Hypertension is the risk factor that is most responsible for premature death worldwide. It is also highly modifiable in most cases. Hypertension affects more than 1 billion people, or 1 in every 4 adults around the globe. Because it often causes no symptoms, the first sign of hypertension may be a heart attack or stroke if someone is not screened.
The factors contributing to hypertension have been extensively studied, yet are still not entirely known. But many are becoming apparent. Among these, we now have options for root cause testing to better tailor treatments for the individual's unique disease pattern.
In many cases, especially if they are started early, lifestyle and functional medicine interventions can adequately control blood pressure, eliminating the need to use medications. In addition, treating root contributing causes addresses the underlying disease processes, not just the symptom of high blood pressure.
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What is Hypertension?
Hypertension is when blood pressure rises to levels that cause damage to the blood vessels. In most cases, this is a gradual increase, and levels gradually and silently rise over time, showing no symptoms indicating a problem. There are also situations where a specific medication or medical condition causes a sudden and sometimes dangerous acute rise in blood pressure, called a hypertensive crisis.
Though specific numbers are set to define hypertension, there is a gradual shift in harm over a range of blood pressures, with the risk of cardiovascular disease doubling from 115/75 to 135/85. Hypertension is generally diagnosed based on a daytime average systolic blood pressure (the top number) over 130 mmHg and/or a daytime average diastolic blood pressure (the bottom number) over 90 mmHg. In most cases, if there is one high reading in a clinical setting, it's not enough to diagnose hypertension. Instead, repeated home measurements or several readings in the clinic may be recommended.
What is Cardiovascular Disease?
Cardiovascular disease is a collection of conditions that involves damage and harm to the heart or blood vessels. Atherosclerosis, or the build-up of arterial plaque, is a significant part of many of these diseases. This narrows the space available for blood to flow and can cause heart attacks and strokes if a clot dislodges and gets stuck in one of these narrow spaces in a vessel supplying either the heart or the brain. Plaque build-up can also lead to other vital organs, like the kidneys, not getting enough oxygen.
Some of the more common cardiovascular diseases, also called heart diseases, include Coronary Artery Disease (CAD), Congestive Heart Failure (CHF), Cerebrovascular Disease (CVD), which includes strokes and Atrial Fibrillation (AFib), a heart rhythm disorder.
How Does Hypertension Cause Cardiovascular Disease?
Hypertension is one of the most important contributing factors to cardiovascular disease. But why?
It comes down to blood vessel damage and how the body responds to this over time. When a fluid (blood) flows through an enclosed space (a blood vessel), a higher pressure creates more opportunity for this flow to create micro-injuries in the lining of the vessels.
When the lining of the blood vessels is damaged in this way, the body tries to heal, but the way it does so involves forming plaques. This process is accelerated by more vessel damage, inflammation, and dyslipidemia (including elevated LDL).
As plaque forms in the vessels, it stiffens the arteries so they are less able to expand to accommodate higher flow rates. The plaque also may physically take up a significant amount of the space inside a vessel, limiting flow to critical organs, like the kidneys. As the flow becomes restricted by the effects of vessel damage, the heart has to work harder to keep blood flowing, so the heart muscle can also thicken with time as a result of unmanaged hypertension.
Cardiovascular Disease Symptoms
Cardiovascular disease is a collection of different diseases, so the symptoms can be broad. Some of the most common symptoms to show up in the most common cardiovascular diseases include:
- Chest tension, pressure, discomfort, or pain
- Feeling out of breath
- Feeling the heart skipping beats
- Pain in the jaw or back
- Sweating
- Dizziness or Lightheadedness
- Exhaustion
- Sudden facial paralysis
- Sudden difficulty thinking or speaking clearly
- Sudden weakness felt on one side of the body
Hypertension Symptoms
The dangerous thing about high blood pressure is that you can have it for a long time without having any symptoms. Even acutely dangerous levels may cause only a mild headache or no symptoms at all.
