High blood pressure or hypertension is classified as either Primary or Secondary elevation in either systolic and/or diastolic blood pressure.  In a database search of the prevalence of hypertension worldwide, overall, 26.6% of adult men and 26.1% of adult women had hypertension in 2000, and by 2025, 29.0% of men and 29.5% of women are projected to have hypertension. The estimated total number of adults with hypertension in 2000 was 972 million; 330 million in economically developed countries and 639 million in economically developing countries. The number of adults with hypertension in 2025 was predicted to increase by about 60% to a total of 1.56 billion. More than one-quarter of the world's adult population, which is approximately 1 billion, had hypertension in the year 2000, and this will increase to 1.56 billion by the year 2025. Men and women have similar overall prevalence of hypertension.

Causes

High blood pressure is characterized by a diastolic reading above 90 mm/Hg., and a  systolic reading above 140 m/Hg., or both. There are two types of hypertension:  Primary (aka Essential or Idiopathic) and Secondary.

Primary high blood pressure (1°):  high blood pressure with no discernible cause; conventionally, about 89% of cases are considered to be in this category.   However, many factors are implicated in the development of primary or essential high blood pressure. Some of the  recognized risk factors include family  history, environment (family size, crowding,  eating patterns, occupation,  obesity), salt ingestion and sensitivity (there is  controversy over whether the  sodium or chloride part of the salt molecule is the  principal factor), race  (blacks have more primary hypertension and more morbidity and  mortality than  whites), hyperlipidemia, smoking, diet

• sympathetic nervous system compensation in response to pancreatic  hypoglycemia:  usually will fluctuate; in the morning it will be better and in the afternoon it will be worse
• epinephrine compensation in response to severe pancreatic hypoglycemia: the  patient will seem like they are calm outside but really tense inside. They will tend to have increasing blood pressure as the day goes on.
• Obese high blood pressure: may be hormonal, hormonal with adrenal compensation,  hormonal  with liver compensation, or adrenocortical compensation
• renal high blood pressure: divided into renovascular (pre-eclampsia and   eclampsia), and renal parenchymal (blockage of a renal artery  causing  decreased renal perfusion which results in the kidneys activating the  renin-angiotensin pathway)
• endocrine high blood pressure: this includes adrenal high blood pressure (primary  aldosteronism,  Cushing's syndrome, and pheochromocytoma), acromegaly,  hypercalcemia, and oral  contraceptives (probably the most common cause of  secondary hypertension).
• coarctation of the aorta

•"Blood Pressure and Risk of Cardiovascular Disease in Chinese Men and Women," Gu D, Kelly TN, et al, Am J Hypertens, 2008 Jan 10

Medicine

•"Nonprescription Drugs and Hypertension: Which Ones Affect Blood Pressure?", Bradley, John G., M.D., Postgraduate Medicine, May 1991;89(6):195-202

Laboratory Tests

•"C-Reactive Protein and the Risk of Developing Hypertension," Sesso HD, Buring JE, et al, JAMA, December 10, 2003;290(22):2945-2951

•"C-reactive protein is elevated in the offspring of parents with essential hypertension," Diaz JJ, Arguelles, et al, Arch Dis Child, 2007; 92(4): 304-8

•"Association of Serum Lipoprotein (a) Levels and Apolipoprotein (a) Size Polymorphism With Target-Organ Damage in Arterial Hypertension," Sechi, Leonardo A., M.D., et al, JAMA, June 4, 1997;277(21):1689-1695

•"High Homocysteine Levels Are Independently Related to Isolated Systolic Hypertension in Older Adults," Sutton-Tyrrell, Kim, Dr.P.H., et al, Circulation, September 16, 1997;96(6):1745-1749.

Lifestyle

Lifestyle Modifications

•"Risk factors for early myocardial infarction in South Asians compared with individuals in other countries," Joshi P, Islam S, et al, JAMA, 2007; 297(3): 286-94

•"Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial," Elmer PJ, Obarzanek E, et al, Ann Intern Med, 2006; 144(7): 485-95

•"Impact of dietary and lifestyle factors on the prevalence of hypertension in Western populations," Geleijnse JM, Grobbee DE, Kok FJ, J Hum Hypertens., 2005; 19 Suppl 3: S1-4

Rural Lifestyle

•"Indian Consensus for Prevention of Hypertension and Coronary Artery Disease," Singh, R. B., Journal of Nutritional and Environmental Medicine, 1996;6:309-318

Diet and Nutrition

DASH Diet

•"Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet," Sacks FM, Svetkey LP, Vollmer WM, et al, N Engl J Med, January 4, 2001;344(1):3-10

•"The efficacy of a clinic-based behavioral nutrition intervention emphasizing a DASH-type diet for adolescents with elevated blood pressure," Couch SC, Saelens BE, et al, J Pediatr, 2008; 152(4): 494-501

•"Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women," Fung TT, Chiuve SE, et al, Arch Intern Med, 2008; 168(7): 713-20

Mediterranean Diet

•"Mediterranean Diet, Alzheimer Disease, and Vascular Mediation," Scarmeas N, Stern Y, et al, Arch Neurol., Oct 9

•"The Mediterranean diet and incidence of hypertension: the Seguimiento Universidad de Navarra (SUN) Study," Nunez-Cordoba JM, Martinez-Gonzalez MA, et al, Am J Epidemiol, 2009; 169(3): 339-46

Nordic Diet

•"Effects of a healthy Nordic diet on cardiovascular risk factors in hypercholesterolaemic subjects: a randomized controlled trial (NORDIET)," Adamsson V, Riserus U, et al, J Intern Med, 2010, Sept 10

Vegetarian Diet

•"Vegetarian Diets, Alcohol Consumption, and Hypertension", Beilin, L.J., Annals of the New York Academy of Sciences, 1993:83- 91

