Complementary and alternative medicine approaches to blood pressure reduction (An evidence-based review)

1. Complementary and alternative medicine approaches to blood pressure reduction(An evidence-based review) Richard Nahas MD Canadian Family Physician J. vol54:November2008 Presentation:NaderNowshad MD

2. Introduction • Hypertension :a main risk factor of cardiovascular diseases • Efficacy of drug therapy for achieving optimal BP • Effect of reduction of BP on public health

3. 5 Lifestyle changes for controlling hypertension • 1- Reducing Na-intake • 2-Increasing exercise • 3-Moderating alcohol consumption • 4-Losing weight • 5-Following dietary approaches to stop hypertension(DASH) eating plan

4. Role of complementary and alternative medicine Users of complementary and alternative medicine antihypertensive therapies in Canada and U.S: 36% of Population Some examples in our country

5. Quality of evidence in this study • Reviewing Medline and EMBASE :1966-May 2008 • Prospective studies and human clinical trials • Availability of level 1 evidence • Methodologic limitations of nondrug clinical trials

6. Dark chocolate • Cacao bean(Theobroma cacao) • Flavonoid polyphenols---- procyanidins • Ancient usage for treating pain and inflammation • A prospective study for 15 years in Germany • Consumption of 100 gr daily for 2 weeks:Reduction of BP about 4.7/2.8 mmHg

7. Dark chocolate • Effect of chocolate on both hypertensive and normotensive patients • Consumption of 6.3 gr of dark chocolate for 18 weeks: Reduction of BP about 2.9/1.9 mmHg • Effect on rising of S-nitrosoglutathione • Improving vascular function in diabetic patients • Dark chocolate is better than White one!

10. Coenzyme Q10: • UBIQUINONE • First isolation : Beef mitochondria • Integral component of mitochondrial electron transport chain • Reduction of lipid peroxidation • Benefits :CHF,DM type 2,Atherosclerosis,Migraine,Parkinson • Interaction with statin therpay

11. Coenzyme Q10: • Best effect for reducing BP(abou16.6/8.2) • <It would seem acceptable to add CoQ10 to conventional anti-hypertensive therapy.> • Over-the-counter drug • Dosage:60 to 120 mg daily • Side effect : mild gastrointestinal upset in long-term trials

14. Melatonin • Pineal production of melatonin in absence of light • Indications : sleep aid, treating jet lag • Night time BP is more predictive of cardiovascular outcomes than daytime BP • Impairment of dependent vasodilation in patients with low level of melatonin • Decreasing BP about 3.77/3.63 mmHg after consumption of 3 mg melatonin daily

15. Melatonin • Reverse effect after taking Nifedipine • Adverse effect of beta-blockers on level of melatonin

19. Vitamin D: • Effects on cancer , immunity and cardiovascular diseases • 1,25,hydroxyvitamin D inhibits renin production and vascular smooth muscle proliferation • BP rises with increasing distance from the equator • Low level of activated vitamin D in serum increase the risk of hypertension an myocardial infarction

20. Vitamin D: Ultraviolet B light waves trigger endogenous vitamin D production. Vitamin D toxicity is very rare.

23. Mind-body approaches: Side effects of emotional and psychological stress on BP Qigong; traditional Chinese medicine:Movement,breathing,meditation. Slow , controlled breathing can increase parasympathetic and decrease sympathetic nervous system activity, which are important factors controlling BP.

24. Mind-body approaches: Autonomic dysfunction in patients with DM Effect of Transcendental meditation on BP: ----Mantra

27. Acupuncture: A treatment based on non-Western system of diagnosis Comparison of REAL and SHAM Acupuncture

30. Conclusion: • Economical effects • Necessity of investigations by GOVERNMENTS and INSURERS • The largest BP reduction was seen with use of coenzyme Q10.

31. داروهای گیاهی کاهنده فشار خون: • برگ گل و گل زالزالک • دانه و برگ شنبلیله • پیاز گیاه سیر • برگ و ساقه گیاه دارواش • ساقه و برگ جعفری • تخم کرفس • برگ زیتون