Blood Pressure Support Protocol: A Resource for Practitioners

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by Fullscript’s Integrative Medical Advisory Team


Hypertension, or high blood pressure, is a significant and growing global health concern. Accounting for 7.5 million deaths annually (17), hypertension is the leading risk factor for heart disease, stroke, and premature death. (6) The number of individuals with hypertension is expected to increase in the coming years and is predicted to reach 1.56 billion adults worldwide by 2025. (17)

doctor taking the blood pressure of a patient

Hypertension is the leading risk factor for heart disease, stroke, and premature death globally.

What is hypertension?

Hypertension is a common condition in which blood flows through blood vessels and arteries with greater than normal pressure. (12) While normal blood pressure is defined as systolic blood pressure less than 120 mmHg and diastolic blood pressure less than 80 mm Hg (2)(17), hypertension is characterized by systolic blood pressure greater than 130 mmHg and diastolic blood pressure greater than 80 mmHg. The American Heart Association outlines the following blood pressure ranges:

  • Normal blood pressure: systolic blood pressure less than 120 mmHg and diastolic blood pressure less than 80 mmHg
  • Elevated blood pressure: systolic blood pressure greater than 120 mmHg and diastolic blood pressure less than 80 mmHg
  • Stage 1 Hypertension: systolic blood pressure greater than 130 mmHg and diastolic blood pressure greater than 80 mmHg
  • Stage 2 Hypertension: systolic blood pressure greater than 140 mmHg and diastolic blood pressure greater than 90 mmHg
  • Hypertensive Crisis: systolic blood pressure greater than 180 mmHg and diastolic blood pressure greater than 120 mmHg (19)

Causes and risk factors

Several causes and risk factors have been identified in the development of hypertension, including:

  • Excess dietary intake of sodium
  • Age: the risk of developing hypertension increases with age
  • Sedentary lifestyle
  • Family history/genetic predisposition
  • Excess alcohol intake
  • Race: hypertension is more common in African American individuals compared to white, Hispanic, and Asian individuals
  • Gender: men are more likely to develop high blood pressure before age 55, while women are at an increased risk after 55
  • Certain medications such as contraceptive pills and cold-relief medications
  • Certain medical conditions such as chronic kidney disease, obesity, sleep apnea, thyroid conditions, and certain tumors (12)
  • Urban living (compared to rural) (17)

Signs, symptoms, and complications

Hypertension is known as the “silent killer”. While individuals with hypertension will sometimes experience lightheadedness, fainting episodes, vertigo, or altered vision, the condition is most often asymptomatic until the occurrence of a severe medical event such as a heart attack or stroke. (17)

Complications associated with high blood pressure include:

  • Mycardial infarction
  • Heart failure
  • Peripheral artery disease
  • Stroke
  • Aneurysms
  • Visual impairment and retinal hemorrhage
  • Renal impairment
  • Vascular dementia (12)(17)

Integrative protocol for blood pressure support

Hypertension and its complications are largely preventable with lifestyle and dietary modifications. (6) Studies have shown that reductions as little as 10mmHg systolic or 5 mm Hg diastolic blood pressure decreased the risk of cardiovascular-related death and stroke by approximately 25% and 40%, respectively. (7)

The evidence-based ingredients and dosing included in this protocol have been shown to effectively reduce blood pressure in individuals with hypertension.

Magnesium

Among the most abundant minerals in the body, magnesium plays an integral role in many body functions, including insulin metabolism, energy production, nerve transmission, cardiac excitability, and blood pressure regulation. (5) A number of underlying mechanisms are believed to be involved in the hypotensive effects of magnesium. These mechanisms include:

  • Interaction with calcium in the body
  • Reduced peripheral vascular resistance
  • Increased secretion of endothelial prostaglandin I2
  • Enhanced effect of antihypertensive medication
  • Increased nitric oxide levels (3)

Research findings:

  • Consistent supplementation resulted in a decrease of both systolic and diastolic blood pressure (3)(22)
  • An inverse correlation between levels of circulating magnesium and the incidence of hypertension has been clearly identified (5)(20)

US: Search for Magnesium in the Fullscript catalog.
CAN: Search for Magnesium in the Fullscript catalog.

garlic gloves in a basket

Garlic, a bulbous plant belonging to the Lillaceae family, has a long history of culinary and therapeutic uses dating back to ancient civilizations.

