Cardiovascular Herbs and hypertension

by Paul Bergner

Medical Herbalism 3(1):1,4-6

An estimated 60 million Americans have high blood pressure. The disease plays a contributing role in most heart attacks and strokes. More than 80 percent of hypertensives have mild or moderate disease—systolic pressure between 140 and 180 and diastolic pressure between 90 and 115. Most cases of mild to moderate disease will respond to lifestyle changes and herbal treatment.

Hypertension greatly increases the risk of serious diseases, including cardiac failure, coronary heart disease, angina pectoris, myocardial infarction, stroke, and kidney failure. Insurance studies have shown that even slight increases in blood pressure decrease survival rates (Krupp et al.).

Conventional medical science cannot establish a cause in about 90% of cases, and treats the problem with pharmaceutical drugs, with only lesser attention put on lifestyle changes.

Conventional drug protocol

The normal protocol for giving conventional medications is the “step approach.” The patient is given progressively stronger drugs until the blood pressure falls to normal ranges. Conventional texts recommend first giving a simple diuretic, or a drug called a beta blocker. If that does not work, a combination of both is tried. If those do not work, stronger drugs, such as vasodilators, sympathetic depressants, and calcium channel blocker are given. In the past few years, with growing concerns about possible serious side effects to diuretic and beta-blocker therapy, it has become more common to give stronger drugs immediately.

Side effects

Diuretic-induced hypokalemia (potassium deficiency) has been reported in 10 to 30% of patients on long-term treatment. Recent studies show that hypokalemia may lead to previously unsuspected and potentially fatal heart arrhythmias, particularly after an earlier heart attack. Increases in plasma cholesterol of 10 to 20 mg/dl may also occur with diuretic therapy. Diuretics are also known to decrease glucose tolerance. Beta-adrenergic blocking drugs also raise serum lipids, increasing the long term risk of atherosclerosis. Overly-aggressive lowering of blood pressure can also cause heart attacks, and one physician suggests that as many as 25,000 heart attacks a year are caused by such treatment (Alderman). These side effects are suggested as possible reasons why high blood pressure medication does not decrease the incidence of fatal heart attacks in hypertensives. The side effects negate any benefits of the lower pressure. Other side effects, almost universal with high blood pressure medications, range from dry mouth to impotence. About half of all patients stop taking the drugs because of the side effects. Patients complaining of these side effects are common in alternative medical and herbal practices.

Non-pharmacological treatments

According to the Surgeon General’s Report on Nutrition and Health “adverse drug effects call attention to benefits of non-pharmacological treatments” for hypertension. Hypertension is associated exclusively with western diet and lifestyle; it is virtually unknown in undeveloped areas of the world following traditional diets. Although hypertension affects as many as 30% of blacks in the U.S., it is not found in Africa in areas living a traditional lifestyle (Meneely; Freis). The difference is presumably due to diet and stress.

Increase in dietary fiber, dietary linolenic acid, calcium, magnesium, and exercise, and decrease of dietary sodium, body weight, caffeine, alcohol, and tobacco consumption have all been found scientifically to reduce blood pressure. Hypertension has also been found to be aggravated by stress, and a wide range of stress reducing techniques have been found useful in reducing it (Pizzorno).

Clinical Cautions

Some clinical points for herbal practitioners: Most patients with mild to moderate hypertension can be weaned from blood pressure medications entirely by altering the diet and lifestyle. Don’t suddenly withdraw a patient from BP medications however—rebound heart attacks have been reported among people who suddenly stopped taking beta-blocker medications. All patients with severe or chronic hypertension should be monitored by a physician if trying to stop taking blood pressure medications. A patient coming to you taking medications may also be suffering from secondary hypertension due to kidney disease or other conditions, in which case a licensed physician, preferably naturopathic or homeopathic, should be managing the case.

Herbal formulas

Herbal treatment may include increasing dietary garlic and onions (Piotrowski; Petkov; Mowrey). Other herbs commonly used, usually in combination, are alteratives such as dandelion root and/or leaf; cardiotonics such as hawthorne or mistletoe; sedatives and antispasmodics such as valerian, scullcap, or black cohosh; and cayenne as a synergist. See the accompanying case studies and commentaries for more details of herbal treatment and drug replacement strategies.