•"Vegetarian and Other Complex Diets, Fats, Fiber and Hypertension", Beilin, Lawrence, The American Journal of Clinical Nutrition, 1994;59(Suppl.):1130S-5S

Paleolithic Diet

•"Biological and Clinical Potential of a Paleolithic Diet," Lindeberg S, Cordain L, Eaton SB, J Nutr Environ Med, September 2003;13(3):149-160

Vegetables, Fruits and Whole Grains

•"Dietary Changes Modulate Blood Pressure and Blood Lipids in Hypertension", Singh, R.B., M.D., et al, Journal of Nutritional Medicine, 1991;2:17-24

Vegetables and Fruits

•"Role of vegetables and fruits in Mediterranean diets to prevent hypertension," Nunez-Cordoba JM, Alonso A, et al, Eur J Clin Nutr, 2008 Feb 27

•"Fruit and vegetable consumption and the risk of hypertension determined by self measurement of blood pressure at home: the Ohasama study," Utsugi MT, Imai Y, et al, Hypertens Res, 2008; 31(7): 1435-43

•"Dietary patterns and blood pressure change over 5-y follow-up in the SU.VI.MAX cohort," Dauchet L, Hercberg S, et al, Am J Clin Nutr, 2007; 85(6): 1650-6

Fruits

•"Fiber and Fruit Protects Against Hypertension", Faivelson, Saralie, Medical Tribune, November 26, 1992;33(22):1

•"Favorable effects of berry consumption on platelet function, blood pressure, and HDL cholesterol," Erlund I, Koli R, et al, Am J Clin Nutr, 2008; 87(2): 323-31

Whole Grains

•“Whole grains and incident hypertension in men,” Flint AJ, Rimm EB, et al, Am J Clin Nutr, 2009 Jul 1

•"Whole- and refined-grain intakes and the risk of hypertension in women," Wang L, Gaziano JM, et al, Am J Clin Nutr, 2007; 86(2): 472-9

•"Whole-grain diets reduce blood pressure in mildly hypercholesterolemic men and women," Behall KM, Scholfield DJ, et al, J Am Diet Assoc, 2006; 106(9): 1445-9

Lean Animal Proteins

•"Partial substitution of carbohydrate intake with protein intake from lean red meat lowers blood pressure in hypertensive persons," Hodgson JM, Burke V, et al, Am J Clin Nutr., 2006; 83(4): 780-7

Plant Proteins

•"Vegetable protein and fiber from cereal are inversely associated with the risk of hypertension in a spanish cohort," Alonso A, Beunza JJ, et al, Arch Med Res., 2006; 37(6): 778-86.

•"Association between protein intake and blood pressure: the INTERMAP Study," Elliott P, Stamler J, et al, Arch Intern Med, 2006; 166(1): 70-87

Nuts

•"Nut consumption and risk of hypertension in US male physicians," Djousse L, Rudich T, Gaziano JM, Clin Nutr, 2008 Sept 30

Protein & Mono-unsaturated Fats

•"Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial," Appel LJ, Sacks FM, et al, JAMA, 2005; 294(19): 2455-2464

Eating Breakfast

•"Dietary intake of whole and refined grain breakfast cereals and weight gain in men," Bazzano LA, Song Y, et al, Obes Res, 2005; 13(11): 1952-60

Vitamins and Minerals Deficiencies

•"Lowered Risks of Hypertension and Cerebrovascular Disease After Vitamin/Mineral Supplementation: The Linxian Nutrition Intervention Trial," Mark, Steven, D., et al, American Journal of Epidemiology, 1996;143(7):658-64

•"Multivitamin supplementation of HIV-positive women during pregnancy reduces hypertension," Merchant AT, Msamanga G, et al, J of Nutr, 2005; 135(7): 1776-1781

Plant Foods with Most of Vitamins and Minerals

•"Circulating carotenoid concentrations and incident hypertension: the Coronary Artery Risk Development in Young Adults (CARDIA) study," Hozawa A, Jacobs DR Jr, et al, J Hypertens, 2009; 27(2): 237-42



B-Vitamin Deficiencies

•"Randomized, Double-Blind, Placebo-Controlled Study of the Safety and Efficacy of Vitamin B Complex in the Treatment of Nocturnal Leg Cramps in Elderly Patients With Hypertension," Chan P, et al, J Clin Pharmacol, December, 1998;38(12):1151-1154

•"Homocysteine Rivals Smoking for Risk of CAD," Carpi, John, Family Practice News, August 1, 1996;40-41

•"High Homocysteine Levels Are Independently Related to Isolated Systolic Hypertension in Older Adults," Sutton-Tyrrell, Kim, Dr.P.H., et al, Circulation, September 16, 1997;96(6):1745-1749



Vitamin B6 Deficiency

•"Low plasma pyridoxal 5'-phosphate concentration and MTHFR 677C-->T genotypes are associated with increased risk of hypertension," Lin PT, Cheng CH, et al, Int J Vitam Nutr Res, 2008; 78(1): 33-40



Folate Deficiency

•"Folate intake and incidence of hypertension among American young adults: a 20-y follow-up study," Xun P, Liu K, et al, Am J Clin Nutr. 2012 Apr 4

•"Folic acid supplementation for 3 wk reduces pulse pressure and large artery stiffness independent of MTHFR genotype," Williams C, Kingwell BA, et al, American Journal of Clinical Nutrition, 2005; 82(1): 26-31

•"High-dose folic acid supplementation effects on endothelial function and blood pressure in hypertensive patients: a meta-analysis of randomized controlled clinical trials," McRae MP, Journal of Chiropractic Medicine, 2009; 8(1): 15-24



Vitamin C Deficiency

•"Vitamin C in plasma is inversely related to blood pressure and change in blood pressure during the previous year in young Black and White women," Block G, Jensen CD, et al, Nutr J, 2008; 7(1): 35

