complementary and alternative therapies for hypertension

Complementary and Alternative

Therapies for Hypertension

Dr. P.Naina Mohamed PhDPharmacologist

Introduction The therapies which could be combined with conventional

medicine is termed “Complementary Medicine”. “Alternative Medicine” includes therapies that are used in

place of conventional medicine. “Complementary and Alternative Medicine” (CAM) refers

to a wide range of clinical therapies outside the conventional medicine.

“Conventional Medicine” is a type of medicine practiced by medical doctors and by allied health professionals, such as physical therapists, psychologists, and registered nurses. It is also called Western or Allopathic medicine.

“Integrative Medicine” represents a combination of conventional medicine, CAM, and evidence-based medicine.

CAM Use An US study reported that the Complementary and Alternative

Medicine (CAM) use is high and continues to increase. The most important reason cited by patients for the

supplemental CAM use is the perception that CAM is harmless. CAM use is highest in patients include

Female Nonsmokers Physically active Having normal body mass index (BMI) Eating low-fat diets with a high fruit and vegetable content Individuals aged 35 to 54 years with a high level of education.

Types of CAM Practices

Mind-Body and Manipulative Practices

Traditional Medical Systems "Modern" Medical Systems

Mind and BodyPractices

  Acupuncture and Acupressure Yoga Hypnosis Massage Meditation Reflexology Alexander technique Tai chi Spinal manipulation Therapeutic touch Guided imagery Rolfing/structural integration

Traditional Medical Systems

  • Ayurvedic medicine • Siddha medicine • Unani medicine • Native American medicine • Tibetan medicine • Traditional Chinese medicine • Curanderismo

"Modern" Medical Systems

• Homeopathy • Naturopathy • Osteopathy • Chiropractic • Anthroposophic medicine

Hypertension Hypertension (High blood pressure) is one of the most important

cardiovascular risk factors in the world. Lifestyle changes recommended for Hypertensives: The Joint National Committee on Prevention, Detection,

Evaluation and Treatment of High Blood Pressure recommends to - Reduce sodium intake Increase Physical activity Moderate alcohol consumption Lose weight Follow Dietary Approaches to Stop Hypertension (DASH) diet

CAM used for Hypertension

Mind and Body Practices Dynamic Aerobic (Endurance) Exercise Dynamic Resistance Exercise Device-Guided Slow Breathing Transcendental Meditation (TM) Biofeedback Techniques Acupuncture

Herbal Supplements Garlic, Black cumin, Cinnamon, Flaxseed, Sour Tea, Ginger, Cardamom,

Green Tea, Sweet basil, Celery, Ginseng, Saffron, Goldthread, Oats, Chinese hawthorn, Carrot, Tomato, Pomegranate, Radish, Sesame.

Dietary Supplements Coenzyme Q10, Omega 3 FAs, Melatonin, Vitamin D.

Dynamic Aerobic (Endurance) Exercise

Dynamic regular and purposeful movement of large muscle groups in moderate or vigorous activity stressing the cardiovascular system is termed Aerobic training.

Usual examples of aerobic training exercises include speed walking, jogging, running, dancing, cycling, swimming, etc.

If not contraindicated, dynamic aerobic exercise should be performed by most individuals to reduce BP.

http://hyper.ahajournals.org/content/early/2013/04/22/HYP.0b013e318293645f.full.pdf+html

Dynamic Resistance Exercise

The exercises in which the effort is performed against an opposing force accompanied by purposeful movement of joints and large muscle groups is known as Dynamic resistance exercises.

Common types include weight lifting and circuit training. Dynamic resistance exercise is reasonable to perform in clinical practice to reduce BP. http://hyper.ahajournals.org/content/early/2013/04/22/HYP.0b013e318293645f.full.pdf+html

Device-Guided Slow Breathing

The US FDA has approved one OTC device to be used in stress reduction and adjunctive treatment to reduce blood pressure.

This interactive system uses a belt around the thorax to monitor breathing rate, which feeds real-time data into a small battery-operated controller box, which in turn generates musical tones into headphones, corresponding to inspiration and expiration.

