This study investigated whether drugs that reduce high blood pressure (antihypertensive drugs) reduce the risk of developing Parkinson’s disease in patients with high blood pressure.

This article reviewed the latest questions and research concerning hypertension treatment today, with special emphasis on new generation drugs now becoming available.

This analysis reviewed recently reported studies that compared the effect on blood pressure reduction and adverse events between amlodipine and aliskiren alone (monotherapy), or amlodipine-aliskiren (AmAl) combination therapy.

This study investigated the connection between ambulatory heart rate and the incidence of cardiovascular events in patients with hypertension. 

High blood pressure ranks as the #1 risk factor for death and disability in the world. Previously, I showed how a plant-based diet may prevent high blood pressure. But what if we already have it?

The American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention recommend, as the first-line treatment, lifestyle modification. If that doesn’t work, you start the patient on a thiazide diuretic, or water pill, and then you keep piling on the meds until you get their blood pressure down. Commonly people will end up on three drugs, though researchers are experimenting with four at a time, and some people end up on five.

Why not just jump straight to the drugs? Well, they don’t treat the underlying cause, and they can cause side effects. Less than half of patients stick with even the first-line drugs, perhaps due to the adverse effects such as erectile dysfunction, fatigue, and muscle cramps. So, what are these recommended lifestyle changes? They recommend to control one’s weight, salt, and alcohol intake, engage in regular exercise, and adopt a DASH eating plan.

The DASH diet has been described as a lactovegetarian diet, but it’s not. It emphasizes fruits and vegetables and low-fat dairy, but just a reduction in meat. Why not vegetarian? We’ve known for decades that food of animal origin is highly significantly associated with blood pressure. In fact, you can take vegetarians, give them meat, and watch their blood pressures go right up.

I’ve talked about how there are benefits to getting blood pressure down as low as 110 over 70, but who can get that low? Populations eating traditional whole food plant-based diets. Like in rural China, about 110 over 70 their whole lives, with meat eaten only on special occasions. Or rural Africa, where the elderly have perfect blood pressure as opposed to hypertension.

In the Western world, as the American Heart Association has pointed out, the only folks really getting down that low are the strict vegetarians, coming out about 110 over 65. So, when they created the DASH diet, were they just not aware of this landmark research, done by Harvard’s Frank Sacks? No, they were aware. The Chair of the Design Committee who came up with the DASH diet was Dr. Sacks. In fact, the DASH diet was explicitly designed with the #1 goal of capturing the blood pressure-lowering benefits of a vegetarian diet, yet containing enough animal products to make it palatable to the general public. In fact, Sacks found that the more dairy the lactovegetarians ate, the higher their blood pressures. But they had to make the diet acceptable. Research has since shown that it’s the added plant foods, not the changes in oil, sweets, or dairy that appear to be the critical component, so why not eat plant-based?

A recent meta-analysis showed vegetarian diets are good, but strictly plant-based diets may be better. Vegetarian diets in general confer protection against cardiovascular diseases, some cancers and death, but completely plant-based diets, vegan diets, seem to offer additional protection for obesity, hypertension, type 2 diabetes, and heart disease mortality. Based on a study of 89,000 people, those eating meat-free diets appeared to cut their risk of high blood pressure 55%, but those eating meat-free, egg-free, and dairy-free had 75% lower risk.

If, however, you’re already eating a whole food plant-based diet, no processed foods, no table salt, and you’re still not hitting 110 over 70, there are a few foods recently found to offer additional protection. Ground flaxseeds, a few tablespoons a day, induced one of the most potent antihypertensive effects ever achieved by a dietary intervention, two to three times more powerful than instituting an aerobic endurance exercise program.

Watermelon also appears to be extraordinary, but you’d have to eat like two pounds a day. Sounds like my kind of medicine, but it’s hard to get year-round. Red wine may help, but only if the alcohol has been taken out. Raw vegetables or cooked? And the answer is both, though raw may work better. Beans, split peas, chickpeas, and lentils may help a little. Kiwifruits don’t seem to work at all, even though the study was funded by a kiwifruit company. Maybe they should have taken direction from the California Raisin Marketing Board, which came out with this study showing raisins can reduce blood pressure–but only, apparently, compared to fudge cookies, Cheez-Its, and Chips Ahoy!

This article reviewed the recent advances in the treatment of hypertension (HTN) as published in the latest clinical trials.

During the past two years, a large focus has been given to the treatment of resistance hypertension. It is defined as persistently high blood pressure despite medical treatment with at least 3 blood pressure lowering drugs. Most of the interest has been focused on interventions that target the nervous system. Catheter-based procedures are minimally invasive techniques that involves inserting a small wire through the artery of the hand or the groin to reach the target organ. Two such procedure are renal denervation and carotid baroreceptor stimulation, both have been shown to dramatically improve blood pressure control. Renal sympathetic denervation involves disruption of nerve ends in the artery of the kidneys (the renal artery). Carotid baroreceptor stimulation involves implanting a small electrical device near nerve ends in the artery of the neck (the carotid artery).

Drug therapies have also evolved in recent years, and different drug combinations are the focus of investigation. Combining drugs from different classes (drugs with different mechanisms of action) has been shown to be useful, while combining drugs from similar classes does not generally show benefit, and comes at the cost of adverse events. One such example is the combination of aliskiren (Tekturna) with another drug of the ACE inhibitor class. Both drugs share the same mechanism of action. 

Thiazides are a class of diuretic drugs, that increase the volume and frequency of urination thereby reducing blood pressure. Despite evidence (clinical studies) in favor of the thiazide-like drug chlorthalidone (Hygroton) and the thiazide bendroflumethiazide (Aprinox), another thiazide called hydrochlorothiazide (Aquazide H) is more often used in clinical practice.   

Management of HTN usually involves lifestyle modifications. The dietary approaches to stop hypertension (DASH) diet - a low-sodium diet - has continued to show benefit in blood pressure management. Adopting the DASH diet plan continues to be recommended by every guideline. Weight loss in the obese and overweight is also recommended, however, recent trials have shown that not all patients show a similar degree of blood pressure reduction in response. The mechanisms behind this variability is now under further investigation and might open new avenues of treatment.

Aerobic (isotonic) exercise, such as regular walking, is well established as an effective way for lowering blood pressure and reducing cardiovascular risk (i.e. heart attacks, stroke). Resistance exercise (high-intensity, short duration exertion) on the other hand is still under debate. 

This study examined the most beneficial blood pressure targets for patients with hypertension and increased cardiovascular risk.

This analysis examined the effect of reduced blood pressure on major cardiovascular events such as heart attacks and strokes. The incidence of these events was reviewed compared to the blood pressure values achieved with treatment. The effect of blood pressure reduction on kidney damage was also reviewed.

This study examined if elevated blood pressure increases the risk of vascular dementia. The authors concluded that for individuals under the age of 70, a higher systolic blood pressure (pressure when the heart is contracting) leads to an increased risk of vascular dementia. 

This paper looked at the management of patients with high blood pressure and elevated heart rate. An elevated heart rate increases the risk of heart disease.