•"Supplementation with vitamins C and e improves arterial stiffness and endothelial function in essential hypertensive patients," Plantinga Y, Ghiadoni L, et al, Am J Hypertens, 2007; 20(4): 392-7

•"Effects of vitamin C supplementation on blood pressure: a meta-analysis of randomized controlled trial," Juraschek SP, Guallar E, et al, Am J Clin Nutr, 2012 Apr 4



Quercetin Deficiency

•"Quercetin reduces blood pressure in hypertensive subjects," Edwards RL, Jalili T, et al, J Nutr, 2007; 137(11): 2405-11

CoQ10 Deficiency

•“Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension,” Ho MJ, Bellusci A, et all, Cochrane Database Syst Rev, 2009; 7(4): CD007435

•"Effect of Coenzyme Q10 on Essential Arterial Hypertension", Digiesi, V., et al, Current Therapeutic Research, May 1990;47 (5):841-845

•"Coenzyme Q10 in the treatment of hypertension: a meta-analysis of the clinical trials," Rosenfeldt FL, Haas SJ, et al, Journal of Human Hypertension, 2007; 21(4): 297-306

Vitamin D Deficiency

•"Low 25(OH)D3 levels are associated with total adiposity, metabolic syndrome, and hypertension in Caucasian children and adolescents," Pacifico L, Anania C, et al, Eur J Endocrinol, 2011 Oct; 165(4): 603-11

•"Independent associations of serum concentrations of 25-hydroxyvitamin D and parathyroid hormone with blood pressure among US adults," Zhao G, Ford ES, et al, J Hypertens, 2010 July 5

•"Relation of vitamin D deficiency to cardiovascular risk factors, disease status, and incident events in a general healthcare population," Anderson JL, Lappe DL, et al, Am J Cardiol, 2010; 106(7): 963-8



Vitamin E Deficiency

•"Lipid Peroxide and Vitamin E Patterns in Pregnant Women With Different Types of Hypertension in Pregnancy," Gratacos, Eduard, M.D., et al, American Journal of Obstetrics and Gynecology, May, 1998;178:1072-1076

•"Diminution of oxidative stress through vitamins C and E supplementation associates with blood pressure reduction in essential hypertensives," Rodrigo R, Prat H, et al, Clin Sci (Lond), 2007 Nov 14

•"Effects of Vitamin E and Glutathione on Glucose Metabolism: Role of Magnesium," Barbagallo M, Dominguez LJ, et al, Hypertension, 1999;34(Part 2):1002-1006



Mineral Deficiencies

•"Dietary Modulators of Blood Pressure and Hypertension", Singh, R.B., et al, European Journal of Clinical Nutrition, 1990;44:319- 327

•"Relationship of Electrolytes to Blood Pressure in Men: The Yi Peoples Study", He, Jiang, et al, Hypertension, March 1991;17(3):378-385

Calcium Deficiency

•"Effect of Calcium Supplementation on Pregnancy-Induced Hypertension and Preeclampsia: A Meta-Analysis of Randomized Controlled Trials," Bucher, Heiner, C., et al, JAMA, April 10, 1996;275(14):1113-1117

•"Blood pressure response to calcium supplementation: a meta-analysis of randomized controlled trials," van Mierlo LA, Arends LR, et al, J Hum Hypertens., 2006 May 4

•"Dietary Calcium and Pregnancy-Induced Hypertension: Is There a Relation?" Ritchie LD, King JC, Am J Clin Nutr, 2000;71(Suppl):1371S-1374S



Iron Deficiency

•“Low Total and Nonheme Iron Intakes Are Associated with a Greater Risk of Hypertension,” Galan P, Hercberg S, et al, J Nutr, 2009 Nov 18

•“Effects of iron supplementation and depletion on hypoxic pulmonary hypertension: two randomized controlled trials,” Smith TG, Talbot NP, et al, JAMA, 2009; 302(13): 1444-50

•"Relation of iron and red meat intake to blood pressure: cross sectional epidemiological study," Tzoulaki I, Elliott P, et al, BMJ, 2008; 337: a258



Magnesium Deficiency

•"Dietary Magnesium Intake and Risk of Incident Hypertension Among Middle-Aged and Older US Women in a 10-Year Follow-Up Study," Song Y, Sesso HD, et al, The American Journal of Cardiology, 2006; 98(12): 1616-1621

•"Associations of Serum and Dietary Magnesium With Cardiovascular Disease, Hypertension, Diabetes, Insulin and Carotid Artery Wall Thickness." Journal of Clinical Epidemiology, 1995;48:927-940

•"Serum and Dietary Magnesium and Risk of Ischemic Stroke: The Atherosclerosis Risk in Communities Study," Ohira T, Peacock JM, et al, Am J Epidemiol, 2009 April 16



Phosphorus Deficiency

•"Dietary phosphorus and blood pressure: international study of macro- and micro-nutrients and blood pressure," Elliott P, Kesteloot H, et al, Hypertension, 2008; 51(3): 669-75

Potassium Deficiency

•"Potassium Supplementation For Hypertension: A Meta-Analysis", Cappuccio, F.P., et al, Journal of Hypertension, May 1991;9:465-73

•"Antihypertensive Effect of Oral Potassium Aspartate Supplementation in Mild to Moderate Arterial Hypertension," Franzoni F, Santoro G, et al, Biomed Pharmacother, 2005;59:25-29

•"The effect of a dietary supplement of potassium chloride or potassium citrate on blood pressure in predominantly normotensive volunteers," Braschi A, Naismith DJ, Br J Nutr, 2007 Dec 6



Zinc Deficiency

•"Zinc, Copper and Zinc- Or Copper- Dependent Enzymes in Human Hypertension," Vivoli Gianfranco, et al, Biological Trace Element Research, 1995;49:97-105