When symptoms do occur, these can include:
- Headaches
- Nosebleeds
- Dizziness
- Blurred vision
- Buzzing in the ears
- Anxiety
- Heart palpitations
- Nausea
- Vomiting
- Difficulty Breathing
- Chest Pain
Possible Causes of Hypertension
Though once considered a discrete disease, primary hypertension is now considered a highly complex syndrome involving multiple organ systems and various contributing causes.
Lifestyle and Stress
In terms of lifestyle, a sedentary lifestyle is a risk factor for hypertension, likely because it contributes to insulin resistance. Other factors related to insulin resistance in developing hypertension include inflammation and oxidative stress.
One key regulating factor for blood pressure is the sympathetic nervous system (SNS), which creates a fight/flight/freeze response. When activated, it signals for the heart to increase output, the peripheral blood vessels to constrict, and the kidneys to reabsorb more sodium, increasing blood volume. These things increase blood pressure. For this reason, lifestyle, stress, immunity, and other factors that chronically increase sympathetic nervous system activation may contribute to the development of hypertension.
Allergies and Sensitivities
Allergies and immune sensitivities may elevate blood pressure and contribute to hypertension. Immunoglobulins are made by immune system cells when they recognize something that registers as a foreign invader. IgE antibodies are those that produce classic allergy symptoms. Studies show a positive association between hypertension and high IgE levels, as well as high IgG and IgA levels.
Poor Diet and Nutrient Deficiencies
Significant evidence shows the contribution of a diet high in fat (and a low omega-3 to omega-6 ratio), added salt, added sugar, refined carbs, and energy-dense foods and low in fruits and vegetables to hypertension. These poor dietary habits can also lead to high cholesterol (high lipids), another cause of hypertension. Another risk factor related to diet is elevated homocysteine levels. This can result from eating a meat-heavy but low fruit and vegetable diet or a diet that contains no animal products but does not supplement with Vitamin B12. The mechanism appears to be through damaging the blood vessels, impairing their ability to expand.
The deficiency of magnesium increasing with age is thought to partially explain increased rates of hypertension with age. Adequate magnesium intake or supplementation is safe and can reduce blood pressure.
Environmental Toxins
Environmental toxins, including heavy metals, at least including lead (Pb), cadmium (Cd), and arsenic (As), can contribute to hypertension by inducing oxidative stress and depleting antioxidant enzymes (SOD, GSH, TAC).
Genetic Factors
Genetic factors are associated with at least 50% of cases of primary hypertension. Some involve salt sensitivity in the kidneys or adrenals and pathways that affect homocysteine build-up (MTHFR) and lipid levels (ApoE). We are learning ways to modify nutrition and lifestyle specific to these variants to reduce their health impacts.
Oxidative Stress
When levels of inflammation and oxidative stress are elevated and antioxidants are depleted, research shows this is associated with hypertension. Inflammation and oxidative stress may impair the function of the endothelium (lining of blood vessels) and cause organ damage, both of which may contribute to the progression of hypertension. Markers of inflammation, oxidative stress, and even antioxidant status may be helpful in the early detection of the processes that contribute to hypertension and cardiovascular disease.
Functional Medicine Labs to Test for Root Cause of Hypertension
Functional medicine labs can be valuable tools for understanding the root causes of hypertension. Below are the top recommended labs run by functional medicine practitioners to assess hypertension.
BostonHeart Lipid Panel Comprehensive
In addition to working with hypertension to create arterial plaques, unhealthy lipids can also be a part of the root cause of hypertension. This test provides a comprehensive insight into the current lipid balance. This information can drive treatment decisions through diet, lifestyle, and possible medications.
Advanced Oxidative Stress Test
Oxidative stress is a key component in vascular damage progression, leading to chronically elevated blood pressure. This test looks at markers of oxidative stress in the blood. If markers are elevated, removing sources of oxidative stress, such as smoking, and increasing the consumption of antioxidants may help to reduce oxidative stress.
Metals Combo Test
This test evaluates hair, blood, and urine for past and present exposure to common heavy metals, which can increase blood pressure through increasing oxidative stress.
