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- Strong Scientific Evidence:
[Omega-3 fatty acids]: Omega-3 fatty acids are essential fatty acids found in some plants and fish. There should be a balance of omega-6 and omega-3 fatty acids for health. Multiple human trials report small reductions in blood pressure with intake of omega-3 fatty acid. DHA, or docosahexaenoic acid, may have greater benefits than EPA, or eicosapentaenoic acid. However, high intakes of omega-3 fatty acids per day may be necessary to obtain clinically relevant effects, and at this dose level, there is an increased risk of bleeding. There is strong scientific evidence from human trials that omega-3 fatty acids from fish or fish oil supplements significantly reduce cholesterol levels, which may also help in reducing blood pressure. Omega-3 supplements can cause an increase in bleeding in susceptible individuals including those taking blood thinning medications such as warfarin (Coumadin ®).
- Good Scientific Evidence:
[Coenzyme Q10 (CoQ10)]: Coenzyme Q10 (CoQ10) is produced by the human body and is necessary for the basic functioning of cells. CoQ10 levels are reported to decrease with age and to be low in patients with some chronic diseases such as heart conditions, muscular dystrophies, Parkinson's disease, cancer, diabetes, and HIV/AIDS. Some prescription drugs may also deplete CoQ10 levels, such as HMG Co-A inhibitors, or statin drugs, for high cholesterol. Preliminary research suggests that CoQ10 causes small decreases in blood pressure (systolic and possibly diastolic). Low blood levels of CoQ10 have been found in people with hypertension, although it is not clear if CoQ10 "deficiency" is a cause of high blood pressure. Well-designed long-term research is needed.
[Hibiscus]: Hibiscus (Hibiscus sp.) has been used for centuries by Ayurvedic (Hindu) and Chinese medical practitioners. Two human studies have shown that extracts of hibiscus may lower the systolic and diastolic pressure. In one study, hibiscus standardized extract worked as well as captopril (Capoten ®), a commonly used angiotensin converting enzyme (ACE) inhibitor, in lowering blood pressure. Additional high-quality studies comparing hibiscus to placebo are needed to confirm these results, although the use of hibiscus for lowering blood pressure looks promising. Caution is advised when taking hibiscus, as numerous adverse effects including diuresis (increased excretion of fluid) can occur.
[Qi gong]: Qi gong is a type of Traditional Chinese Medicine (TCM) that is thought to be at least 4,000 years old. There are two main types of Qi gong practice: internal and external. Internal Qi gong is a self-directed technique that involves the use of sounds, movements, and meditation. Internal Qi gong actively engages people in their own health and well-being, and can be performed with or without the presence of a Master instructor. It may be practiced daily to promote health maintenance and disease prevention. Several human trials suggest benefits of Qi gong in the treatment of high blood pressure, particularly when added to conventional treatments such as prescription drugs. There is early evidence that there may be lower death rates in people with high blood pressure who practice Qi gong. Some studies report that high blood pressure associated with pregnancy may be partially controlled through internal Qi gong relaxation exercises. Although this research is promising, a major problem is that the way Qi gong is practiced is not always clear in these studies, and may not be similar to the way Qi gong is practiced in the community.
[Stevia]: Stevia (Stevia rebaudiana) standardized extracts are used as natural sweeteners and dietary supplements. Stevioside is a natural plant component isolated from stevia that has demonstrated blood pressure lowering effects. Despite evidence of benefits in some human studies and support from laboratory and animal studies, more research is warranted to compare stevia's effectiveness with the current standard of care. Caution is advised when taking stevia, as numerous adverse effects including blood sugar lowering have been observed. Stevia should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.
[Yoga]: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy over 2,000 years ago. Several human studies support the use of yoga in the treatment of high blood pressure, when practiced for up to one year. It is not clear if yoga is better than other forms of exercise for blood pressure control. Better research is needed in this area. Yoga practitioners sometimes recommend that patients with high blood pressure should avoid certain positions, such as headstands or shoulder stands, which may increase blood pressure.
- Unclear or Conflicting Scientific Evidence:
[Acupressure, Shiatsu]: The practice of applying finger pressure to specific acupoints throughout the body has been used in China since 2000 BC, prior to the use of acupuncture. Acupressure techniques are widely practiced internationally for relaxation, wellness promotion, and the treatment of various health conditions. Small studies in men and women report that acupressure may reduce blood pressure. Study results on the effect of acupressure on heart rate have yielded mixed results. Large, well-designed studies are needed.