Fatty Acid Deficiency

•"Effect of low-dose omega-3 fatty acids substitution on blood pressure, hyperinsulinemia and dyslipidemia in Indians with essential hypertension: A pilot study," Bhise A, Krishnan PV, et al, Indian J Clin Biochem, 2005 Jul; 20(2):4-9

•"Diet During Pregnancy and Risk of Preeclampsia or Gestational Hypertension," Oken E, Ning Y, et al, Ann Epidemiol, 2007 May 21

•"Relationship of Dietary Linoleic Acid to Blood Pressure. The International Study of Macro-Micronutrients and Blood Pressure Study," Miura K, Zhao L, et al, Hypertension, 2008 July 7



Fiber Deficiency

•"Different effect of psyllium and guar dietary supplementation on blood pressure control in hypertensive overweight patients: a six-month, randomized clinical trial," Cicero AF, Derosa G, et al, Clin Exp Hypertens, 2007; 29(6): 383-94

•"Dietary fiber intake in early pregnancy and risk of subsequent preeclampsia," Qiu C, Coughlin KB, et al, Am J Hypertens, 2008; 21(8): 903-9



Nitrate Deficiency

•"Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial," Taubert D, Roesen R, et al, JAMA, 2007; 298(1): 49-60

•"Acute blood pressure lowering, vasoprotective, and antiplatelet properties of dietary nitrate via bioconversion to nitrite," Webb AJ, Patel N, et al, Hypertension, 2008; 51(3): 784-90

•"Blood pressure-lowering effects of beetroot juice and novel beetroot-enriched bread products in normotensive male subjects," Hobbs DA, Kaffa N, et al, Br J Nutr, 2012 Mar 14:1-9

Probiotic Deficiency

•"Effect of powdered fermented milk with Lactobacillus helveticus on subjects with high-normal blood pressure or mild hypertension," Aihara K, Kamimoto O, et al, Journal of the American College of Nutrition, 2005; 24(4): 257-65

Oxidative Stress

•"Oxidative stress in patients with essential hypertension," Tandon R, Sinha MK, et al, Natl Med J India, 2005; 18(6): 297-9

•"Malondialdehyde, Lipofuscin and Activity of Antioxidant Enzymes During Physical Exercise in Patients With Essential Hypertension," Koska J, et al, J Hypertens, 1999;17(4):529-535

"Systemic oxidative alterations are associated with visceral adiposity and liver steatosis in patients with metabolic syndrome," Palmieri VO, Grattagliano I, et al, J Nutr, 2006; 136(12): 3022-6

Antioxidant Deficiency

Tomato Extract

•"The Effects of Natural Antioxidants from Tomato Extract in Treated but Uncontrolled Hypertensive Patients," Paran E, Novack V, et al, Cardiovasc Drugs Ther, 2008 Dec 4

•"Natural antioxidants from tomato extract reduce blood pressure in patients with grade-1 hypertension: a double-blind, placebo-controlled pilot study," Engelhard YN, Gazer B, et al, Am Heart J, 2006; 151(1): 100

Cocoa Flavonol

•"Epicatechin ingested via cocoa products reduces blood pressure in humans: a nonlinear regression model with a Bayesian approach," Ellinger S, Reusch A, et al, Am J Clin Nutr; 2012 Jun; 95(6):1365-77

•"Chocolate consumption in relation to blood pressure and risk of cardiovascular disease in German adults," Buijsse B, Weikert C, et al, Eur Heart J, 2010 March 30

•"Dark Chocolate and Blood Pressure: A Novel Study from Jordan," Al-Safi SA, Ayoub NM, et al, Curr Drug Deliv, 2011 June 22

Potato Antioxidants

•"High-Antioxidant Potatoes: Acute in Vivo Antioxidant Source and Hypotensive Agent in Humans after Supplementation to Hypertensive Subjects," Vinson JA, Demkosky CA, et al, J Agric Food Chem, 2012 Feb 6

Excess Dietary Fat

•"High Costs of Poor Eating Patterns in the United States," Frazao E, Nutrition Week, June 18, 1999;29(23):4-5.

•"Hypertension Is Related to the Degradation of Dietary Frying Oils," Soriguer F, Rojo-Martinez G, et al, Am J Clin Nutr, 2003;78:1092-1097

•"Low-fat dairy products and blood pressure: follow-up of 2290 older persons at high cardiovascular risk participating in the PREDIMED study," Toledo E, Delgado-Rodriguez M, et al, Br J Nutr, 2009; 101(1): 59-67

Moderate Drinking

•"Moderate Wine Drinkers Have Lower Hypertension-Related Mortality: A Prospective Cohort Study in French Men," Renaud SC, Gueguen R, et al, Am J Clin Nutr, 2004;80:621-625

•"Alcohol consumption and risk for coronary heart disease among men with hypertension," Beulens JW, Rimm EB, et al, Ann Intern Med, 2007; 146(1): 10-9

•"Acute resveratrol supplementation improves flow-mediated dilatation in overweight/obese individuals with mildly elevated blood pressure," Wong RH, Berry NM, et al, Nutr Metab Cardiovasc Dis, 2010 Jul 29

Caffeine Excess

•"Coffee Intake and Risk of Hypertension: The Johns Hopkins Precursors Study," Klag MJ, Wang N-Y, et al, Arch Intern Med, March 25, 2002;162:657-662

•"Effects of Coffee on Ambulatory Blood Pressure in Older Men and Women: A Randomized Controlled Trial," Rakic V, et al, Hypertension, 1999;33:869-873

Genetics

•"Diet, Genetics and Hypertension," Preuss, Harry G., Journal of the American College of Nutrition, 1997;16(4):296-305

