Hypertension not the silent killer

Bill, age 45, came into my office to discuss his recent diagnosis of hypertension (high blood pressure).

He had been prescribed Ramipril, an ACE inhibitor, and he wanted to know if I could help him get off the medication.

In our recent Pharmacy training we were taught that, in fact, hypertension is not the “silent killer” after all. Certainly, if someone has high blood pressure with symptoms of headaches, nosebleeds, heart palpitation, dizziness and shortness of breath, then they need to be treated. However asymptomatic moderately high blood pressure of 140/90 to 150/90 has proven not to be pathological. The other problem could be that the blood pressure is only high in the doctor’s office or “white coat syndrome.”


Bill’s blood pressure in the office was normal at 130/80 down from 150/90 when he was initially diagnosed.

I asked him if he had worn a Halter monitor to evaluate his blood pressure over 24 hours? He said no. I then asked him to record his blood pressures at home first thing in the morning and last thing at night for a two-week period. I told him that I would add some naturopathic recommendations to his current prescription and that we would evaluate him to see if we could reduce the Ramipril dosage.

Bill’s MD was concerned about his high cholesterol and warned that if it didn’t come down he would recommend a statin drug. Bill definitely wanted to avoid that!

I explained to Bill about nitric oxide (NO) and the significant effects it plays in the role of cardiovascular disease including hypertension. NO is a free radical gas produced in the cells that line the blood vessels, nerve cells and white blood cells. NO relaxes smooth muscle in the arteries, decreases platelets from clotting and regulates fat metabolism. Individuals with low levels of NO will have signs and symptoms of hypertension, coronary artery disease, stroke and atherosclerosis.

Bill and I discussed NO-friendly nutrients and herbs including folic acid, L-arginine, vitamin B6, and B12, Folic acid, vitamin E, garlic, resveratrol, quercitin and green tea.

My hypertension program includes the following:

  • Lose weight by reducing carbohydrate intake. Bill’s waist was greater than 40 inches, a risk factor for cardiovascular disease.
  • Exercise to make sure getting 10,000 steps per day, increases NO production and lowers hypertension.
  • Fish oils: these are anti-inflammatory as well as antithrombotic (anti-clotting) and lower blood pressure, triglycerides and LDL cholesterol.
  • Minerals: calcium, magnesium and potassium have all shown efficacy in the management of hypertension.
  • Vitamin D is measured to maintain blood levels of 150nmol/l.
  • Hawthorne is my favorite herb and is in my herbal blood pressure formulas.
  • B complex and folic acid: lower homocysteine an independent risk factor for cardiovascular disease, as well as improve NO production.
  • A Mediterranean diet, high in vegetables, olive oil and fish improves NO levels in the arteries and lowers weight.

Bill’s blood pressures were lower when he took them at home but still high enough to stay on the Ramipril at least initially.

Over the course of the following si months Bill was able to lose more than 20 pounds and his cholesterol normalized. His blood pressure did come down to 110/70 and he had occasional dizzy spells. His blood pressure was getting too low so he was able to reduce his Ramipril dosage by half.

There are some patients who can manage without medication but I kept Bill on the Ramipril because he still had a few risk factors including an elevated homocysteine at 9.0. I added CoQ10 to his regime because not only does Ramipril deplete this nutrient, important for energy protection and performance of the heart muscle, it also lowers blood pressure.

Dr. Ingrid Pincott, naturopathic physician, has been practicing since 1985 and can be reached at 250-286-3655.

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