A Botanical Approach To Hypertension

Hypertension—also known as high blood pressure—afflicts more than one-third of American adults. This common and serious condition can cause life-threatening diseases such as heart attack, stroke, heart or kidney failure, and more. Although drugs are the treatment of choice in conventional medicine, hypertension is primarily the result of an unhealthy lifestyle. In most cases, I find that high blood pressure can be effectively normalized with proper diet, exercise, stress management, and appropriate herbal remedies.

Last December, the Joint National Committee published new guidelines for the treatment of hypertension: If you are older than 60 years, the new guideline is to treat for a blood pressure of less than 150/90 mm Hg. If you are younger than 60 years, the goal is less than 140/90 mm Hg. For patients who have kidney disease and diabetes, the goal is 140/90 mm Hg.

It’s important to understand that hypertension is not a single condition, but rather a warning signal, and often occurs in conjunction with atherosclerosis, hyperinsulinism, obesity, diabetes, congestive heart disease, kidney disease, and anxiety. I consider hypertension to be a red flag, resulting from an underlying, identifiable, and usually correctable cause. Common prescription drugs do not address the underlying cause, have a host of side effects, and in my experience, are often not needed.

Some of the common underlying causes of hypertension:

• Atherosclerosis
• Aldosteronism (kidney/adrenal hormone that increases water retention, associated with increase in salt and licorice sensitivity; if you have normal levels of aldosterone your blood pressure will not be affected by moderate amounts of salt or licorice)
• Elevated stress hormones (excess catecholamines) and an over-stimulated central nervous system
• Renal disease or weakness
• Metabolic syndrome (hyperinsulinism)
• Sleep disorders (obstructive sleep apnea)
• Obesity
• Drug side effects (steroids, over-the-counter or prescription decongestants, weight loss drugs, caffeine)
• Diet (high in refined sugars, starches, and fats; also excess salt in the those with elevated aldosterone)
• High alcohol intake
• Lack of exercise

Mental and emotional stress is a significant contributing factor to high blood pressure and cardiovascular disease. Moderate to high levels of prolonged stress can cause the walls of blood vessels to thicken, resulting in reduced blood flow, especially to the heart’s critical coronary arteries. This increased pressure within the blood vessels forces the heart to work harder and causes certain portions to contract more vigorously or to bulge. Furthermore, the vascular resistance and coronary artery constriction caused by stress increase blood pressure, while at the same time decreasing the amount of blood available to the heart. This results in the heart being deprived of essential nutrients and increases its demand for oxygen.

The Eclectic Triphastic Medical System (ETMS) Approach

The ETMS is multidisciplinary collaborative approach for health promotion and disease prevention. The ETMS addresses hypertension by implementing the following four toolboxes:

1)   Botanical Medicine
2)   Nutritional Medicine
3)   Dietary
4)   Lifestyle (Exercise, relaxation, counseling, sleep etc.)
5)   Pharmaceutical (only to be used if cannot be controlled with 1-4)

In this post, I’m going to focus on the first four botanicals in this list: hawthorn (Crataegus oxycantha), arjuna (Terminalia arjuna), olive leaf (Olea europea), and coleus (Coleus forskohlii), all of which have therapeutic benefit for the treatment of cardiovascular disease and in particular, hypertension.

Hawthorn (Crataegus oxycantha)

Hawthorn leaf and flower, as well as the berry, have been used traditionally as a cardiac tonic; current uses include treatment for angina, hypertension, arrhythmias, and congestive heart failure. The leaves, flowers, and berries of hawthorn contain a variety of bioflavonoid-like compounds that are primarily responsible for the cardiac actions of the plant.

Clinical research has demonstrated that hawthorn extract has multi-targeted benefits for cardiovascular health. These include: 1) increased contractility of the myocardium (positive inotropic effect); 2) reduced peripheral vascular resistance (reduction in after load); 3) improved left ventricular ejection fraction; 4) improved coronary blood flow; and 5) increased tolerance of the myocardium to oxygen and substrate deficiency. In clinical trials, hawthorn extract has demonstrated a significant benefit as an adjunctive treatment for chronic heart failure. [1]

Research shows that hawthorn extract modifies left ventricular remodeling and counteracts myocardial dysfunction in early pressure overload-induced cardiac hypertrophy[2] and improves left ventricular remodeling of aortic constriction.[3]

Hawthorn exerts mild blood pressure-lowering activity, which appears to be a result of a number of diverse pharmacological effects. It dilates coronary vessels, inhibits angiotensin-converting enzyme, acts as an inotropic agent, and possesses mild diuretic activity.[4],[5],[6] Animal and human studies have also indicated that hawthorn extracts may also have potential use as anti-ischemic and lipid-lowering agents.[7]

Arjuna (Terminalia arjuna) .5% Arjunolic acid      

For centuries, Aruvedic physicians have used the powdered tree bark of arjuna (Terminalia arjuna) for treating angina, hypertension and other cardiovascular conditions. The stem bark contains glycosides, which have cardiotonic properties, and large quantities of flavonoids, which have antioxidant, anti-inflammatory, and lipid lowering effects. [8] In addition, the bark extract also has diuretic and hypotensive properties.