Heavy Metal Toxicity

Arsenic Toxicity

•"Arsenic exposure from drinking water, dietary intakes of B vitamins and folate, and risk of high blood pressure in Bangladesh: a population-based, cross-sectional study," Chen Y, Factor-Litvak P, et al, Am J Epidemiology, 2007; 165(5): 541-52

•"Arsenic and Non-Cirrhotic Portal Hypertension: A Report of 8 Cases", Nevens, F., et al, Journal of Hepatology, 1990;11:80-85

Lead Toxicity

•"Blood Cell Lead, Calcium, and Magnesium Levels Associated With Pregnancy-Induced Hypertension and Preeclampsia," Dawson EB, Evans DR, Kelly R, Van Hook JW, Biol Trace Elem Res, 2000;74:107-116

•"Dietary calcium as a potential modifier of the relationship of lead burden to blood pressure," Elmarsafawy SF, Hu H, et al, Epidemiology, 2006; 17(5): 531-7

•"Blood Lead Level Is Associated With Elevated Blood Pressure in Blacks," Vupputuri S, He J, et al, Hypertension, 2003;41:463-468

Mercury Toxicity

•"Mercury Intoxication and Arterial Hypertension: Report of Two Patients and Review of the Literature," Torres AD, Rai AN, Hardiek ML, Pediatrics, March, 2000;105(3):1-4

•"Mercury Intoxication Presenting With Hypertension and Tachycardia," Wossmann W, et al, Arch Dis Child, 1999;80:556-557

Cigarette Smoking

•"Maternal Tobacco Smoke Exposure and Persistent Pulmonary Hypertension of the Newborn," Bearer, Cynthia, et al, Environmental Health Prospectives, February, 1997;105(2):202-206

Licorice Excess

•"Licorice, Tobacco Chewing and Hypertension", Morris, David J., et al, The New England Journal of Medicine, March 22, 1990;322 (12): 849

Green Algae

•"Antihyperlipemic and antihypertensive effects of Spirulina maxima in an open sample of Mexican population: a preliminary report," Torres-Duran PV, Juarez-Oropeza MA, et al, Lipids Health Dis, 2007 Nov 26

Insulin Resistance and Blood Sugar Imbalance

•"Carbohydrate Metabolism in Gestational Diabetes: Effect of Chronic Hypertension," Caruso A, et al, Obstet Gynecol, October, 1999;94(4):556-561

•"Hyperinsulinemia Is Associated With the Incidence of Hypertension and Dyslipidemia in Middle-Aged Men," Salonen, Jukka T., et al, Diabetes, 1998;47:270-275

•"Hyperinsulinemia in Relation to Hypertension and Other Coronary Risk Factors in Japanese Men," Maruno, Yoshiko, M.D., et al, Japanese Heart Journal, September, 1997;38(5):685-696

Comment:  Numerous studies have found that Chromium can help stabilize blood sugar and reduce sugar cravings.



Salt Intake And Imbalance

•"Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP)," Cook NR, Cutler JA, et al, British Med J, 2007 April 20

•"Are Low-Sodium Diets Appropriate for Treating Hypertensive Men?" Fleet James C., Nutrition Reviews, October, 1995;53(10):296-298

•"Gender difference in blood pressure responses to dietary sodium intervention in the GenSalt study," Je J, Whelton PK, et al, J Hypertens, 2009; 27(1): 48-54

Lack of Exercise

•"Exercise Recommendations for the Patient With Hypertension," Pescatello LS, AJMS, May/June 2003;230-232

•"Daily Life Activity and the Risk of Developing Hypertension in Middle-Aged Japanese Men," Nakanishi N, Suzuki K, Arch Intern Med, January 24, 2005;165:214-220

•"Physical Activity and Hypertension: An Epidemiologic View", Paffenbarger, Ralf S., et al, Annals of Medicine, 1991;23:319-328

•"Walking to Work and the Risk for Hypertension in Men: The Osaka Health Survey," Hayashi T, et al, Ann Intern Med, July 6, 1999;131(1):21-26

•"Markers of inflammation are inversely related to physical activity and fitness in sedentary men with treated hypertension," Hjelstuen A, Anderssen SA, et al, Am J Hypertens., 2006; 19(7): 669-75

Obesity

• "Sodium Reduction and Weight Loss in the Treatment of Hypertension in Older Persons: A Randomized Controlled Trial of Nonpharmacologic Interventions in the Elderly (TONE)," Whelton, Paul K., M.D., M.Sc., et al, JAMA, March 18, 1998;279(11):839-846

•"Urinary Sodium Excretion: Association With Hyperinsulinemia, Hypertension and Sympathetic Nervous System Activity in Obese and Control Children," Csabi, G., et al, European Journal of Pediatrics, 1996;155:895-897

•"Salt intake is related to soft drink consumption in children and adolescents: a link to obesity?" He FJ, Marrero NM, et al, Hypertension, 2008; 51(3): 629-34

Lack of Sleep and Melatonin Deficiency

•"Short sleep duration as a risk factor for hypertension: analyses of the first National Health and Nutrition Examination Survey," Gangwisch JE, Heymsfield SB, et al, Hypertension, 2006; 47(5): 816-7

•"Sleep-Related Breathing Disorder is an Independent Risk Factor for Uncontrolled Hypertension," Grote L, Hedner J, Peter JH, J Hypertens, 2000;18(6):679-685

•"Melatonin treatment improves blood pressure, lipid profile, and parameters of oxidative stress in patients with metabolic syndrome," Kozirog M, Broncel M, et al, J Pineal Res, 2010, Dec 8

Herbs

Green Tea Extract

•"Green tea extract reduces blood pressure, inflammatory biomarkers, and oxidative stress and improves parameters associated with insulin resistance in obese, hypertensive patients," Bogdanski P, Suliburska J, et al, Nutr Res, 2012 Jun; 32(6):421-7