Device-guided breathing is reasonable to perform in clinical practice to reduce BP.http://hyper.ahajournals.org/content/early/2013/04/22/HYP.0b013e318293645f.full.pdf+html

Meditation Techniques

Transcendental Meditation (TM) is a technique to avoid distracting thoughts and promote a state of relaxed awareness.

The overall evidence supports that Transcendental Meditation could lower BP modestly and it might be considered in clinical practice for BP reduction.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2592323/

Biofeedback Techniques

Biofeedback is a technique by which one can improve health by controlling certain involuntary bodily processes, such as heart rate, blood pressure, muscle tension, and skin temperature.

Biofeedback may be considered in clinical practice for the reduction of blood pressure.

http://hyper.ahajournals.org/content/early/2013/04/22/HYP.0b013e318293645f.full.pdf+html

Acupuncture

Acupuncture is a key component of traditional Chinese medicine (TCM) which involves the insertion of thin needles into the body at acupuncture points.

Acupuncture is not recommended in clinical practice to reduce BP at this point of time.

http://hyper.ahajournals.org/content/early/2013/04/22/HYP.0b013e318293645f.full.pdf+html

Other Alternative Approaches

Other nonpharmacological methods useful for the reduction of BP, include… Endovascular radiofrequency renal nerve ablation Baroreceptor activation therapy with carotid

baroreceptor pacing Continuous positive airway pressure for individuals

with sleep apnea But these methods were not reviewed

systematically.

Garlic (Allium Sativum )

“Based on the evidences from some studies Garlic might lower blood pressure slightly”, says National Institutes of Health (NIH).

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266250/

Garlic (Allium Sativum )

Garlic may interact with blood thinners such as Warfarin, Clopidogrel and Aspirin.

Garlic can also interact with many other medications, including some medications used to treat HIV/AIDS.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266250/

Black Cumin - Habbatul barakah (Nigella sativa )

Black cumin (Nigella sativa) is also known as Habbatul barakah (seed of blessing). Black cumin is effective against Hypertension, Diabetes and Gastrointestinal diseases. Thymoquinone (TQ) is the major element of healing effects of Nigella sativa's seeds. Daily intake of 5 mL N. sativa seed oil lowers systolic and diastolic BPs in healthy

volunteers without adverse effects on hepatic and renal functions.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642492/

Cinnamon (Cinnamonum verum )

o A recent research has confirmed that even short-term use of cinnamon can significantly reduce blood pressure especially in Diabetics.

http://link.springer.com/article/10.1007%2Fs00424-014-1472-8

Sesame (Sesamum indicum)

Sesame contains Sesamin and Sesaminol. A study in hypertensive patients indicated that sesame oil

consumption remarkably reduced oxidative stress and simultaneously increased glutathione peroxidase, superoxidase dismutase, and catalase activities.

https://www.jstage.jst.go.jp/article/bpb/25/9/25_9_1247/_pdf

Flaxseed (Linum usitatissimum)

Flaxseed contains Omega-3 fatty acids (ALA), lignans, peptides and fiber which may reduce BP.

Flaxseed has shown antiatherogenic effects, anti-inflammatory properties, improvements in vascular contractile function, and a potent antiarrhythmic action in animal trials.

Flaxseed may protect against atherosclerotic cardiovascular disease by reducing serum cholesterol, improving glucose tolerance and acting as an antioxidant.

http://hyper.ahajournals.org/content/64/1/53.full

Sour Tea (Hibiscus sabdariffa)

Hibiscus (Roselle) is used traditionally for hypertension, fever, and other diseases.

The observed BP-lowering effect of hibiscus tea could be due to its major flavonoid components, delphinidin-3-sambubioside and cyanidin-3-sambubioside. Anthocyanins also contribute to hypotensive action.

http://jn.nutrition.org/content/140/2/298.full

Ginger (Zingiber officinale)

Ginger has been shown to improve blood circulation and vasodilation.

http://online.liebertpub.com/doi/abs/10.1089/jmf.2012.0264

Cardamom

The phytoconstituents of cardamom include Alkaloids, Flavonoids, Saponins, Sterols and Tannins.

