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HIGH BLOOD PRESSURE

Vitamins D and K help cardiac rhythm. Vitamin K activates the protein osteocalcin, which strengthens bone mass, but decalcifies soft tissues like arterial walls reducing blood pressure. (link: vitamin D and vitamin K; blood pressure; source: LPI meeting 2009; added 6/2009)

Stroke is a well-known risk factor for vascular dementia. Systolic blood pressure >140 was most strongly associated with prevalent memory impairment  Other associated risk factors included non-white race, male gender, age, education <or=12 years, and history of any alcohol use.  Among transient ischemic attacks symptoms, self-reported weakness in the face, arm, or leg was significantly associated with memory impairment. (Link: blood pressure and Alzheimers; Source: Alzheimers newsletter:
http://www.healthandage.com/html/min/iananda/newsletter.htm; added 6/2009)

March 2009 AJCN - Nutrition to control blood pressure - Observational studies have shown the relation between blood pressure (BP) and several nutrients, including protein, fiber, potassium, magnesium, and calcium. However, randomized intervention trials of individual nutrient supplements often have shown an inconsistent or only a small effect on BP. When ≥2 of these nutrients are consumed naturally together in foods at the recommended levels such as in vegetarian diets or in the Dietary Approaches to Stop Hypertension (DASH) dietary pattern, their BP effects are more evident and consistent (Lin, PH, Batch, B & Svetkey, LP. Nutrition, lifestyle and hypertension. In: , Coulston, A & Boushey, C, eds. Nutrition in the prevention and treatment of disease. 2nd ed. San Diego, CA: Elsevier/Academic Press, 2008).

Below are information and links from a review of Nutrition Investigator sources in April, 2008, to determine what has been written about using nutrition to reduce high blood pressure.

LITERATURE NOTES FOR WHAT TO DO FOR HIGH BLOOD PRESSURE

INDEX AND SUMMARY - in order of comments and references/links below.  Based on the citations and links below and my other readings about nutrition, biochemistry, and Science, here are ideas worth discussing with your physician if you have been diagnosed with high blood pressure.  In many of the studies linked below, people have returned blood pressure to normal over a period of months.  I have tried to prioritize ideas starting with the most important.

1. FISH OIL - The American Heart Association recommends up to 6g of fish oil daily. This is also considered an effective treatment for depression. (I take at least 1g daily)
2. Vitamin D - Young people should take 1,000 IU per day. Older people require 2,000 IU daily. (I take 1,000 IU daily.)
3. VITAMIN C - 500 mg twice a day - This has been shown also to restore elasticity to arteries.
4. DASH diet AND EXERCISE - At least 30 minutes of moderate exercise every day, and the DASH diet was developed and has been proven to reduce blood pressure. See table below for guidelines what and how to eat. --Dear Roc: Just want to add my vote for your number 4, the DASH diet-a good overview of it with sample menus is at the following link:http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/index.htm
5. Berries - I eat strawberries and blueberries almost every day on fiber -containing cereal.
6. Tea - Drinking tea is really wonderful for health in general, and is on this list for its help with blood pressure.
7. Nuts (as linked to DASH Diet)- Eating a handful on 4 days a week is minimal, I keep cans in my car and office for regular efforts at health.

8. OLIVE OIL - Only thing to use for salads and cooking, key to the Mediterranean diet.
9. FIBER - It helps with blood pressure - watch out for white anything in food.
10. Chocolate - Dark chocolate rates high on this list because of blood pressure benefits.
11. Potassium - Eat a banana.
12. Probiotics - Yogurt is good for blood pressure and intestinal health.
13. SOY - Soy is good for blood pressure.
14. Saturated fat - Avoid saturated fat. Vegetarian diet is best, olive oil instead of butter - TRANS-FATs in most snacks are the best way to get high blood pressure.
15. Low Glycemic Index foods - This is another way to say be cautious about eating white foods.

16. SALT - Most of my reading indicates salt is not that hazardous to blood pressure, and worry is bad for blood pressure.
17. COFFEE - Very low on the list of what I would abandon, and most studies indicate coffee is not hazardous for most people. But here's one study indicating that it may be better to just drink tea.
18. Calcium hazard - Though yogurt is good to reduce blood pressure, and dairy products may also be okay for blood pressure, too much calcium, such as supplements, is not good for blood pressure and may be haazardous.

So there's what I have found thus far. Reading comments below will explain many of these notes more clearly, at least providing links to the actual studies that are key to the comments above.

