Hypertension

What is hypertension?

Hypertension is the condition of having chronically elevated blood pressure.

Hypertension increases the risk of (Rakel, 2022):

  • atherosclerosis
  • heart attack
  • heart failure
  • stroke
  • kidney failure
  • aneurysm
  • cognitive dysfunction
  • erectile dysfunction
  • vision loss

Medical standard of care for hypertension

  • The medical approach to hypertension involves basic lifestyle modifications and pharmacological treatments.
  • Medications commonly taken for hypertension include:
    • ACE inhibitors
    • angiotensin receptor blockers
    • beta blockers
    • calcium-channel blockers
    • thiazide diuretics
  • Lifestyle recommendations typically focus on:
    • weight loss
    • exercise
    • alcohol limitation
    • stress reduction
    • salt limitation

Why consider the orthomolecular approach?

High blood pressure can be caused by many different factors, as shown by both research and clinical experience. The medical standard of care addresses only some of these factors.

An orthomolecular approach:

  • identifies the drivers and causes of hypertension and focuses on addressing them
  • addresses the specific biological factors that may be affecting each individual
  • works WITH the body to restore balance and normal function, and considers the person with the condition versus just the condition
  • addresses nutrient depletions and other factors that promote hypertension
  • can be done SAFELY in conjunction with most medical interventions

About blood pressure

Blood pressure is the force exerted by blood against the inner walls of blood vessels as it circulates through the body.

Blood pressure is represented by:

  • systolic pressure – the force exerted against artery walls with the heart is beating (top number)
  • diastolic pressure – the force exerted against artery walls when the heart is at rest between beats (bottom number)

Optimal blood pressure is considered to be 120 mm Hg / 80 mm Hg.

Blood pressure management by the body:

  • ensures that all tissues and organs receive an adequate supply of oxygen and nutrients while preventing damage caused by excessively high or low pressures
  • allows the body to adapt to various conditions such as:
    • the increased or decreased demands for oxygen with physical activity or rest
    • increasing blood pressure during the “fight or flight” response
    • maintaining blood flow to the brain when standing up quickly

Normal blood pressure is the result of an appropriate balance of increasing and decreasing blood pressure appropriate to body needs.

How the body manages blood pressure

Blood pressure is regulated by a complex and interconnected system of organs, tissues, bio-sensors, and biochemistry. This system:

  • measures blood pressure via:
    • stretch receptors
    • measurement of sodium and other solutes in the blood and fluids
  • signals organs and tissues via:
    • hormones
    • enzymes
    • nervous system signalling
  • increases or decreases blood pressure by:
    • constricting (vasoconstriction) or relaxing blood vessels
    • altering the amount of fluid in the bloodstream
    • altering heart rate

How the blood-pressure-management system works

  • Kidneys – increase or decrease the amount of water and sodium in the blood
  • Heart – increases or decreases heart rate and stroke volume
  • Baroreceptors – nerve endings in the walls of blood vessels that measure the amount of stretch in vessel walls (as a way of measuring pressure)
  • Osmoreceptors – specialized neurons that measure the amount of sodium and other substances (as a way of measuring blood viscosity)
  • Antidiuretic Hormone – a hormone released by the pituitary gland that increases blood pressure by promoting water retention by the kidneys
  • Vascular smooth muscle (a type of muscle tissue in walls of blood vessels) – contracts and dilates to change blood vessel diameter and volume
  • Elastin is a layer of structural protein that gives elasticity to artery walls, allowing them to stretch and recoil as blood pulses through them, reducing shear stress and workload on the heart (Cocciolone et al., 2018)
  • Endothelial tissue a single layer of cells that line blood vessels and other tissues that regulates vascular smooth muscle contraction and permeability of the arteries to substances in the blood (da Cunha Martins et al., 2018)
  • Glycocalyx – a layer of hair-like filaments that surround the membranes of endothelial and other cells that acts as a protective barrier to substances in the blood, reduces shear stress from blood flow (Kolářová et al., 2014), and mediates nitric oxide production
  • Nitric oxide (a signalling molecule generated by the lining of the arteries) – decreases blood pressure by relaxing smooth muscle in the blood vessels
  • Blood zeta potential (the electrical charge at the surface of particles, such as blood cells, when suspended in a liquid) – optimal zeta potential keeps blood cells from clumping together, reducing the risk of clotting and excessive stickines