Case Studies: Hypertension

Case 1

PATIENT: Sixty year-old male. 5’6". 175 lbs. Lawyer.

Moderately stressful home situation. Standard American diet. No exercise. Smokes tobacco.

FIRST VISIT. 12/19/1986.

Chief Complaint: Headache; occasional pain in left shoulder; occasional dizziness; insomnia.

Diagnosis, after routine lab work: essential hypertension, BP 180/110

BOTANICAL TREATMENT:

Wild oat tincture.

DOSE: 40 drops three times a day to help reduce smoking.

Dandelion root and leaf             2 parts

Hawthorne flowers, leaf and berries    4 parts

Valerian Root                2 parts

DOSE: 30-40 drops of tincture 4 times a day.

OTHER TREATMENT: moderate exercise; massage; meditation; light yoga; relaxation techniques. Diet: Salt restriction. Low fat vegetarian diet recommended. Garlic and Onions to be consumed freely. Supplements: Potassium, 1 g/day. Fiber supplement, 10 g/day. Calcium, 800 mg/day.

Magnesium, 800 mg/day.

FOLLOW-UP: 12/28 (eight days later)

Patient maintaining light exercise, taking supplements and herbs. Complains of fatigue and muscle cramps. Blood pressure 160/100. Advised to increase potassium in the form of orange and tomato juice.

BOTANICAL TREATMENT:

Mistletoe                    3 parts

Hawthorne flowers, leaf and berries     4 parts

Scullcap                    2 parts

Garlic                    1 part

DOSE: 30 drops three times a day with ¼ cup water before meals.

FOLLOW-UP: 1-2-1987.

Patient feeling better. Blood pressure 155/90. Headache and fatigue reduced but still complains of fatigue, anxiety and weakness. Patient advised to take natural multivitamin cap once a day and continue orange juice and tomato juice with other diet as advised to increase potassium. Serum potassium level within normal limits.

BOTANICAL TREATMENT:

Dandelion                    2 parts

Hawthorne flowers, leaf and berries    3 parts

Scullcap                    2 parts

Astragalus                1 part

Cayenne 15 drops added to 1 ounce tincture bottle.

DOSE: 30 drops three times a day with ¼ cup of water.

PRACTITIONER’S COMMENT

Patient is feeling better, his blood pressure is gradually coming down, feeling less fatigue, his headache is less, he doesn’t complain of his shoulder pain, his anxiety lessened; taking due interest in his work, maintaining light exercise program, has reduced his weight seven pounds. I will continue the above botanicals with alteration of dandelion off and on as per his complaints of muscle cramps. [See “Dandelion as a diuretic.”]

Case 2

PATIENT: Forty year-old female. Obese. Married housewife with 6 children.

FIRST VISIT: 3/24/1986

chief complaint: severe headaches, and gall bladder pain. BP: 120/92

BOTANICAL TREATMENT:

    Hawthorne        ½ ounce

    Dandelion        ½ ounce

    Cayenne        30 drops

DOSE: 30-40 drops three times a day.

OTHER TREATMENT: Advised on dietary and stress reduction techniques. Homeopathic treatment of headaches.

FOLLOW-UP: 5/9/1986

BP: 122/98

FOLLOW-UP: 6/4/1986

BP: 120/94

Patient stopped coming over the summer and discontinued the botanicals.

FOLLOW-UP: 9/18/1986

BP: 126/96

FOLLOW-UP: 10/2/1986

BP: 124/96

BOTANICAL TREATMENT:

Add scullcap, 3 capsules a day

FOLLOW-UP: 10/10/1986

BP: 126/86

FOLLOW-UP: 11/18/1986

BP: 126/82

A Bach flower remedy was added.

FOLLOW-UP: 12/18/1986

BP: 118/84

FOLLOW-UP: 1/22/1987

BP: 122/80

FOLLOW-UP: 3/5/1987

BP: 122/78

PRACTITIONER’S COMMENT

A 39 year old woman showing a continuing decrease in diastolic blood pressure with the maintenance of botanical formulas. Significant because the woman has had no significant weight loss, and did not change her diet. This is roughly a 20% decrease, to a normal level.

Case 3

PATIENT: Male. Height 5’7". Weight 175 lbs. Administrator.

Married for 35+ years. Personality: “In control” not expressive.

HISTORY: Hypertension for twenty years.