Olive Leaf Extract

•"Olive (Olea europaea) leaf extract effective in patients with stage-1 hypertension: Comparison with Captopril," Susalit E, Agus N, et al, Phytomedicine, 2011 Feb 15; 18(4): 251-8

•"Food supplementation with an olive (Olea europaea L.) leaf extract reduces blood pressure in borderline hypertensive monozygotic twins, Perrinjaquet-Moccetti T, Busjahn A, et al, Phytother Res, 2008 Aug; 22(9): 1239-1242

Licorice Extract Side Effect

•"Dietary Factors in the Pathogenesis and Treatment of Hypertension," Nurminen, M-L, et al, Annals of Medicine, 1998;30:143-150

•"Is Blood Pressure Commonly Raised by Moderate Consumption of Licorice," Sigurjonsdottir H.A., et al, Journal of Human Hypertension, 1995;9:345-348

Garlic

•"Effects of Garlic on Blood Pressure in Patients With and Without Systolic Hypertension: A Meta-Analysis (December)," Reinhart KM, Coleman CI, et al, Ann Pharmacother, 2008 Nov 18

•"Aged garlic extract lowers blood pressure in patients with treated but uncontrolled hypertension: A randomised controlled trial," Ried K, Stocks NP, et al, Maturitas, 2010 Jun 29

•"Effect of garlic on blood pressure: A systematic review and meta-analysis," Ried K, Frank OR, et al, BMC Cardiovascular Disorders, 2008; 8: 13

•"Garlic supplementation prevents oxidative DNA damage in essential hypertension," Dhawan V, Jain S, Molecular and Cellular Biochemistry, 2005; 275(1-2): 85-94

Herbal Formula with Aged Garlic 
Cardiovascular Support

Hawthorn Berries

•"Hypotensive effects of hawthorn for patients with diabetes taking prescription drugs: a randomised controlled trial," Walker AF, Marakis G, et al, Br J Gen Pract., 2006; 56(527): 437-43

Herbal Formula with Hawthorn 
Cardiovascular Support

Pycogenol

•"Kidney flow and function in hypertension: protective effects of pycnogenol in hypertensive participants--a controlled study," Cesarone MR, Belcaro G, et al, J Cardiovasc Pharmacol Ther, 2010 March; 15(1): 41-6

•"Rapid relief of signs/symptoms in chronic venous microangiopathy with pycnogenol: a prospective, controlled study," Cesarone MR, Belcaro G, et al, Angiology, 2006; 57(5): 569-76

Hibiscus

•"The effects of sour tea (Hibiscus sabdariffa) on hypertension in patients with type II diabetes," Mozaffari-Khosravi H, Jalali-Khanabadi BA, et al, J Hum Hypertens, 2008 Aug 7

Gotu Kola

•"Microcirculatory Effects of Total Triterpenic Fraction of Centella asiatica in Chronic Venous Hypertension: Measurement by Laser Doppler, TcPO2-CO2, and Leg Volumetry," Cesarone MR, Belcaro G, Rulo A, et al, Angiology, 2001;52(Suppl. 2):S45-S48

Black Seed

•"Antihypertensive effect of Nigella sativa seed extract in patients with mild hypertension" Dehkordi FR, Kamkhah AF, et al, Fundam Clin Pharmacol, 2008; 22(4): 447-52

Other Herbs

• Achillea millefolium (Yarrow): essential hypertension
• Allium sativum (Garlic)
• Apium graveolens (Celery): juice and seeds
• Arctium lappa (Burdock root)
• Berberis vulgaris (Barberry root & bark): 
• Cimicifuga spp. (Black cohosh)
• Crataegus oxyacantha (Hawthorn berries): cardiotonic, stabilizes heart 
• Fagopyrum esculentum (Buckwheat): with vitamin C: raised arterial tension with   capillary bleeding 
• Ginkgo biloba (standardized extract)
• Hamamelis virginiana (Witch hazel)
• Olea europaea (Olive): in combinations           
• Scutellaria lateriflora (Skullcap): nervine
• Taraxacum officinale (Dandelion): diuretic, tonic
• Tilia platyphyllos (Linden): hypertension associated with atherosclerosis
• Valeriana spp. (Valerian)

•"Acupuncture, a promising adjunctive therapy for essential hypertension: a double-blind, randomized, controlled trial," Yin C, Seo B, et al, Neurol Res, 2007; 29(Suppl 1): 98-103

"Randomized trial of acupuncture to lower blood pressure," Flachskampf FA, Gallasch J, et al, Circulation, 2007; 115(24): 3121-9

Stress

•"Psychosocial factors and progression from prehypertension to hypertension or coronary heart disease," Player MS, King DE, et al, Ann Fam Med, 2007; 5(5): 403-11

•"White Coat Hypertension Linked to End-Organ Damage," Johnson K, Family Practice News, July 1, 2000:13

•"Slow breathing improves arterial baroreflex sensitivity and decreases blood pressure in essential hypertension," Joseph CN, Porta C, et al, Hypertension, 2005; 46(4): 714-8

•"Loneliness is a unique predictor of age-related differences in systolic blood pressure," Hawkley LC, Masi CM, et al, Psychol Aging, 2006; 21(1): 152-64

Summary and Suggestions

Modern life has brought refined, highly processed, high fat, salty foods and stress with little opportunity for exercise, resulting in weight gain. These factors have been found to promote hypertension, which is indicated by blood pressure readings of 140 over 90 or above that are taken on 3 separate occasions. Hypertension generally has no outward symptoms and commonly occurs in industrialized countries. It is rare in countries where diets are high in fiber such as in China, Africa, and areas of South America. Therefore, the main focus in the treatment of hypertension is diet.