In study of arjuna’s influence on stable and unstable angina, researchers noted a 50 percent reduction of angina episodes in patients with stable angina after three months of treatment. A statistically significant reduction was also noted in systolic blood pressure in these patients.[9]

In several animal studies, intravenous administration of aqueous extract of arjuna resulted in a dose-dependent decrease in blood pressure, which researchers believe may occur through modification of autonomic nervous system responses.[10],[11] Arjuna has also been shown to improve cardiomyopathy[12]and animal studies suggest that arjuna can reduce blood lipids. In one study, arjuna caused a significant dose related decrease in total and LDL cholesterol compared to the placebo.[13]

Olive leaf extract (Olea europea) 20% Oleuropein           

Mediterranean countries enjoy a significantly lower incidence of cardiovascular diseases when compared to other European countries. This phenomenon has been associated with olives and olive oil, which are central components of the Mediterranean diet. Several studies have indicated that high olive oil intake reduces blood pressure.[14],[15]

The cardioprotective activity of olives is attributed to α-tocopherol, polyphenols, and other phenolic compounds, which increase the generation of vascular relaxing factors such as nitric oxide (NO) and prostacyclin. In Southern Europe, olive leaves are used as a folk remedy for hypertension.Unique compounds such as oleuropein and hydroxytyrosol found in olive leaves have been shown to reverse the chronic inflammation and oxidative stress underlying cardiovascular disease.[16]

In a recent clinical study, researchers looked at how sets of identical human twins with borderline hypertension responded to taking olive leaf extract. Identical twins were used to help keep the data consistent, because genetic differences can make people respond differently to the same treatments.

One study compared twins who took 500 milligrams of olive leaf extract a day at breakfast with a comparison group of their siblings who didn’t. A second study compared a group who took 500 milligrams a day to those who took 1,000 milligrams a day. A total of 40 people participated, aged 18 to 60. Those who took the highest daily dosage of olive leaf extract (1,000 milligrams) experienced the greatest benefits, significantly lowering their cholesterol and blood pressure when compared to the group that took 500 milligrams.

At the end of the eight-week study, the group that took 1,000 milligrams per day had dropped their systolic blood pressure (the “top” number) by an average of 11 points. The participants who received 500 milligrams of olive leaf extract dropped their systolic blood pressure by five points, and those who took no supplements saw their blood pressure edge up by two points.[17] Calcium channel inhibition was found to be one of the mechanisms involved in the blood pressure lowering effects of olive leaf extract.[18]

Coleus (Coleus forskohlii) extract 20% Forskolin

Coleus forskohlii is used in Ayurvedic medicine for a wide range of ailments, including cardiovascular disease and hypertension. Forskolin, the main active compound, is unique to coleus. The biological activity of forskolin, in part, includes the activation of the enzyme adenylate cyclase, which increases cyclic adenosine monophosphate (cAMP) in cells. Forskolin has also been shown to inhibit a number of membrane proteins and channel proteins through mechanisms independent of cAMP.  The overall effects of forskolin are muscle relaxation and inhibition of platelet activating factors (PAF). PAF plays a major role in inflammatory processes.

Forskolin’s blood pressure lowering effects appear to be the result of relaxation of arterial vascular smooth muscle. In a study with isolated heart tissue, forskolin activated membrane-bound adenylatecyclase and cytoplasmic cAMP-dependent protein kinase. Researchers postulated the positive inotropic effect was via an enhanced calcium uptake by the heart muscle cell.  Another constituent from coleus, ditermene coleonol, has also been found to lower blood pressure.[19],[20]

A good botanical and nutritional program, together with diet and life-style modifications, must address all of the factors that contribute to hypertension. The ETMS approach provides not only symptom improvement, but also has long lasting therapeutic benefits. Although stress is an inevitable part of life, it’s how we deal with it that determines the effects on our lives and our health. Ancient physical/spiritual practices such as meditation, yoga, and tai chi together with prayer are great aids in learning to cope in a healthy way with stress. When we recognize that we have choice in our response to life stressors, we can choose to take a deep breath, relax, and do the best we can in any situation without attachment to outcome.