Saponins and flavonoids might be responsible for the cholinomimetic and CCB effects.

http://www.sciencedirect.com/science/article/pii/S0378874107005478

Green Tea (Camellia sinensis )

Tea has antibacterial, anti-inflammatory, anti-cancer, anti-diabetic, as well as antihypertensive actions.

Catechins (Major flavonoids in tea) include Epicatechin (EC), Epicatechin-3-gallate (ECG), Epigallocatechin (EGC), and Epigallocatechin-3-gallate (EGCG).

http://journal.frontiersin.org/article/10.3389/fphar.2015.00323/full

Sweet basil (Ocimum basilicum)

Sweet basil (Ocimum basilicum) is a medicinal herb used in traditional Chinese medicine to treat cardiovascular diseases including hypertension. 

http://www.nature.com/hr/journal/v33/n7/full/hr201064a.html

Celery (Apium graveolens )

Celery (Apium graveolens) has long been used to treat hypertension in China.

http://online.liebertpub.com/doi/abs/10.1089/jmf.2012.2664

Ginseng (Panax Ginseng)

Ginseng also have antihypertensive parameters such as antioxidative, antiproliferative, and antiinflammatory activities.

The active principle components of ginseng include Ginsenosides (Panaxosides) and saponins.

Ginseng also plays anti-carcinogenic and antidiabetic roles.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659571/

Saffron (Crocus sativus )

Active constituents of Saffron (Crocus sativus) include crocin, picrocrocin, safranal, and crocetin.

http://journal.frontiersin.org/article/10.3389/fphar.2015.00323/full

Goldthread (Coptis chinensis )

Chinese Goldthread (Coptis chinensis) is widely used in Chinese folk medicine.

The main component of goldthread is identified as Berberine.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0059794

Oats (Avena sativa)

Whole oat cereals contain high amounts of soluble fibers, proteins, unsaturated fatty acids, vitamins, minerals, and phytochemicals.

Oats may effective against Diabetes, Cardiovascular Diseases, Obesity and certain cancers.

A diet containing soluble fiber-rich whole oats can significantly reduce both systolic and diastolic BP and decrease the need for antihypertensive medication.

http://www.ncbi.nlm.nih.gov/pubmed/11978262/

Chinese Hawthorn (Crataegus pinnatifida)

Chinese Hawthorn (Crataegus pinnatifida) has been used in China as a decoction to treat Hypertension for thousands of years.

Flavonoids and oligomeric procyanidins of Chinese Hawthorn are potent antioxidant agents.

http://link.springer.com/article/10.1007%2Fs10557-006-8723-7

Carrot (Daucus carota)

Carrot (Daucus carota) has been used in traditional medicine for the treatment of Hypertension.

Carrot contains two coumarin glycosides coded as DC-2 and DC-3 which have been shown to decrease BP.

http://www.ncbi.nlm.nih.gov/pubmed/11081994/

Tomato(Lycopersicon esculentum)

Tomato (Lycopersicon esculentum) contains antioxidants such as Lycopene, α-Tocopherol and carotenoids (Beta carotene, Phytoene, and Phytofluene).

http://link.springer.com/article/10.1007/s10557-008-6155-2/fulltext.html

Pomegranate (Punica granatum)

Research shows that pomegranate reduces the activity of angiotensin converting enzymes (ACE) by about 36%.

Pomegranate juice is rich in tannins possessing anti-atherosclerotic properties due to its potent anti-oxidative characteristics.

http://www.sciencedirect.com/science/article/pii/S0021915001004129

Radish (Raphanus sativus)

Radish is used traditionally by people in gastrointestinal, biliary, hepatic, urinary, respiratory disorders and in cardiovascular diseases such as hypertension.

Phytochemical studies show that radish contains proteins, polyphenols, flavonoids, peroxidases, isoperoxidases, alkaloids such as pyrrolidine, isoquinoline, phenethylamine and sulphuric compounds such as glucoparin and sinigrin.

http://onlinelibrary.wiley.com/doi/10.1111/j.1472-8206.2005.00382.x/full

Dark Chocolate (Theobroma cacao)

Flavonoid polyphenols such as procyanidins are major constituents of the cocoa solids.