Other causes of hypertension include overconsumption of caffeine and alcohol. Alcohol causes overstimulation of adrenalin secretion. It is also high in sodium.  Smoking and chewing tobacco also stimulate adrenalin secretion. Smoking has also been found to increase the desire for sugar, alcohol, and caffeine, and it reduces levels of vitamin C in the body as well.

Always consult a physician if you suspect hypertension, and never stop medication on your own, especially a beta blocker.

Dietary Suggestions 

• Consume more fruits and vegetables for fiber, minerals, phytonutrients;  eat at least 3 cups per day of assorted vegetables (ideally a large salad at lunch and cooked vegetables for dinner), and at least 1 piece of fruit per day
• Consume whole grains and cereals like brown rice and oatmeal as source of complex carbohydrates, and fiber
• Consume lean animal protein or vegetarian protein sources, avoid animal fats, fried foods, and trans-fats
• Avoid trans-fatty acids, hydrogenated oils (margarine, vegetable shortenings, imitation butter spreads, most commercial peanut butters), oxidized fats (deep fried foods, fast food, ghee, barbequed meats)
• Reduce meat and other animal products, vegetarians have lower blood pressure levels. Try, at least, to cut down the amounts of red meats, dairy products, and fatty foods
• Eat regularly, ideally four meals per day including breakfast, lunch, afternoon snack and dinner; this stabilizes blood sugar which reduces risk to high blood pressure
• Reduce salt intake to a minimum; if you are not sure how much to take, measure BP regularly to determine if you’re sensitive to salt and make adjustments accordingly
• Salt and salty foods include: pickles, olives, chips, packaged snacks, meat, (especially ham, frankfurters, bacon, bologna, corned beef, lunch meats, frozen fish fillets, sardines, herring, caviar, anchovies, shellfish), dairy products, spicy foods: salsa, white and black pepper, mustard, ginger, canned tomato juice, V-8 juice, processed cheese, canned, dried or instant soups, frozen peas and beans, most processed and refined foods, MSG, mayonnaise, salad dressings, gravies, ketchup, food with Sodium benzoate as a preservative, Sodium proprionate in cheese and bread, baking powder, baking soda, ice cream, milkshakes, soft drinks, smoked meats and fish, Jello, pretzels, potato chips, salted nuts, candy, rennet tablets, pudding mixes, beverage mixes, spicy foods, alcohol, fried foods, fatty foods, pork
• Avoid stimulants like caffeine in coffee, tea, and sodas
• Avoid sugar such as in candies and pastries and replace it with fresh fruits and unsweetened juices.
• Avoid foods containing tyramine
• Avoid smoking cigarettes
• Drink at least 8 cups a day in the form of water, herbal teas, broths, or diluted juices.
• Other beneficial foods are onions, garlic, 
• Grapefruit juice and drug interaction: grapefruit juice can interference with cytochrome P450 which affects the metabolism of drugs

• Plant foods rich in Vitamin A and Carotenes including sweet potatoes, carrots, turnip greens, kale, spinach, Swiss chard, collard greens
• Plant foods high in Vitamin B6 including sunflower seeds, basil, Russet potatoes, red bell peppers, turnip greens
• Plant foods high in Folate including spinach, turnip greens, lentils, pinto beans, black beans, navy beans, collard greens
• Plant foods high in B-Vitamins including sunflower seeds, almonds, peanuts, mushrooms (crimini, shiitake), avocado
• Plant foods high in Vitamin C including red bell peppers, kale, kiwifruit, green bell peppers, broccoli, Brussel sprouts, papayas, strawberries
• Plant foods high in Vitamin D including Portobello mushroom (exposed to sunlight)
• Plant foods high in Vitamin E including sunflower seeds, almonds, turnip greens, spinach
• Plant foods high in Calcium including sesame seeds, collard greens, turnip greens, kelp seaweed, wakame seaweed, kale
• Plant foods high in Iron including sesame seeds, lentils, garbanzo beans, spinach, lima beans, navy beans
• Plant foods high in Magnesium including pumpkin seeds, cocoa powder (unsweetened), sesame seeds, sunflower seeds, Swiss chard, spinach
• Plant foods high in Potassium including yams, spinach, Russet potatoes, lima beans, avocado, pinto beans, kidney beans, Swiss chard
• Plant foods high in Zinc including pumpkin seeds, sesame seeds, oats
• Plant foods high in Omega 3 oil including flaxseed, chia seeds, hemp seeds, walnuts
• Plant foods high in Nitrates including turnip, Chinese cabbage, celery, kohlrabi, radish, spinach, endive, lettuce, beet root

• 1 cup filtered water                                                             
• 1 heaping tbsp Purefood A-Z  (10 g)                                                
• 1 scoop Purefood B   (1.5 g)                                                       
• 1 scoop Acerola C   (1.25 g)                                                       
• 1 scoop Portobello D (0.6g)
• 1 scoop Annatto E  (0.6 g)  
• 1 scoop Curry Iron (0.6g)                                                          
• 1 tsp organic raw chia seeds (6 g)                                                 
• 2 tsp organic raw pumpkin seeds seeds (8.6 g)                                    
• 1 medium organic apple (125 g)                                                     
• 1 heaping tsp raw cacao (5.8 g) 

Directions                                                                        
Wash the apple and cut into medium pieces. Combine all ingredients in a blender and blend until smooth. Drink slowly and enjoy.

• Organic non citrus fruit juices to replace water for taste
• Organic raw flaxseed to replace chia seeds for omega fatty acid
• Organic sesame seeds or walnuts to replace pumpkin seeds (for zinc
• Fresh organic pear or banana to replace apple for fiber, nutrients and flavor

• 2 medium organic carrots (256g)
• 1 medium apple (125g) 
• 1/4 organic cucumber (107.5g)
• 1 stalk celery (85g) 

Directions                                                                        
Wash produce well. Cut produce into small enough pieces to feed through your juicer. Juice, combine, drink slowly and enjoy!

