Hypertension patients rejecting medicine in favor of alternatives

More and more, patients show up to appointments with hypertension expert John Bisognano, MD, PhD carrying bags full of “natural” products they hope will help lower their blood pressure. And like most physicians, Bisognano doesn’t always know if these products will do any good, or if they’ll cause any harm.

“Right now we’re seeing a cultural shift where an increasing number of people want to avoid standard pharmaceuticals,” said Dr. Bisognano, professor of medicine and director of Outpatient Cardiology at the University of Rochester Medical Center. “We’re also seeing a growing number of patients who require a large number of drugs to control their blood pressure and are looking for something else to help manage it.”

In an effort to better educate health care professionals and patients, Bisognano and Kevin Woolf, MD, a cardiology fellow at the Medical Center, conducted the most comprehensive review to date of the evidence behind a wide range of non-drug interventions for the treatment of high blood pressure. The review is featured in the September issue of the Journal of Clinical Hypertension.

“Patients have different backgrounds and different approaches to living their lives,” said Dr. Woolf. “This is where the art of medicine comes in; getting to know patients and what they will and will not embrace can help physicians identify different therapies that suit their patients’ habits and that will hopefully make a difference for them.”

Bisognano, who is a member of the editorial board of the Journal of Clinical Hypertension, and Woolf emphasize that all patients with hypertension should adhere to the low-salt, low fat, high fiber DASH diet, which includes lots of fruits and vegetables, and follow an exercise and weight loss regimen – lifestyle modifications recommended by the American Heart Association. Any alternative options should be considered for use in addition to these lifestyle changes.

Among the alternatives studied were dietary supplements, particularly the coenzyme Q10. Patients with hypertension tend to have lower levels of the enzyme, and a meta-analysis – an overarching analysis of past studies – found that treatment with coenzyme Q10 supplements significantly reduced blood pressure.

Woolf also found that potassium helps lower blood pressure, and there’s evidence that increasing the amount of potassium we get through the foods we eat could carry some of the same mild benefits as taking supplements.

The researchers also examined herbal remedies, identifying mistletoe extract, used in traditional Chinese medicine, as one herb used to treat hypertension. Mistletoe extract reduced blood pressure in animal studies, but Woolf cautions that it may be toxic at high doses. The extract from Hawthorn, a type of tree, is also used, but provides only a slight reduction in blood pressure. Conversely, Woolf uncovered a handful of herbal remedies – St. John’s wort, ephedra/ma huang, yohimbine, and licorice – that may increase blood pressure.

Finally, the researchers looked into acupuncture and meditation and concluded that while there’s no conclusive evidence that either lowers blood pressure, acupuncture does reduce blood pressure compared to placebo in patients also taking anti-hypertensive medications. Other techniques that may provide some benefit include Zen Buddhist meditation and Qi Gong.

Their examination did not include recent research into the ability of chiropractic care to reduce high blood pressure.

SOURCES: University of Rochester Medical Center press release; “Nondrug Interventions for Treatment of Hypertension,” by Kevin J. Woolf and John D. Bisognano. Journal of Clinical Hypertension, September 2011 DOI: 10.1111/j.1751-7176.2011.00524.x Abstract online