Here's a few notes from a kind respondent who sent the DASH link: Regarding potassium: Page 21 of that DASH handout has a good list of common foods and their potassium content. You'll get double duty from your yogurt - the probiotics and the potassium.....and besides the vegetables, the legumes are good sources of potassium, too. I also have high blood pressure and I'm a dietitian.
RD, CD, MA
Dietitian and "Beloiter"

UNEDITED COMMENTS AND LINKS/REFERENCES

1. FISH OIL- OMEGA 3 REDUCES HEART ATTACK RISK http://www.nutrition.org/cgi/content/abstract/134/11/2991 Dietary Linolenic Acid Reduces Inflammatory and Lipid Cardiovascular Risk Factors in Hypercholesterolemic Men and Women   Guixiang Zhao*, Terry D. Etherton*,, Keith R. Martin*, Sheila G. West**, Peter J. Gillies and Penny M. Kris-Etherton*,2 Linolenic acid (ALA) reduces cardiovascular disease (CVD) risk, possibly by favorably changing vascular inflammation and endothelial dysfunction. Inflammatory markers and lipids and lipoproteins were assessed in hypercholesterolemic subjects (n = 23) fed 2 diets low in saturated fat and cholesterol, and high in PUFA varying in ALA (ALA Diet) and linoleic acid (LA Diet) compared with an average American diet (AAD).,, The 2 high-PUFA diets decreased serum total cholesterol, LDL cholesterol and triglycerides similarly (P < 0.05); the ALA Diet decreased HDL cholesterol and apolipoprotein AI compared with the AAD (P < 0.05). ALA appears to decrease CVD risk by inhibiting vascular inflammation and endothelial activation beyond its lipid-lowering effects.

2. Vitamin D - Vitamin D lowers blood pressure - "Conclusions: Systolic blood pressure is inversely associated with serum vitamin D concentrations in nonhypertensive white persons in the United States." (http://www.ajcn.org/cgi/content/abstract/87/1/136)

3. VITAMIN C -
a. http://www.beloit.edu/nutrition/heartdis.htm
Vitamin C dose over 700 mg/day reduces heart disease! Antioxidant vitamins and coronary heart disease risk: a pooled analysis of 9 cohorts Paul Knekt et al Am. J. Clinical Nutrition,  Dec 2004;  80:  1508 - 1520. Design:A cohort study pooling 9 prospective studies that included information on intakes of vitamin E, carotenoids, and vitamin C and that met specific criteria was carried out. During a 10-y follow-up, 4647 major incident CHD events occurred in 293 172 subjects who were free of CHD at baseline. Results:… Compared with subjects who did not take supplemental vitamin C, those who took >700 mg supplemental vitamin C/d had a relative risk of CHD incidence of 0.75…Supplemental vitamin E intake was not significantly related to reduced CHD risk. Conclusions:The results suggest a reduced incidence of major CHD events at high supplemental vitamin C intakes.
b. Sauberlich, H. E., "Pharmacology of vitamin C", Annu. Rev. Nutr. 14: 371-91 (1994) "Ascorbic acid is probably the most effective, least toxic antioxidant identified in mammalian systems...Ascorbic acid is superior to other water-soluble plasma antioxidants (uric acid and bilirubin) as well as to the lipoprotein-associated antioxidants (alpha-tocopherol, beta-carotene, and lycopene)....Vitamin C can also interact with the tocopheroxy radical to regenerate tocopherol. Consequently, ascorbic acid may be important in protecting against oxidative stress-related diseases and degeneration associated with aging, including coronary heart disease, cataract, and cancer" [also reviews evidence connected with vitamin C and diabetes, blood pressure, parkinson's, respiratory symptoms, immune function, sickle cell anemia, and idiopathic thrombocytopenia purpura].

4. DASH diet AND EXERCISE- Caryl A Nowson et al, Blood pressure change with weight loss is affected by diet type in men Am J Clin Nutr 2005 81: 983-98 Background: Weight loss reduces blood pressure,… Objective: Our goal was to assess the effect on blood pressure of 2 weight-reduction diets: a low-fat diet (LF diet) and a moderate-sodium, high-potassium, high-calcium, low-fat DASH diet. Design: After baseline measurements, 63 men were randomly assigned to either the WELL or the LF diet for 12 wk, and both diet groups undertook 0.5 h of moderate physical activity on most days of the week…Conclusions: For a comparable 5-kg weight loss, a diet high in low-fat dairy products, vegetables, and fruit (the WELL diet)resulted in a greater decrease in blood pressure than did the LF diet. This dietary approach to achieving weight reduction may confer an additional benefit in reducing blood pressure in those who are overweight. (http://www.ajcn.org/cgi/content/abstract/81/5/983)

SUMMARY OF THE DASH DIET

5. BERRIES - AJCN Feb, 2008 berry consumption decreases blood pressure, increases HDL, and decreases improper blood clotting.

6. Tea - http://www.beloit.edu/nutrition/tea.htm
vasodilatory - relaxes blood vessels lowering blood pressure

7. Nuts - Eat a handful on at least 4 days each week

8. OLIVE OIL  USE OLIVE OIL: http://www.ajcn.org/cgi/content/abstract/80/4/1012
Mutual adjustment between olive oil and vegetables, which are frequently consumed together, indicated that olive oil has the dominant beneficial effect on arterial blood pressure in this population.
http://www.beloit.edu/nutrition/litnotes/litnotes07mayajcn.htm   Oil and vinegar rather than creamy salad dressing is an easy choice to improve health and even reduce blood pressure.

