovascular disease including hypertension.  Some research has shown that garlic can reduce hypertension by as much as 7% or 8% and even lowers blood pressure in people with normal blood pressure. Garlic has also been found to reduce blood lipids and prevent arthrosclerosis in the aged. Because garlic works partially by thinning the blood and has potential to reduce even normal blood pressure, it should not be used with those taking blood-thinning drugs and used with caution for those taking hypertensive drugs.

From an herbalist’s perspective, garlic is a virtual pharmacopeia in terms of the many benefits it has in health and healing. No wonder the old adage says, ‘Garlic treats all diseases except the one that it causes.’  It is also said that there is no remedy for garlic breath except that others should also be taking garlic. I find that garlic gently promotes blood circulation, aids digestion, prevents and reduces fluid and phlegm accumulation and is anti-inflammatory. All of these together have a powerful effect on reducing hypertension.

Fish Oil

Fish oil assists blood viscosity (aiding circulation) and is powerfully anti-inflammatory. Preliminary studies have shown that it may have a modest effect on lowering high blood pressure.

Co Q10

Coenzyme Q10, or ubiquinone, is a naturally-occurring compound found in every cell of the body, thus its name ‘ubiquinone,’ from the word ‘ubiquitous’ meaning ‘everywhere.’  From a TCM perspective Co Q10 would be an ultimate Spleen Qi tonic because of its key role in producing energy in the mitochondria of the cell which is responsible for the production of adenosine triphosphate (ATP), which acts as the cell’s major energy source, responsible for many vital biological processes including muscle contraction, which would have a direct bearing on the contractile strength of the heart and the production of protein. In addition, Co Q10 is one of the most powerful antioxidants, serving to detoxify the body, strengthen the immune system and promote maximum longevity. Based on these facts, I would deem Co Q10 as the ‘ginseng’ of natural supplements.

Based on this fact alone, one would easily see how Co Q10 could benefit heart energy, most notably congestive heart failure. Certainly anyone taking antihypertensive drugs such as ACE inhibitors and calcium channel blockers, which are notoriously associated with fatigue, would benefit from adding at least 100 to 300 mg of Co Q10 to their daily regime.

For hypertension, there is evidence that Co Q10 may help in reducing hypertension. So far only a few relatively small trials have been conducted. However these have shown that even a modest dose of 60 mg of Co Q10 taken twice daily for 12 weeks will reduce systolic blood pressure 17.8 mm Hg. Another study conducted at the University of Western Australia involving 74 people with type 2 diabetes who were give 100mg of CoQ10 twice daily for 12 weeks significantly reduced both systolic and diastolic blood pressure with a mean reduction of 6.1 mm Hg and 2.0 mm Hg respectively.

So from the above we see how a Western herbalist might address hypertension.  A more wholistic oriented Western herbalist, however, would not be simple prescribing herbs and supplements for the heart but based on individual presentation, they might treat some of the underlying causes perhaps involving the liver or the kidneys that would be part of the unique imbalance of a patient presenting with high blood pressure.

Ayurvedic Treatment of Hypertension

In Ayurveda, the traditional medicine of India, high blood pressure, as with other diseases, is treated according to tridosha or the three constitutional types: pitta (fire), vata (air) and kapha (water) types.

The pitta or fire type has a tendency towards inflammation and will exhibit a more inflammatory form of hypertension, similar to a hypertensive pattern in TCM ‘Exuberant Liver Fire’ discussed below. This type will have many other heat sensitive signs, including heat sensitivity, flushed face, red eyes, headaches, light sensitivity, anger, irritability, and possibly nosebleeds. Keep in mind that one does not have to exhibit all of these to have a mixture of different Ayurvedic forms of hypertension.

The kapha or more phlegmatic, water type may have similar symptoms to what in TCM would is described below as ‘Obstruction of Phlegm and Dampness’ type hypertension. This type might exhibit symptoms of excess weight, water retention, high cholesterol and general feelings of heaviness and fatigue.

Finally, the vata or air type is a predominant neurological type of hypertension. It may be similar in TCM to what is described as both ‘˜Yin Deficient and Yang Excess’ or ‘Yang Deficient’ type of hypertension. This individual will exhibit signs of general hypersensitivity to cold, bloating and gas, constipation, insomnia, nervousness, worry, or anxiety.

Besides recommending an appropriate pitta, kapha or vata balancing diet, specific herbal compounds would be prescribed. First and foremost Triphala, consisting of three fruits which harmonize and balance each of the three doshas, would be given. Amla fruit (Emblica myrobalan) works on the liver and lowers inflammation. Bhibitaki (Beleric myrobalan) works on the heart and cardiovascular system and reduces kapha in the form of excess fluids and blood lipids. Haritaki (Chebulic myrobalan) works on the vata or nervous system. All three are gently detoxifying and promote regular elimination.