[Acupuncture]: The practice of acupuncture originated in China 5,000 years ago. Today it is widely used throughout the world and is one of the main pillars of Chinese medicine. It involves the insertion of needles in various point of the body to help move the "chi" or energy. Although used for centuries to lower blood pressure, human trials are lacking.
[Acustimulation]: Acustimulation is the mild electrical stimulation of acupuncture points to control symptoms such as nausea and vomiting. A low intensity electrical current is used to penetrate just slightly below the surface of the skin. It may be delivered by acupuncture needles attached to electrodes or, more commonly, by battery-powered appliances that can be worn on the body (touching the surface of the skin). Acustimulation has been examined in the treatment of high blood pressure in one small study of patients diagnosed with diastolic hypertension. A set of four different acupuncture points were used, with results showing an immediate reduction of diastolic blood pressure. At this time, the evidence is insufficient for use of acustimulation in high blood pressure.
[L-arginine]: L-arginine, or arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required. A small study suggests that arginine taken by mouth may dilate the arteries and temporarily reduce blood pressure in hypertensive patients with type 2 diabetes. Larger, high-quality studies are needed. L-arginine is generally safe in recommended dosages.
[Beta glucan]: Beta-glucan is a soluble fiber derived from the cell walls of algae, bacteria, fungi, yeast, and plants. It is commonly used for its cholesterol-lowering effects. A study found that the addition of oat cereals to the normal diet of patients with hypertension significantly reduces both systolic and diastolic blood pressure. Soluble fiber-rich whole oats may be an effective dietary therapy in the prevention and adjunct treatment of hypertension.
[Chiropractic]: Chiropractic is a healthcare discipline that focuses on the relationship between musculoskeletal structure (primarily the spine) and body function (as coordinated by the nervous system), and how this relationship affects the preservation and restoration of health. Manipulation involves the hands-on application of a physical therapy. The effects of spinal manipulative techniques on blood pressure remain controversial. It has been hypothesized that nervous system effects of spinal manipulation can lower both systolic and diastolic pressure. Numerous trials, reviews, and commentaries have been published in this area. Although some studies are suggestive, overall the existing evidence remains debatable. Better research is necessary before a firm conclusion can be drawn.
[Flaxseed oil]: Flaxseed (Linum usitatissimum)
and its derivative flaxseed oil/linseed oil are rich sources of the essential fatty acid alpha-linolenic acid, which makes omega-3 essential fatty acids in the body. Omega-3 fatty acids have been associated with a decreased risk of heart disease. In animals, diets high in flaxseed have mixed effects on blood pressure. One study in humans suggests that flaxseed might lower blood pressure. The evidence in this area is not clear, and more research is needed. Caution is advised when taking flaxseed supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible.
[Garlic]: Garlic (Allium sativum) is traditionally used for heart health. Numerous human studies report that garlic can lower blood pressure by a small amount, but larger, well-designed studies are needed to confirm this possible effect. Garlic supplements can cause an increase in bleeding in susceptible individuals, including those taking blood thinning medications such as warfarin (Coumadin ®).
[Ginseng]: Asian ginseng, or Panax ginseng, has been used for more than 2,000 years in Chinese medicine for various health conditions. Several studies from China report that ginseng in combination with various other herbs may reduce symptoms of coronary artery disease. Preliminary research suggests that ginseng may lower blood pressure (systolic and diastolic). It is not clear what doses may be safe or effective. Well-conducted studies are needed to confirm these early results. Caution is advised when taking ginseng supplements, as adverse effects including drug interactions are possible. Ginseng supplements should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.
[Green tea]: Green tea is made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. Green tea has a long history of use, dating back to China approximately 5,000 years ago. Green tea, black tea, and oolong tea are all derived from the same plant, just processed differently. Green tea helps protect blood vessels from injury, and has been reported in laboratory studies to lower blood pressure. Green tea is considered cardioprotective, or helps protect the heart from disease. Healthcare professionals recommend using caffeine-free supplements when using in people with hypertension (high blood pressure).
