Hypertension (High Blood Pressure)
Dr. Weyrich's Naturopathic Functional Medicine Notebook
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Etiology
Regulation of blood pressure is complex, with numerous interacting systems and signalling pathways.One of the most important systems is the renin-angiotensin system. When oxygenated blood flow to the kidneys is reduced, the kidneys respond by releasing a hormone called renin. Renin travels in the blood to the lungs, where it activates an enzyme called angiotensin converting enzyme (ACE). The ACE then acts to make the hormone angiotension which raises blood pressure in an effort to increase the flow of oxygenated blood to the kidneys.
This begs the question of why the blood flow to the kidneys was reduced in the first place. One common cause is atherosclerosis of the renal artery. Another cause that has been proposed is hypothyroidism (see below).
One often-overlooked cause of hypertension is Sleep Apnea.
Treatment
- Diet, exercise, and weight loss are among the most effective interventions for hypertension.
- Treat hypothyroidism if present [Barnes; Starr2005, pg 15]. When treating hypothyroid patients with hypertension, the rate of titration must be kept slow in order to prevent agravating the problem [Starr2005, pg 180].
- Angiotension Converting Enzyme Inhibitor (ACE-I) or Angiotension Receptor Blocker (ARB) drugs are often the first-line drug of choice.
- Diuretic herbs or drugs are often prescribed.
- Reduction in salt intake reduces blood pressure in some (but not all) patients.
- The TCM herbal preparation Eucomia Combination (Du Zhong Pian, from Plum Flower) may be useful for some patients.
Hypotheses
Hypertension is sometimes associated with hypothyroidism and it has been observed that hypertension resolved (80%) if the hypothyroid condition is treated. It may take several months to several years to acheive maximum therapeutic effect [Barnes; Starr2005, pg 137]. It has been proposed that in these cases, the body is compensating for low thyroid status by increasing sympathetic tone (adrenaline or other adrenal hormones) [Starr2005, pg 15].ICD-9 Codes
| ICD9-Code | Description | Comments |
|---|---|---|
References
Unless specifically noted above, references used in the construction of this web page include the following:[FDM] Lecture notes from Functional Medicine University.
[SCNM] Lecture notes from Southwest College of Naturopathic Medicine.
[UT] Lecture notes from the University of Tennessee graduate programs in Chemistry and Biochemistry.
[Barnes] Broda O. Barnes M.D. Research Foundation at http://www.brodaobarnes.org. Cited by [Starr2005].
[Starr2005] Mark Starr. Hypothyroidism Type 2: The Epidemic. Columbia, MO: Mark Starr Trust (2005).
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