Garlic (Allium sativum)

Garlic, a bulbous plant belonging to the Lillaceae family, has a long history of culinary and therapeutic uses dating back to ancient civilizations. Allicin is the primary active constituent of garlic and commonly extracted for use in supplements. Allicin is produced by the allinase enzyme, which is activated when raw garlic is crushed or chopped. Another common form of garlic extract, aged garlic extract, is produced by storing the plant in 15-20% ethanol for longer than one and a half years. (1) Among the most popular complementary therapies for hypertension (21), garlic demonstrates immunomodulatory and cardiovascular protective effects. (15)

Research findings:

  • Consistent supplementation for 8-12 weeks has demonstrated reduction in both systolic and diastolic blood pressure (11)(15)(16)(18)(21)
  • Garlic supplementation is widely considered a safe and effective approach to hypertension (11)(15)(16)(21)

US: Search for Garlic in the Fullscript catalog.
CAN: Search for Garlic in the Fullscript catalog.

L-arginine

L-arginine is an amino acid involved in protein synthesis, tissue repair, immune function, and the urea cycle. (13) It is characterized as a “semi-essential” or “conditionally essential” amino (9), as it can be synthesized by the body, but its production may be limited by a number of factors, such as the individual’s health and the availability of precursors. (14) L-arginine is also a precursor for the production of nitric oxide, a signaling molecule involved in cellular function (8) and essential for the regulation of blood pressure. (9)

Research findings:

  • Reduction in blood pressure observed in patients with mild to moderate hypertension (10)
  • Compared to placebo, L-arginine supplementation was shown to lower systolic blood pressure in patients with gestational hypertension (4)

US: Search for L-arginine in the Fullscript catalog.
CAN: Search for L-arginine in the Fullscript catalog.

The bottom line

While hypertension is a widespread and serious condition, it is also largely preventable. A protocol using natural supplements can be used therapeutically on its own or as an adjunct to existing treatment. If you are not an integrative healthcare provider, we recommend speaking with one to learn whether these supplements are right for your wellness plan.


Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

  1. Bayan, L., Koulivand, P.H., & Gorji, A. (2014). Garlic: A review of potential therapeutic effects. Avicenna Journal of Phytomedicine, 4(1), 1–14.
  2. Delacroix, S., Chokka, R.G., & Worthley, S.G. (2014). Hypertension: Pathophysiology and treatment. Journal of Neurology & Neurophysiology, 5, 250.
  3. Dibaba, D.T., Xun, P., Song, Y., Rosanoff, A., Shechter, M., He, K. (2017). The effect of magnesium supplementation on blood pressure in individuals with insulin resistance, prediabetes, or noncommunicable chronic diseases: a meta-analysis of randomized controlled trials. The American Journal of Clinical Nutrition, 106(3), 921–929.
  4. Gui, S., Jia, J., Niu, X., Bai, Y., Zou, H., Deng, J., & Zhou, R. (2014). Arginine supplementation for improving maternal and neonatal outcomes in hypertensive disorder of pregnancy: a systematic review. Journal of the Renin-Angiotensin-Aldosterone System, 15(1), 88-96.
  5. Han, H., Fang, X, Wei, X., Liu, Y., Jin, Z., Chen, Q., … Cao, Y. (2017). Dose-response relationship between dietary magnesium intake, serum magnesium concentration and risk of hypertension: a systematic review and meta-analysis of prospective cohort studies. Nutrition Journal, 16, 26.
  6. Joffres, M., Falaschetti, E., Gillespie, C., Robitaille, C., Loustalot, F., Poulter, N., … Campbell, N. (2013). Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study. BMJ Open, 3(8).
  7. Law, M.R., Morris, J.K., & Wald, N.J. (2009). Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ, 338, b1665.
  8. Luiking, Y. C., Engelen, M. P., & Deutz, N. E. (2010). Regulation of nitric oxide production in health and disease. Current Opinion in Clinical Nutrition and Metabolic Care, 13(1), 97–104.
  9. McRae M. P. (2016). Therapeutic benefits of l-arginine: An umbrella review of meta-analyses. Journal of Chiropractic Medicine, 15(3), 184–189.
  10. Menzel, D., Haller, H., Wilhelm, M., & Robenek, H. (2018). L-arginine and B vitamins improve endothelial function in subjects with mild to moderate blood pressure elevation. European Journal of Nutrition, 57(2), 557-568.
  11. Nakasone, Y., Nakamura, Y., Yamamoto, T., & Yamaguchi, H. (2013). Effect of a traditional Japanese garlic preparation on blood pressure in prehypertensive and mildly hypertensive adults. Experimental and Therapeutic Medicine, 5(2), 399-405.
  12. National Health, Blood, and Lung Institute (n.d.). High blood pressure. Retrieved from https://www.nhlbi.nih.gov/health-topics/high-blood-pressure
  13. Pahlavani, N., Jafari, M., Sadeghi, O., Rezaei, M., Rasad, H., Rahdar, H. A., & Entezari, M. H. (2017). L-arginine supplementation and risk factors of cardiovascular diseases in healthy men: a double-blind randomized clinical trial. F1000Research, 3, 306.
  14. Reeds P.J. (2000). Dispensable and indispensable amino acids for humans. The Journal of Nutrition, 130(7), 1835S-40S.
  15. Ried, K. (2016). Garlic lowers blood pressure in hypertensive individuals, regulates serum cholesterol, and stimulates immunity: An updated meta-analysis and review. The Journal of Nutrition, 146(2), 389S-396S.
  16. Ried, K., Frank, O.R., & Stocks, N.P. (2010). Aged garlic extract lowers blood pressure in patients with treated but uncontrolled hypertension: a randomised controlled trial. Maturitas, 67(2), 144-50.
  17. Singh, S., Shankar, R., & Singh, G.P. (2017). Prevalence and associated risk factors of hypertension: A cross-sectional study in urban Varanasi. International Journal of Hypertension, 2017, 5491838.
  18. Sobenin, I.A., Andrianova, I.V., Fomchenkov, I.V., Gorchakova, T.V., & Orekhov, A.N. (2009). Time-released garlic powder tablets lower systolic and diastolic blood pressure in men with mild and moderate arterial hypertension. Hypertension Research, 32(6), 433-7.
  19. The American Heart Association. (2017). Understanding blood pressure readings. Retrieved from https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings
  20. Wu, J., Xun, P., Tang, Q., Cai, W., & He, K. (2017). Circulating magnesium levels and incidence of coronary heart diseases, hypertension, and type 2 diabetes mellitus: a meta-analysis of prospective cohort studies. Nutrition Journal, 16(1), 60.
  21. Xiong, X.J., Wang, P.Q., Li, S.J., Li, X.K., Zhang, Y.Q., & Wang, J. (2015). Garlic for hypertension: A systematic review and meta-analysis of randomized controlled trials. Phytomedicine, 22(3), 352-61
  22. Zhang, X., Li, Y., Del Gobbo, L.C., Rosanoff, A., Wang, J., Zhang, W., & Song, Y. (2016). Effects of magnesium supplementation on blood pressure: A meta-analysis of randomized double-blind placebo-controlled trials. Hypertension, 68(2), 324-33.