MEDICATIONS: Lopressor (beta-blocker) 50 mg twice a day.

FIRST VISIT: 4-1-1988

History and physical. Assigned to keep a diet diary. Continue medication.

FOLLOW UP: 4-8-1988

BOTANICAL TREATMENT:

Wild oat        2 parts

Hawthorne    2 parts

Dandelion        1 part

Garlic        1 part

DOSE: 40 drops three times a day.

OTHER TREATMENT:

Cut Lopressor dose in half.

Diet: strict low fat, high complex carbohydrates, low protein (40-50 g/day) limit animal sources.) Homeopathic sulphur 30C. One dose. (constitutional). Increase exercise 3-4x week 20-30 minutes

FOLLOW-UP: 4-22-1988

BP within normal limits. Feels good. Lost 6 lbs (wt: 169)

Continue herbs. Sulphur 200C (1 dose)

Continue reduced Lopressor dosage.

FOLLOW-UP: 5-13-1988

BP within normal limits. Feeling Great. Lost 7 more pounds (wt: 162 lbs).

Continue botanical treatment; decrease dose to 30 drops twice a day Decrease Lopressor dosage to 25 mg/day.

Review of Herbs

Astragalus (Astragalus membranaceus)

This is a tonic and immune-stimulant from traditional Chinese medicine. It is introduced later in case one as a tonic to address the complaints of fatigue and weakness. Recent research shows that it decreases the side effect of cancer chemotherapy, especially when combined with ligustrum

Cayenne (Capsicum annum)

Cayenne is a circulatory tonic and antispasmodic, increasing peripheral circulation.

Dandelion (Taraxacum off.)

Dandelion root is a traditional alterative, liver tonic, and mild diuretic. Dandelion leaf has stronger diuretic properties, and in large quantities is equivalent to conventional diuretics.

Garlic (Allium sativum)

As long ago as 1948, investigators found that some patients had a reduction of 20 mmHg or more after only a week of garlic treatment. In another study, garlic was shown to reduce systolic pressure by 20-30 mmHg and diastolic pressure by 10-20 mmHg. The mechanism of garlic’s action in lowering blood pressure is assumed to be threefold: 1) by lowering serum lipids 2) by expanding the vessel walls (8) and 3) by inhibiting platelet aggregation, the tendency of blood cells to stick together (10) The substance methyl allyl trisulfide is presumed to be the factor expanding the vessel walls, and ajoene to inhibit platelet aggregation.

Hawthorne (Crataegus oxycantha)

Hawthorne regulates blood pressure by tonifying the heart. Its healing properties are attributed to its ability to increase blood supply to the heart by dilating the coronary blood vessels, and its ability to improve the metabolic processes within the heart muscle (Petkov). Side effects and contraindications are unknown, according to the German drug monograph. Hawthorne may potentiate the action of digitalis; patients on heart medications should keep their physicians informed of their program, so that medication can be adjusted if necessary. European researchers have found different properties in the berries, leaves and flowers. Some companies sell products combining all three.

Mistletoe (Viscum album).

    According to Dr. RF Weiss, the noted German phytotherapist, it must be continued for several weeks to see an effect in mild and moderate hypertension. It also has no side effects, is non-toxic in the normal dosage, and is safe for long-term use. Weiss says that although its ability to dramatically lower blood pressure is limited, patients consistently report excellent subjective effects on headaches, dizziness, loss of energy, irritability and other symptoms sometimes connected with high blood pressure. Weiss suggests the cold water extract as the best form: Pour ¼ liter of cold water over 2-4 teaspoons of chopped mistletoe, leave to stand overnight, and take first thing in the morning; another cup to be prepared in the morning to be taken at night before bed (Weiss). See page seven for a discussion of the two mistletoe species.

Scullcap (Scutellaria lateriflora)

This bitter herb is both a sedative and a long term nerve tonic. See Dr. Meloche’s commentary for more details.

Valerian (Valeriana off)

The classic sedative herb. See Dr. Meloche’s commentary on using valerian and scullcap in hypertension.

Wild Oat (Avena sativa)

Some clinical trials have found that avena will help with stopping smoking. Other trials have failed to verify the action. Avena was used in Eclectic practice as a tonic for nervous debility following serious illness. It is nutritive, reputedly high in calcium and magnesium.