[Iridology]:
Iridology is the study of the iris (colored part of the eye) with the intention of gaining information about underlying diseases. Iridologists believe that the degrees of light and darkness in the iris give clues to the body's general health. Preliminary studies by a South Korean team of researchers using a computerized approach suggest that iridology may assist in the identification of individual predispositions for vascular diseases such as hypertension. Further research is needed to confirm these findings, and further teams of researchers would need to conduct parallel work in order for these methods to become validated.
[Lycopene]: Lycopene is a carotenoid, which is a naturally occurring class of fat-soluble pigments (coloring) found mainly in plants and algae, where they play a critical role in the photosynthetic process. Photosynthesis is the making of glucose (energy) from sunlight, carbon dioxide and water, with oxygen as a waste product. Lycopene is present in human serum, liver, adrenal glands, lungs, prostate, colon, and skin at higher levels than other carotenoids. Based on early study, lycopene may reduce the development of pre-eclampsia and intrauterine growth retardation in women having their first child. Further research is needed to confirm these results.
[Massage]: Various forms of therapeutic superficial tissue manipulation have been practiced for thousands of years across cultures. Chinese use of massage dates to 1600 BC, and Hippocrates made reference to the importance of physicians being experienced with "rubbing" as early as 400 BC. Based on early study, massage may decrease blood pressure in hypertensive patients. More high-quality studies are needed.
[Meditation]: Various forms of meditation have been practiced for thousands of years throughout the world, with many techniques originating in Eastern religious practices. Meditation may involve breathing exercises or repeating phrases or words over and over to "clear" the mind. Several studies of transcendental meditation (repeating phrases or words) report small decreases in blood pressure levels over short periods of time, and that its long-term effects may improve mortality. However, the available research has not been well designed or reported, and cannot be considered conclusive.
[Melatonin]: Melatonin is a hormone produced in the brain by the pineal gland, from the amino acid tryptophan. The synthesis and release of melatonin are stimulated by darkness and suppressed by light, suggesting the involvement of melatonin in circadian rhythm and regulation of diverse body functions. Levels of melatonin in the blood are highest prior to bedtime. Synthetic melatonin supplements have been used for a variety of medical conditions, most notably for disorders related to sleep and as an antioxidant. Antioxidants help stop free radical (reactive oxygen) damage to vessels. Several controlled studies in patients with high blood pressure report small reductions blood pressure when taking melatonin by mouth (orally) or inhaled through the nose (intranasally). Better-designed research is necessary before a firm conclusion can be reached. Caution is advised when taking melatonin, as adverse effects including drowsiness and drug interactions are possible. Melatonin should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor. Melatonin is for short-term use only (one to two weeks).
[Pet therapy]: Animal companionship has been used as an informal source of comfort and relief of suffering across cultures throughout history. There is evidence from one well-designed trial that pet ownership may have additive value in patients with hypertension who are taking conventional blood pressure medication.
[Psychotherapy]: Psychotherapy is an interactive process between a person and a qualified mental health professional (psychiatrist, psychologist, clinical social worker, licensed counselor, or other trained practitioner). Its purpose is the exploration of thoughts, feelings and behavior for the purpose of problem solving or achieving higher levels of functioning. Relaxation techniques have been associated with reduced pulse rate, systolic blood pressure, diastolic blood pressure, lower perception of stress and enhanced perception of health. Further research is needed to confirm these results.
[Pycnogenol]: Pycnogenol ® is the patented trade name for a water extract of the bark of the French maritime pine (Pinus pinaster ssp. atlantica), which is grown in coastal south-west France. Use of Pycnogenol ® may reduce the need for nifedipine (Procardia ®) and decrease systolic blood pressure in patients with high blood pressure. Further research is needed to confirm these results.
[Reishi]: Reishi (Ganoderma lucidum) is a fungus (mushroom) that grows wild on decaying logs and tree stumps.
Reishi has been used in traditional Chinese medicine for more than 4,000 years to treat liver disorders, high blood pressure, arthritis and other ailments. Ancient Chinese monks utilized the reishi mushroom to calm their mind for meditation. Theory would lead one to believe that the physiological effects of decreasing blood pressure may have lead to the calming effect after ingested reishi. Preliminary data suggest that reishi may exert a blood pressure lowering effect; however, the currently available evidence in this area is weak. Future studies are warranted to validate the results of these small studies and to provide clinical usefulness of reishi as a possible treatment for high blood pressure. Caution is advised when taking reishi supplements, as adverse effects including an increase in bleeding and drug interactions are possible. Reishi supplements should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.