Blood pressure management dysfunction and hypertension

Blood pressure is determined by these three variables:

  • volume of the system (how much arteries and veins can hold)
  • amount of fluid in the system (how much fluid volume is in the system)
  • the resistance to the blood flow (“thickness” of the blood and “stiffness” of the arteries)

Hypertension occurs when one or more of these variables become imbalanced or disrupted.

Dysfunction of key tissues and components in the context of hypertension

  • Heart – sustained increase in stroke force and volume
  • Kidneys – retain sodium, and maintain elevated blood pressure due to misperceiving actual blood pressure as being too low (Ameer, 2022)
  • Arteries – In the context of hypertension arteries can become stiff and inflexible, requiring increased blood pressure to move blood through the circulatory system. Arteries can become stiff due to:
    • inflammation – promotes arterial wall structural changes and stiffening
    • oxidative stress – degrades elastin and impairs nitric oxide signalling
    • elastin degredation – results in loss of arterial elasticity
    • arterial calcification – calcium deposits in artery walls due to inflammation, oxidative stress damage to the arterial walls, and vitamin K2 deficiency
    • smooth muscle proliferation (as a result of hypertension) – causes artery wall thickening and stiffness
    • autonomic nervous system (ANS) dysfunction – which leads to persistent smooth muscle contraction
    • advanced glycation end products (AGEs) – cause cross-linking of collagen and other proteins, resulting in stiffening
  • Endothelium – damage leads to decreased nitric oxide production, and increased levels of oxidized low-density lipoprotein (LDL) (Moreno-Luna et al., 2012)
  • Glycocalyx – damaged by inflammation (Kolářová et al., 2014), oxidative stress (Ali et al., 2019), elevated sodium, and other factors
  • Blood – “thickness” is increased which requires increased pressure to move blood through the arteries. Causes of increased blood thickness include:
    • Decreased zeta potential – low zeta potential increases clumping of particles in blood – and therefore blood thickness
      • key factors that decrease zeta potential include cell membrane lipid composition, low pH, and oxidative stress
    • Damage to the endothelial lining of blood vessels reduces the production of nitric oxide and other anticoagulant factors like prostacyclin.
    • Increased platelet aggregation (Mullan et al., 2002)
      • Abnormal fibrinolysis (breakdown of blood clots) (Beevers et al., 2001″ results in increased coagulation
      • Hypertension causes shear stress on vessel walls which activates platelets more readily.
      • Activated platelets release pro-coagulant substances, such as thromboxane A2 and ADP, enhancing clot formation.
  • Autonomic nervous system – dysfunction can contribute to hypertension through (How Does Alcohol Affect Blood Pressure?, 2021):
    • increased cortisol production
    • increased secretion of norepinephrine and epinephrine
    • decreased baroreceptor activity
  • RAAS
    • excessive renin release – leading to increased angiotensin II release, resulting in vasoconstriction
    • aldosterone overproduction (adrenal gland dysfunction) – causes excessive sodium and water retention, increasing blood volume
    • renal artery stenosis – (narrowing of the arteries that supply blood to the kidneys) causes the kidneys to mistakenly sense low blood pressure, leading them to release extra renin, even when blood pressure is already normal or high
    • Angiotensin II sensitivity – blood vessels become more sensitive to angiotensin II, meaning even normal levels of the hormone can cause pronounced vasoconstriction, leading to elevated blood pressure.

All of the contributing factors to hypertension can be favourably modified by targeted nutrients and other orthomolecular therapies.

References xxx

Hypothyroid / Contributing Factors >