USE OLIVE OIL: http://www.ajcn.org/cgi/content/abstract/80/4/1012 Mutual adjustment between olive oil and vegetables, which are frequently consumed together, indicated that olive oil has the dominant beneficial effect on arterial blood pressure in this population.

9. FIBER - a. Whole grains reduce heart disease risk - "Conclusions: Both hypocaloric diets were effective means of improving CVD risk factors with moderate weight loss. There were significantly (P < 0.05) greater decreases in CRP and percentage body fat in the abdominal region in participants consuming whole grains than in those consuming refined grains." (http://www.ajcn.org/cgi/content/abstract/87/1/79)

b. For fiber, Use whole grain foods! http://www.beloit.edu/nutrition/wholegrain.htm

10. CHOCOLATE - Cocoa, diabetes, and hypertension: should we eat more chocolate? Cesar G Fraga “With respect to cardiovascular health, one class of flavonoids, the flavanols, is receiving increasing attention (2). Cacao, tea, grapes, and grapefruit are examples of edible plants that are rich in flavanols… the consumption of dark chocolate improves glucose metabolism and decreases blood pressure…The polyphenol contents of the dark and white chocolate were assumed to be 500 and 0 mg, respectively …The authors found that the dark chocolate supplement was associated with improved insulin resistance and sensitivity and decreased systolic blood pressure, whereas white chocolate had no effect… Cocoa is rich in flavanols,… the regulation of nitric oxide (NO) production by the flavanols present in dark chocolate could explain its effects on both insulin sensitivity and blood pressure…”

11. Potassium Daily Value: 3,500 mg  Hazardous level: safe at 10xRDA Average intake in US diet: 2,500 mg   Function: principal intracellular cation (positive ion), contributing to nerve impulses, control of  skeletal muscle contraction, and maintenance of normal blood pressure

12. Probiotics [milk products may lower blood pressure] Milk Peptides and Blood Pressure J. Nutr. 2007 137: 825S-829S "Epidemiological studies suggest that milk consumption and dietary intake of dairy proteins are inversely related to the risk for hypertension. Also, some intervention studies have shown a blood pressure-lowering effect of milk products and dairy proteins. Milk peptides are formed from milk proteins by enzymatic breakdown by digestive enzymes or by the proteinases formed by lactobacilli during the fermentation of milk."

13. Soy - [Soy lowers blood pressure] Gong Yang et al,  Longitudinal study of soy food intake and blood pressure among middle-aged and elderly Chinese women Am J Clin Nutr 2005 81: 1012-1017
Objective: Our aim was to examine the association between usualintake of soy foods and BP. Design: The usual intake of soy foods was assessed at baseline,and BP was measured 2–3 y after the baseline survey among45 694 participants of the Shanghai Women's Health Study aged40–70 y… Conclusion: Usual intake of soy foods was inversely associatedwith both systolic and diastolic BPs, particularly among elderlywomen.

14. Saturated fat - SATURATED FAT AND HEART DISEASE: http://www.ajcn.org/cgi/content/full/80/5/1102 "After a comparison of the effects of the 2 diets in both men and women, the incidence of coronary artery disease was lower by 50% and 65% after the consumption of polyunsaturated fat in the 2 hospitals." Roc's Translation: Unsaturated fats, especially olive oil and fish oil which contain omega-3 fatty acids which reduce inflammation, remain particularly beneficial to health.

15. Low Glycemic Index foods - http://www.beloit.edu/nutrition/ln/ln08janajcn.htm - into your webserver to read the summary and details of the many nutrition discoveries reported this month. 1. Low glycemic index foods are better for health, and may lower blood pressure.

16. SALT - IV. homocysteine JAMA, 1995 Nov 15, 274:19, 1526-33"A total of 7591 men and 8585 women, 40 to 67 years of age, with no history of hypertension,diabetes, coronary heart disease, or cerebrovascular disease were included... CONCLUSIONS--Elevated plasma tHcy level was associated with major components of the cardiovascular risk profile, ie, male sex, old age, smoking, high blood pressure, elevated cholesterol level, and lack of exercise. These findings should influence future studies on the etiology and pathogenesis of cardiovascular disease. "

17. COFFEE - [Study compared drinking no coffee vs. 1 cup a day vs. 2 cups a day vs. more than that. Impact on blood pressure went from 3.4 to 7.7 to 8.0 mm Hg, which was the maximum even for those exceeding 2 cups a day.] Am J Clin Nutr 2005 81: 1307-1312

18. CALCIUM HAZARD - Among other things, I was concerned because just as too little calcium can cause osteoporosis, too much can lead to numerous unpleasant and even dangerous side-effects, from diarrhea to high blood pressure.

With concern, from Nutrition Investigator, "Roc"