References

Mowrey, D. The Scientific Validation of Herbal Medicine. Keats Publishing. New Canaan Ct. 1986.

Piotrowski, G. “L’ail en therapeutique,” Praxis, 37, 488-492 (9).

Petkov, V. Plants with hypotensive, antiatheromatous, and coronary dilating action" Am J Chin Med 7:197-236, 1979.

Weiss, RF Herbal Medicine. Beaconsfield Publishers. Beaconsfield, England. 1988.

Commentary:

Linda Meloche, ND, Lac

These cases show how herbal medicine can be very effective in dealing with high blood pressure. Alternative practitioners can get a good handle on it, especially when we combine herbs with other therapies.

The cases demonstrate an important point about selecting herbs: Don’t just think about cardiac and diuretic herbs—the nervines are also very important. In case two, notice that there was no progress until scullcap was added. The basic hypotensive formula of dandelion-hawthorne-cayenne is too weak for most cases. Hawthorne is a cardiotonic, dandelion a mild diuretic, and cayenne a good synergist. The formula can be modified, according to the patient’s needs, to add a stronger cardiotonic, such as the mistletoe in case one, and/or the nervine herbs.

Scullcap is my favorite nervine for hypertension. In case two, it totally turned the case around. In case one, which used nervines from the start, there was a much better response. The nervines are so important because stress is often an element in high blood pressure, and these herbs can get at the cause of the condition. They don’t just sedate, but also tonify the nervous system. I think it is good that they replaced valerian with scullcap in case one. I have heard before, and also seen in my own practice, that valerian does not work so well for long-term use. It can be excellent for acute conditions, but once you go past a couple of weeks, people don’t respond as well. I often will start a hypertension case with valerian, as in case one, but then switch to scullcap later.

Energetics

I think of the energetics of scullcap as moving blocked energy (constrained liver chi in chinese medicine). High blood pressure is characterized by tension and tight muscles, and the scullcap helps to ease the tension. The Chinese use a different species of scullcap (Scutellaria baicalensis),and use the root instead of the tops. I use the flowering tops of the local species (Scutellaria lateriflora), and I find that both have the same effect on moving energy. This property made is especially well suited to the woman in case two, who reported headache and gall-bladder pain, symptoms which often indicates an underlying condition of “stuck” energy.

Mistletoe, used in case one, is my favorite of the stronger cardiac herbs. I stick with the European species Viscum album. I can usually get the effect I want with higher blood pressure.

If using dandelion as a diuretic, it may make more sense to take it as a tea, which is a better way of extracting minerals—the potassium in Dandelion is important.

The last case is very typical of the cases I see in practice. Most patients who come to me are already on high blood pressure medications. It is very important to slowly decrease the dose, giving the herbs and the lifestyle changes a while to work. I have had cases where I took them off the medications, and their blood pressure shot up.

In cases one and three, notice that they did a lot more work than just using herbs. This is very important in high blood pressure. So many factors are involved that you have to take a holistic approach, using diet, relaxation, and exercise as well as herbs.

Linda Meloche is a naturopathic physician and licensed acupuncturist in private practice in Beaverton, Oregon. She is a former instructor in botanical medicine at National College of Naturopathic Medicine in Portland, Oregon.

References

Alderman MH et al. “Treatment-induced blood pressure reduction and the risk of myocardial infarction.” JAMA 262(7):920-924

Bordia, A. “Effect of garlic on human platelet aggregation, in vitro.” Atherosclerosis, 30, 355-361, 1978.

Krupp et al. Current Medical Diagnosis and Treatment, 1987.

Freis E. “Salt volume and prevention of Hypertension.” Circ 53:589-95, 1976.

Meneely G. and Battarbee H.: High sodium-low potassium environment and hypertension. Am J Card

Mowrey, D. The Scientific Validation of Herbal Medicine, Keats Publishing, New Canaan Ct. 1986.

Petkov, V. “Plants with hypotensive, antiatheromatous, and coronary dilating action” Am J Chin Med 7:197-236, 1979.

Piotrowski, G. “L’ail en therapeutique,” Praxis, 37, 488-492. (9)

Pizzorno J., Murray M. The Textbook of Natural Medicine Bastyr College Publications, 1985.
  Copyright 2001 Paul Bergner


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