Guggul is another Ayurvedic compound that is used because it is anti-inflammatory and promotes healthy cardiovascular circulation and reduces excess blood lipids. Finally, the Ayurvedic herb arjuna (Terminalia arjuna) is regarded as the single most effective herb for the heart and cardiovascular system generally. It relieves hypertension, lowers blood lipids, and strengthens the heart muscle for more efficient contractions. It is a virtual panacea for the heart.

Traditional Chinese Medical approach to treating hypertension

Traditional Chinese Medicine (TCM) treats according to disease and corresponding patterns. Hypertension in TCM is called Gao Xue Ya and there are four associated patterns that the TCM doctor must distinguish between.

The following is excerpted from Traditional Chinese Medicine: Pathologies and Patterns compiled and researched by John Ryan Wahnish, D, Ac., D.Ac., L.Ac.

Some if not all of the above Chinese formulas are available as a Plum Flower Brand manufactured by Mayway Herbs.  The East West Clinic carries many of these but you may also purchase them from Chinese Herbs Direct.Dietary and Lifestyle Changes for HypertensionIdeally, any practitioner treating someone for hypertension would recommend dietary and lifestyle changes including reduction of salt, less or no red meat and dairy, and limiting or cutting out sugar, alcohol and caffeine.Benefits have been found from following a high-protein or even a high animal fat diet, the ketogenic diet. There is not sufficient consensus on this extreme dietary approach and other issues associated with it. That most individuals are unable to follow it on a long-term basis is an issue to consider.High vegetable and fruit diet seems to be beneficial for most people because these serve to eliminate toxic wastes and acids that tend to build up in the body. Reduction or elimination of refined carbohydrates, especially sugar and flour, are extremely important dietary measures to take for this condition.Whenever possible the healthiest cuts of fish, meat, poultry, range-fed eggs, and unpasteurized dairy should be favored over inferior options.Other lifestyle factors should also be attended to including lessening one’s daily stress setting aside sufficient down time to recuperate. In addition one should try to include some aerobic activity a few times a week and get seven to eight hours of sleep each night. If, as with many who are older, it is difficult to sleep a full eight hours, try integrating a short afternoon nap as part of your daily routine.There are many causes and predispositions that can lead to hypertension and while most are, some are not amenable to natural herbal treatment. Again, consulting with a qualified health provider is ideal. In general, if it is not immediately life threatening, it is good to give the more natural approach to treatment a chance for one or two months before embarking on a lifetime of pharmaceutical drugs with a relatively high risk of adverse reactions.At the East West clinic, we have helped many patients suffering with hypertension. Those of you who are interested can make an appointment to consult with us personally or you can visit the East West Herb and Acupuncture clinic website at http://www.eastwestclinic.net/ and arrange for a personal telephone consultation with myself or my wife, Lesley. The East West Herb and Acupuncture Clinic is located in downtown Santa Cruz, 912 Center St. Sc. 95060. Call us at 831-429-8066.

Pathologies	Indications		Tongue/Pulse			TX Method			Formulas
EXCESS PATTERNS
Exuberant Liver Fire	Dizziness and vertigo, aching of the lower back and knees, hot feeling of the feet, palms and/or chest, palpitations, insomnia				Tongue ‘” red with little coating Pulse ‘” thin, wiry			Nourish Liver and Kidney Yin, subdue Yang			Lycii and Chrysanthemum Pills (Qi du huang wan)
Exuberant Liver Fire	Dizziness and vertigo, distending pain of the head and eyes, irritability and anger, dry bitter mouth taste, dark urine, constipation				Tongue- red with yellow coating Pulse ‘” rapid, wiry			Calm the Liver and drain Fire			Gentiana Combination (Long dan xie gan tang)
Obstruction of Phlegm and Dampness	Dizziness and vertigo, aggravated heaviness and pain of the head, irritability, nausea, oppression in the chest, low appetite, numbness and heaviness of the limbs, obesity				Tongue- enlarged with slimy white coating Pulse-slippery, wiry			Dispel phlegm, transform dampness			Pinellia and Gastrodia Combination (Ban xia bai zhu tian ma tang)
DEFICIENCY PATTERNS
Yin and Yang Deficiency		Dizziness and vertigo, aggravated by movement, blurred vision, headache, tinnitus, palpitations, shortness of breath, weakness and aching of the lower back and legs, lack of strength, numbness of the hands		Tongue ‘” light red Pulse ‘” thin, wiry			Tonify Kidney Yin and Yang			Two Immortals (Er xian tang)