[Relaxation therapy]: Relaxation techniques include behavioral therapeutic approaches that differ widely in philosophy, methodology, and practice. The primary goal is usually non-directed relaxation. Most techniques share the components of repetitive focus (on a word, sound, prayer phrase, body sensation, or muscular activity), adoption of a passive attitude towards intruding thoughts, and return to the focus.
[Rhubarb]: Chinese herbalists have relied on rhubarb (Rheum palmatum) for thousands of years. The rhizomes and roots contain powerful anthraquinones (laxative) and tannins (tonify tissue). Two studies on rhubarb's effect on pre-eclampsia indicate that it may be a helpful treatment to decrease blood pressure. More high quality trials are needed to confirm this hypothesis. Caution is advised when taking rhubarb, as adverse effects including dehydration (loss of fluid) and drug interactions are possible. Rhubarb should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.
[Riboflavin]: Riboflavin or vitamin B2 is a water-soluble vitamin, which is involved in vital metabolic processes in the body, and is necessary for normal cell function, growth, and energy production. Limited study has reported an association between low riboflavin levels and an increased risk of pre-eclampsia (high blood pressure in pregnancy). However, it is not clear if low riboflavin levels are a cause or consequence of this condition or if additional supplementation is warranted in pregnant women at risk of pre-eclampsia/eclampsia beyond the routine use of prenatal vitamins. Riboflavin is safe in recommended dosages.
[Rutin]: Rutin is an antioxidant that naturally occurs in various plants (apple peels, black tea, rue, tobacco, and buckwheat). Quercetin (a flavonoid found in rutin) and rutin are used as vasoprotectants (blood vessel protective) and are ingredients of numerous multivitamin preparations and herbal remedies. The flavonoids found in rutin have documented effects on capillary permeability (leakage) and edema (swelling) and have been used for the treatment of disorders of the venous and microcirculatory (capillary) systems. Overall the results of clinical studies suggest a benefit of rutin for venous hypertension. Well-designed studies are required. Rutin is safe in recommended dosages. Nausea and stomach upset may occur.
[Soy]: Soy (Glycine max) has been a dietary staple in Asian countries for at least 5,000 years. Large-scale soybean cultivation began in the United States during World War II, and currently, Midwestern U.S. growers produce approximately half of the world's supply of soybeans. Soy and components of soy called isoflavones have been studied scientifically for numerous health conditions. Although soy products have not been proven to be effective in lowering blood pressure in humans, laboratory and some human studies do support the use of soy in reducing the risk of developing coronary artery disease (CAD). Caution is advised when taking soy, as adverse effects including drug interactions are possible. Soy supplements should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor. Experts recommend that individuals with breast cancer not use soy products unless under the supervision of a doctor.
[Taurine]: Tuarine is a non-essential amino acid (building blocks of protein) and is important in several metabolic processes of the body, including stabilizing cell membranes in electrically active tissues, such as the brain and heart. It also has functions in the gallbladder, eyes, and blood vessels, and may have some antioxidant and detoxifying effects. In animal studies, taurine has been reported to result in decreased blood pressure in hypertension. Preliminary results from a randomized, controlled trial and a case series suggest that taurine may be beneficial in blood pressure-lowering in individuals with borderline hypertension. Well-designed and reported clinical trials are still needed. Caution is advised when taking taurine supplements, as adverse effects including an increase in bleeding and drug interactions are possible. Taurine supplements should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.
[Vitamin D]: Vitamin D is found in numerous dietary sources such as fish, eggs, fortified milk, and cod liver oil. The sun is also a significant contributor to our daily production of vitamin D, and as little as 10 minutes of exposure is thought to be enough to prevent deficiencies. The term "vitamin D" refers to several different forms of this vitamin. Two forms are important in humans: ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3). Vitamin D2 is made by plants. Vitamin D3 is made by humans in the skin when it is exposed to ultraviolet-B (UVB) rays from sunlight or the diet. Low levels of vitamin D may play a role in the development of high blood pressure. It has been noted that blood pressure is often elevated during the winter season, further distance from the equator, and dark skin pigmentation (color), all of which are associated with lower exposure to vitamin D via sunlight. However, evidence is not clear and comparison with more proven methods to reduce blood pressure has not been conducted.
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