A growing body of clinical research shows that daily consumption of 46 to 105 g daily dark or milk chocolate (T. cacao), can lower systolic BP by about 5 mmHg and diastolic by about 3 mmHg.

http://jama.jamanetwork.com/article.aspx?articleid=197169

Coenzyme Q10

Coenzyme Q10 (CoQ10) is an integral component of the mitochondrial electron transport chain in humans.

Patients with hypertension have reduced serum levels of CoQ10. Coenzyme Q10 is available over-the-counter in doses ranging from 30 to 150

mg. The usual dose of 60 to 120 mg once to 3 times daily.http://www.nature.com/jhh/journal/v21/n4/full/1002138a.html

Omega-3 Fatty Acids

According to the American Heart Association (AHA), research shows that Omega-3 Fatty Acids:

Decrease triglycerides Slow down fatty deposits inside arteries Decrease the risk of abnormal heartbeats Lower blood pressure slightly

The American Heart Association (AHA) recommends eating omega-3 fatty acids rich fish (Salmon, etc.) twice a week.

http://www.nature.com/jhh/journal/v19/n3s/full/1001957a.html

Melatonin

During night, Melatonin is secreted by the pineal gland to regulate biological circadian rhythm.

It is available to treat jet lag.http://onlinelibrary.wiley.com/doi/10.1111/j.1600-

079X.2007.00436.x/full

Vitamin D

The majority of observational data suggest that lower levels of vitamin D may be associated with a higher risk of developing hypertension.

But randomized, controlled trials have failed to confirm that vitamin D supplementation lowers blood pressure, hence additional evidence is required.

http://hyper.ahajournals.org/content/56/5/774.full

Nutritional TIPS to lower BP

Follow DASH diet emphasizing on fresh fruits and vegetables, whole grains, and low-fat dairy, and cut down on salt.

Eat antioxidant foods, including fruits (Blueberries, Cherries, and Tomatoes) and vegetables (Squash and Bell peppers).

Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains, and dark leafy greens (Spinach and kale).

Avoid refined foods, such as white breads, pastas, and especially sugar. Eat fewer red meats and more lean meats, cold-water fish, beans for protein. Use healthy oils, such as olive oil. Reduce or eliminate trans fats, found in commercially-baked goods such as

cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.

Drink 6 to 8 glasses of filtered water daily.

Conclusion

Aerobic and/or dynamic resistance exercise found to be more effective as an adjuvant treatment of Hypertension.

Most of the CVD patients prefer herbal consumption as their CAM. Herbs and plants are becoming part of evidence-based medicine in

the prevention or treatment of CVD. Always remember that dietary supplements may interact with

medications or other dietary supplements. The patients should discuss with their health care provider

regarding the use of CAM therapy. The patients should be advised not to replace their conventional

treatment with an unproven product or practice.

References Textbook of Complementary and Alternative Medicine

Chun-Su Yuan, Eric J. Bieber Evidence Based Guide to Complementary and Alternative

Medicine Bradly P. Jacobs, Katherine Gundling

Hurst's The Heart, 13eValentin Fuster, Richard A. Walsh, Robert A. Harrington

Harrison's OnlineFeaturing the complete contents of Harrison's Principles ofInternal Medicine, 18e Dan L. Longo, Anthony S. Fauci, Dennis L. Kasper, Stephen L. Hauser, J. Larry Jameson, Joseph Loscalzo, Eds.

References https://nccih.nih.gov/health/hypertension http://dietarysupplements.nlm.nih.gov/dietary/

herbIngred.jsp http://www.nlm.nih.gov/medlineplus/

highbloodpressure.html http://naturaldatabase.therapeuticresearch.com/

ce/ceCourse.aspx?s=ND&cs=&pc=10%2D108&cec=1&pm=5

References http://hyper.ahajournals.org/content/early/

2013/04/22/HYP.0b013e318293645f.full.pdf+html

http://my.americanheart.org/professional/ScienceNews/Complementary-Alternative-Therapies-for-Hypertension-Is-It-Worth-It_UCM_451496_Article.jsp