Homocysteine Test
Homocysteine can build up in the body due to the deficiency of B12 or folate. Elevated homocysteine is a risk factor for the development of hypertension, likely through interactions with other risk factors. This test shows homocysteine levels. This may be useful as a baseline and to monitor progress with therapies that target this pathway.
Red Blood Cell Magnesium Test
Magnesium is needed to relax muscles, including the smooth muscles lining blood vessels. Subclinical magnesium deficiency is also prevalent. This test looks at magnesium levels in the red blood cells, which may suggest that increasing dietary or supplemental intake may be helpful.
3x4 Genetics Test
This test looks for genetic variants in several genes related to overall health. Among these are variants specifically associated with blood pressure, salt sensitivity, and unique micronutrient needs.
96 General Food Panel IgG/IgA + IgE
The General Food Panel test looks for IgG and IgA to 96 different foods. The IgE panel can be added to confirm suspected IgE food allergies. IgG, IgA, and IgE antibodies have been shown to be associated with hypertension. Based on the positive antibody results, one can strategize ways to avoid reactive foods and environmental allergens.
Adrenocortex Stress Profile with Cortisol Awakening Response
This test measures the stress hormones cortisol and DHEA at specific times of the day to better understand one's diurnal rhythms and Hypothalamic-Pituitary-Adrenal (HPA) axis health, which correlates with chronic sympathetic activation.
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Conventional Treatment for Hypertension
Sometimes lifestyle strategies are not enough to adequately control blood pressure. In these cases, managing blood pressure levels with medication may help reduce damage from elevated blood pressure, reducing the risk and progression of cardiovascular disease.
Types of medications commonly used for hypertension include thiazide diuretics, calcium channel blockers, ACE Inhibitors, and angiotensin II receptor blockers (ARB). The outcomes between these different types of drugs are similar.
Functional Medicine Treatment for Hypertension
Functional medicine treatments address any causes uncovered through history or lab tests. These may include diet, supplements, and lifestyle interventions, such as exercise and meditation.
Heart Healthy Diet
A diet that supports optimal heart health strongly focuses on two things. Primarily, it is anti-inflammatory. Second, it is low in saturated fats. This looks like a Mediterranean-style diet, mostly plant-based, with abundant fruits and vegetables, moderate healthy fats, and moderate protein intake. It balances energy needs to reach and maintain a healthy weight. It is low in saturated fats from animal foods, low in sugar, and relatively low in alcohol.
High soluble fiber content, like from oats and apples, can help maintain healthy cholesterol levels.
While strict sodium restriction may be necessary for some who are genetically very sensitive, for most people, it is helpful to think of simply eating whole foods and adding a little salt at the table if desired. This automatically significantly reduces sodium over a heavily processed food diet. Fruits and vegetables also provide a higher intake of potassium, which balances the effect of sodium.
One popular diet created in the 1990s specifically for hypertension that incorporates many of these principles is the DASH diet. It is a dietary pattern focusing on eating fresh, unprocessed foods, lots of fruits and vegetables, whole grains, and lean meat and dairy. It may be an ideal model for someone who wants to move toward a plant-heavy healthy diet but still wants to eat some meat and dairy. Transitioning to this diet can improve blood pressure within a few weeks, and given its popularity, many resources are available to help with meal planning and cooking.
If any food or environmental allergies have been identified, avoiding these foods may help reduce the inflammatory contribution of allergies to cardiovascular disease.
Supplements and Herbs for Hypertension
There are many supplements that integrative providers use to help with various aspects of hypertension. Below are some of the commonly recommended ones:
DHA/EPA for Hypertension
Omega 3 (DHA and EPA) supplementation has been shown in multiple studies to reduce blood pressure in hypertension. The exact mechanisms are still being clarified but include reducing oxidative stress, altering the function of proteins on cell surfaces, and regulating vasodilation. Optimal doses may be about 3g total omega 3s daily or more in high-risk cases. The most common form is fish oil which can be taken in either a liquid or capsule form.
Magnesium for Hypertension
Magnesium is required for muscle relaxation. It is a common deficiency in Western societies, especially when consuming highly processed foods. Studies have shown that increasing magnesium intake through food or supplementation can reduce blood pressure in those with hypertension. A standard dose is 350-420 mg daily.