• Organic beets to replace carrots
• Watermelon to replace apple
• Endive or spinach to replace celery 

• 1 cup organic spinach (30g)
• 1 cup organic black kale (71.5 g) 
• 1/2 organic red pepper thinly sliced (120g)
• 1 small beet shredded (sub carrot) (82g)
• 1/4 cup raw sunflower seeds (35g) 
• 1/2 cup garbanzo beans (82g)
• 1 tbsp raw sesame seeds (sub pumpkin seeds)(36g)

Directions
Wash greens well and tear into bite size pieces. In a medium bowl toss greens, pepper, grated beet, beans and seeds. 

• Collards o replace kale
• Pumpkin seeds to replace sesame seeds
• Carrot to replace beets

• 2 tbsp flax seed oil
• 1 tsp organic apple cider vinegar
• 1 tsp organic gluten free tamari
• 1 tsp filtered water
• 1 tbsp nutritional yeast (organic)
• 1 small clove garlic (3 g)

Directions                                                                        
In a small bowl, whisk together apple cider vinegar, tamari, water and oil until well combined. Mix in crushed garlic, and nutritional yeast. You may also combine all ingredients in a blender. Serve on fresh salad and enjoy.

• Substitute apple cider vinegar with fresh lemon juice
• Walnut oil for flax oil

• 1 cup quinoa, cooked (185 g)
• 1 cup organic Brussel sprouts, quartered (156g)
• 1/2 cup organic leek, chopped (52g)
• 1 cup organic portabella mushroom, 1 inch pieces (121g)
• 1/4 cup organic almonds chopped (36g)
• 2 tbsp organic coconut oil/ avocado oil
• 1 tbsp organic lemon juice
• 2 tsp fresh thyme (2g)
• 1 tsp Himalayan Sea Salt
• 1 clove garlic (3g)

Directions
Cook the quinoa- combine 1/2 cup quinoa and 1 cup water in a pot, bring to boil, stir, reduce to simmer and cover for 20 minutes until fluffy. Preheat oven to 350. On a baking sheet toss brussel sprouts, leeks, mushroom with oil, sea salt, thyme and garlic. Roast for 20 to 25 minutes, stirring more than once, until the Brussels sprouts are tender.

In a bowl add combine the cooked quinoa and roasted vegetables, add chopped almonds and dress with fresh lemon juice. Serve warm, chew well and enjoy!
Adapted from http://glutenfreegoddess.blogspot.com

• Cornsilk from an ear of corn, place in a pot with 4 cups of water, boil for 5 minutes, simmer for 15 minutes.  Then drink 3 cups during the day.  Avoid drinking this at night as it has a diuretic effect and can disturb sleep.

• Maintain regular sleep/wake cycles; this will coincide with a healthy glandular rhythm (your internal clock)
• Get adequate sleep every night; lack of sleep with lower your stress tolerance and induce stress hormones
• Eat 4 regular meals a day (3 meals and a snack) including a complex carbohydrate and/or protein at each meal
• Exercise only during the day;  exercise in the evening can disrupt your sleep cycle and cause insomnia
• Praying, meditating, reading and taking a bath in the evening helps to slow down your mind and body before bed
• Watching TV, emailing, playing video games, and socializing are not considered relaxation and may disturb sleep
• Staying positive, being grateful and compassionate, and enjoying a good laugh each day also helps

• Regular Physical Exercise – This is an essential part of a hypertension treatment program. Start gradually and work up to at least 30 minutes 4 times a week. If you haven't exercised for awhile or feel out of shape, consult a physician to set up an exercise program.
• Weight loss – It is of utmost importance that you maintain an appropriate weight, depending on age and height. The diet and exercise recommendations in this program can help you accomplish this.
• Smoking – try to quit. You may want to listen to our "Stop Smoking" article.
• Stress Reduction – You may not be able to eliminate stressful situations in your life (such as a busy schedule or a stressful relationship) but you can learn to cope better with the stress by following these guidelines:
• Relaxation Exercises – 20 minutes once a day. Tapes can be bought at one of your local bookstores. Yoga, practiced on regular basis, can serve the same purpose.
• Deep Breathing – most of us tend to hold our breath or breathe shallow breaths during stressful situations. That can cut down the amount of oxygen available to
• the body with every breath. Try to have a few 1 minute intervals of breathing and relaxation during the day. At these times, pay special attention to relaxing your shoulder muscles and breathing deeply.
• Weight gain - if overweight, reduce weight to normal range
• Extreme hypertension – then restrict salt intake to only 500 mg per day
• Allergies or indigestion – try elimination/rotation diet, rotation diet, rotation diet expanded

• Discuss DASH, Mediterranean, Nordic, Vegetarian and Paleolithic diets
• Moderate drinking of wine (less than 60 grams per day) 
• Drinking coffee may be allowed (it is a stimulant)
• Heavy metal toxicities (arsenic, lead, mercury, etc.)
• Blood sugar imbalance, or insulin resistance
• Mineral and electrolyte status including Calcium, Phosphorus, Sodium, Potassium, Bicarbonate, Chloride
• Food allergies, intolerances, indigestion, malabsorption, dysbiosis, leaky gut syndrome 
• Supervised fast on alkaline juices or watermelon fast, followed by a vegetarian diet
• Nutritional supplements including:

www.whfoods.org 
www.nutritiondata.self.com 
www.ndb.nal.usda.gov/ndb/foods/list  
www.vitasearch.com  

This article is for educational purposes only. This information has not been evaluated by Health Canada nor the Food and Drug Administration.  This information is not intended to diagnose, treat, cure, or prevent any disease.