Hypertension is the most common chronic disease in older women and a significant risk factor for stroke, heart attack, congestive heart disease, and kidney disease. Beginning at age 50, hypertension is more common in women than in men and even more so in black women. Heart disease and stroke remain the first and third leading causes of death, respectively, in the United States.

The most recent national recommendations define incipient hypertension at readings of 140/90mm Hg. Blood pressure readings fairly consistently above these require treatment. Hypertension is divided into two main categories: essential or primary hypertension and secondary hypertension. Over 90% of all diagnosed hypertension is essential, meaning that the underlying mechanism is unknown. In the remaining 6-8%, hypertension is secondary to another disease.

The goal of prevention and management of hypertension is to reduce disability and death by the least intrusive method possible. These goals may be reached with lifestyle modification, herbal and nutritional anti-hypertensives, or pharmacologic intervention.

Lifestyle Modifications

Lifestyle changes have the potential to prevent hypertension, lower blood pressure, and reduce other cardiovascular risk factors. Even if lifestyle changes alone are not satisfactory in controlling hypertension, these changes, along with nutritional supplementation and botanical therapies may be able to adequately treat the situation, or just lifestyle changes may reduce the number and dosage of antihypertensive medications needed. Lifestyle modifications for prevention and management of hypertension include:

• Lose weight if overweight. (Weight reduction of as little as 10 pounds reduces blood pressure in a significant number of individuals who are overweight with hypertension.)
  
• Limit alcohol intake to no more than .5 oz ethanol or 12 oz beer or 5 oz wine or 1 oz 100 proof whiskey per day.
  
• Increase aerobic activity to 30-40 minutes 4 or more times per week
  
• Reduce sodium to no more than 2.4 grams of sodium or 6 grams of sodium chloride per day
  
• Maintain adequate intake of dietary potassium.
  
• Maintain adequate intake of dietary calcium and magnesium.
  
• Stop smoking. Cigarette smoking is a significant risk factor for cardiovascular disease. Blood pressure rises with every cigarette smoked.
  
• Reduce intake of saturated fats in the diet and high cholesterol foods. Although altering ones intake of fats dose not seem to have much effect on hypertension, abnormal cholesterol ratios are a major independent risk factor for coronary artery disease.
  
• Reduce caffeine; caffeine may raise blood pressure; however, no direct relationship between caffeine intake and hypertension has been found in most diet surveys.
  
• Mental/emotional stress can acutely raise blood pressure and if prolonged, can contribute to chronic high blood pressure.
  
• Exercise regularly. Blood pressure can be lowered with moderately intense physical activity, and 30-45 minutes most days of the week. Regular aerobic physical activity can reduce the risk for cardiovascular disease and mortality.
  

Nutritional Supplementation

Calcium - Most population studies have indicated that individuals with hypertension consume less dietary calcium than individuals with a normal blood pressure.

Magnesium - On the average, patients with long-term hypertension have at least a 15 percent deficit in total magnesium. Pregnant women with labor-induced hypertension have decreased blood levels of magnesium. Magnesium also improves cardiac performance by enhancing blood flow in the coronary arteries, prevents oxidation of lipoproteins and subsequent atherosclerosis. Therapeutic doses of magnesium range from 400 mg to 1200 mg per day.

Potassium - In addition to increasing the potassium foods in our diet, several studies now show that potassium supplementation can reduce blood pressure. It has been shown that potassium supplementation of 2.5 grams per day can lower the systolic blood pressure an average of 12 points and diastolic blood pressure an average of 16 points. Potassium supplementation may be even more beneficial in people over age 65 who often do not respond well to anti-hypertensive drugs.

Coenzyme Q10 - CoQ10 deficiency is present in almost 40 percent of patients with high blood pressure. In several studies, CoQ10 has been able to lower blood pressure in hypertensive patients after four to twelve weeks. Typical reductions are in the range of 10 percent for both systolic and diastolic blood pressure. These reductions can be seen with doses of 50 mg three times per day.

Essential fatty acids - The daily consumption of fish oils can lower blood pressure in people with hypertension.   The consumption of 3 grams or more per day of fish oil led to reductions in blood pressure of individuals with hypertension. The effect was found to be greater at higher blood pressures, and no significant effects were noted in people with normal blood pressure. Fish oil supplements usually provide 180 mg of eicosapentaenoic acid (EPA) and 120 mg of docosahexaenoic acid (DHA) in one capsule, although higher potency supplements are now available. The fish-oil supplements used in most studies have generally been 4 capsules three times per day, providing approximately 4 grams of fish oil.

Garlic (Allium sativum) - Garlic mildly lowers blood pressure in women with hypertension. Studies have shown that garlic can lower systolic pressure by 20-30 mm Hg and the diastolic pressure by 10-20 mm Hg. The majority of studies utilizing a garlic powder tablet provide from 600 to 900 mg of garlic. Capsules that contain 5,000 mcg of allicin are generally considered more potent.

Hawthorne (Crataegus oxyacantha) - Hawthorne preparations have been effective in lowering blood pressure and in improving heart function. Although its blood pressure lowering effects should be considered mild, hawthorn is a valuable heart medicine. It can prevent and treat atherosclerosis, lower cholesterol, prevent the oxidation of LDL, improve the blood supply to the heart by dilating the coronary arteries, increasing the force of contraction of the heart muscle and regulating cardiac rhythm.

Additional herbs - Numerous other herbs are used in traditional herbal medicine to bring about either a diuretic effect, a calming effect as in the use of nervines, aids to circulation and heart tonics. Some of these herbs include dandelion leaf, lily of the valley and parsley as diuretics. Heart tonics such as motherwort and night-blooming cactus are frequently used along with hypotensive and diuretic herbs in a combination formula. Herbs such as hawthorn, ginger and cayenne are aids to circulation and herbs such as valerian, chamomile, hops, lemon balm and passion flower help to have a calming effect, enabling individuals to respond to stress better.

Lifestyle and herbal/nutritional treatments are a reasonable first line of intervention for mild to moderate high blood reassure. Blood pressures in this range can usually respond to these natural interventions generally without pharmaceutical intervention. Blood pressure must be monitored, and a lack of response within two months, or blood pressures fitting the definition of stage III hypertension should be treated with pharmaceuticals, with natural therapies and lifestyle as an adjunct.

References available on request.

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