B-Vitamins for Hypertension
A significant body of evidence indicates that supplementation with B2 (riboflavin), B6, L-methyl folate, and B12 may reduce blood pressure by 6-13 mmHg. This effect is linked to the role of high homocysteine levels in promoting cardiovascular disease and the necessity for these nutrients to maintain lower homocysteine levels. Riboflavin, in particular, should be considered in those with MTHFR (677TT) genotype. B vitamins, being water soluble, are also safe in normal amounts and are economical compared to many other possible treatments.
NAC for Hypertension
Given the role of oxidative stress in hypertension, N-Acetyl Cysteine, which can increase glutathione levels, may be helpful by this mechanism. In addition, NAC has been shown to reduce homocysteine by up to 45%. The mechanism is thought to be that NAC breaks the bonds of homocysteine to albumin, an abundant protein in the blood, and takes its place binding to the albumin. This frees the homocysteine so that it can be removed in the kidneys. It is often dosed at 600 mg once daily or more for shorter periods of time.
Complementary and Integrative Medicine for Hypertension
Exercise
Many of us turn to exercise to manage stress and increase feelings of well-being. Studies show that exercise does help to rebalance the autonomic nervous system when it is in sympathetic excess (stress). Extensive evidence supports the use of exercise to reduce blood pressure. While aerobic exercise has a more significant effect in lowering blood pressure readings, resistance exercise and combined resistance and aerobic exercise are equal in improving the ability of blood vessels to dilate. Exercise also likely plays a preventative role in maintaining a healthy insulin response, as insulin resistance is a risk factor for developing hypertension.
Modalities to Reduce the Stress Response
Excess sympathetic (fight/flight/freeze) activation is related to the development of hypertension. The sympathetic (stress) state can be resolved through relaxing activities. Many relaxing modalities have been shown to reduce blood pressure in hypertension. We will examine a few of them here.
Massage
Moderate pressure massage has been shown to bring the system into a parasympathetic (rest and digest) state, as measured through heart rate variability. Massage has been found to reduce blood pressure and improve sleep in hypertensive women. This particular study included twice weekly 30-minute foot and back massage sessions for three weeks.
Music
A 2018 study showed that weekly 30 min music therapy sessions improved autonomic function (as measured by heart rate variability) in mothers of preterm infants experiencing increased stress. A systematic review in 2023 found that music therapy can reduce blood pressure and improve mood in hypertensive patients. The average reduction was 9 mmHg systolic and 6.5 mmHg diastolic.
Yoga
People often practice yoga for its relaxing effects. A 2020 study on German secondary school students showed that substituting yoga for typical school sports over ten weeks improved the students' autonomic nervous system balance, trending toward more parasympathetic activity and higher heart rate variability.
Yoga practice without postures (just breathing exercises and meditation) has been repeatedly shown to reduce systolic blood pressure. This is generally safe, and one study showed a reduction in systolic blood pressure of 3.8 mmHg with only one 90 min session weekly for 12 weeks.
Meditation
Meditation is often pursued as a way of calming the mind. Evidence supports meditation as a means of reducing excess sympathetic activation. Evidence also supports the effectiveness of several kinds of meditation in lowering blood pressure. Given the low risk of adverse effects and other possible benefits, this lifestyle intervention is worth trying for many.
Sauna
Regular sauna bathing has been studied and shown effectiveness in reducing blood pressure in those with hypertension. As an additional benefit, sauna use has also been studied and found helpful in various depuration (detoxification) protocols, which may apply to those with hypertension and high heavy metal levels.
Summary
Hypertension is deeply linked to lifestyle factors that drive cardiometabolic diseases and is a fundamental driver of premature illness and death. Numerous causes must be explored and addressed in a root cause approach. Often, if intervention is early in the progression, non-pharmacological treatments may be able to manage blood pressure fully. Other times, they can be used in conjunction with medications.
As there often are no symptoms of high blood pressure, regular monitoring, both for early detection and during the course of managing hypertension, is essential.
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