Micronutrient therapy
| Definition | |
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Arterial hypertension, hypertension or high blood pressure is a disease associated with the chronic increase in blood pressure in the arterial vascular system. According to the classification of the European Society for Hypertension (ESH), hypertension is defined as systolic blood pressure exceeding 140 mmHg and/or diastolic blood pressure exceeding 90 mmHg. However, this definition excludes temporary increases in blood pressure due to illness, medication, excitement or physical exertion. Hypertension is caused by unhealthy lifestyles or genetic components. Due to its often asymptomatic course, hypertension often remains undetected for a long time until secondary diseases of the heart, kidneys, eyes, brain and blood vessels become noticeable. As a preventive measure, hypertension can be influenced by the lifestyle with sufficient exercise, a healthy diet and avoidance of overweight and stress, and can be reduced by changing the lifestyle and correct medication. According to the Austrian Health Survey (ATHIS) 2014, about 21 % of Austrians aged 15 and over (about 1.53 million people) suffer from hypertension. According to the European Health Interview Survey (EHIS) of 2013, Austria lies on average in the European comparison. |
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| Symptomatology | |
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Since hypertension often develops without symptoms or is accompanied only by unspecific symptoms, it remains undetected in many cases and only becomes noticeable through its consequential damage. Nevertheless, the following symptoms may indicate hypertension: headache, dizziness, ringing in the ears or nosebleeds. If the blood pressure is high above 220/120 mmHg, there may also be shortness of breath, dizziness (possibly associated with headache), paralysis or speech problems, seizures (no calf cramps), burning, pain or angina pectoris (strong chest pressure), severe nausea, drowsiness to the point of unconsciousness, blurred vision (or double vision) and nosebleeds. The long-term damage and secondary diseases of hypertension may include heart failure, coronary heart disease, heart hypertrophy (thickening of the heart muscle), myocardial infarction, changes in kidney structure and kidney failure, damage to small cerebral vessels resulting in dementia, vascular changes in the eyes to the point of blindness, circulatory disorders of the legs and aneurysms (bulging of small or large vessels, which can burst and lead to life-threatening bleeding). |
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| Causes | |
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In terms of hypertension, a distinction is made between a primary or essential form and a non-essential or secondary form. In the majority of patients (about 90 %) no physical cause of the increased blood pressure can be found, which is why one speaks of a primary or essential hypertension, which is caused by several factors and has not yet been completely clarified. Secondary hypertension is an increase in blood pressure as a result of an organic disease, which applies to about 10 % of patients. By treating the underlying disease, the blood pressure of some patients can already be reduced to a normal level. Treatment of hypertension is essential because otherwise, over the years, it can lead to damage to important organs such as the brain, heart, coronary arteries, kidneys and blood vessels and to potential sequelae such as stroke and heart attack. Due to the complexity of blood pressure regulation in the body, the physical causes of hypertension are still only partially understood. According to current studies, however, factors such as genetic predisposition and an unfavourable lifestyle with lack of exercise, unhealthy nutrition, overweight and stress contribute to the development of hypertension. If the affected person has additional diseases, such as diabetes mellitus, hyperlipidemia and obesity, hypertension develops more rapidly, which is why we speak of metabolic syndrome. This leads to many serious secondary diseases, including heart attack, stroke, coronary heart disease, arteriosclerosis, gout, kidney disease and fatty liver. In addition, the following factors increase the risk of developing hypertension: smoking, age, positive family history, increased abdominal girth and obesity. |
| Diagnostics | |||||||||||||||||||||||||||||||||||||
When diagnosing hypertension, the focus is on measuring blood pressure and differentiating between primary and secondary hypertension, classifying and documenting consequential damage and determining the cardiovascular risk. Hypertension cannot be determined by a single measurement, but only by at least three blood pressure measurements on two different days. It also makes sense to consider blood pressure values measured at home, since the patient may have a practice or white coat hypertension, i.e. the repeated increased blood pressure values can only be traced back to measurement by medical specialists. In case of doubt on the part of the doctor, a 24-hour blood pressure measurement can also be carried out. For the definition and classification of blood pressure values, the classification of the European Society for Hypertension (ESH) is often used (Table 1).
Firmicutes/Bacteroidetes ratio-Measurement: The relationship between body weight and individual intestinal flora has already been demonstrated in numerous studies. The lower the body weight, the lower the proportion of the Firmicutes bacterial strain and the higher the proportion of Bacteroidetes. Firmicutes dominate in the intestinal obesity because they extract large amounts of glucose from indigestible food components (e.g. cellulose), which are then absorbed through the intestinal mucosa. Thus obese people absorb about 10 % more calories than people of normal weight, who are found to have a balanced ratio. However, there is a shift in this ratio in favour of Firmicutes when normal-weight people consume high-calorie food. In animal experiments it was observed that a diet rich in fruit and vegetables shifts the Firmicutes/Bacteroidetes ratio in favour of Bacteroidetes. The altered flora breaks down the plant fibres into short-chain fatty acids, which then counteract the development of allergic bronchitis. The measurement of the Firmicutes/Bacteroidetes ratio is therefore an investigation of the metabolic syndrome, which includes diabetes mellitus, hyperlipidemia, obesity and arterial hypertension. The Organix® dysbiosis urine test is a sensitive mass spectrometric method that indicates early colonization of the intestine with pathogenic microorganisms by analysis of organic acids. Digestive disorders due to a lack of enzymes and micronutrients, as well as unbalanced nutrition and diseases of the small intestine usually lead to incomplete degradation of proteins and carbohydrates in the intestine. The resulting change in pH promotes the spread of pathogenic microorganisms, which break down the excess metabolites into toxic degradation products (organic acids) that are excreted by the kidneys. The Organix® dysbiosis test includes the analysis of benzoic acid, hippuric acid, p-hydroxybenzoic acid, phenylacetic acid, p-hydroxyphenylacetic acid, indan, aerobic bacterial strains, dihydroxyphenylpropionic acid production, d-arabinitol, citramalic acid and tartaric acid. The metabolic by-products detected in the urine are a marker for intestinal infestation with a specific pathogenic germ and sometimes serve to indicate metabolic disorders. The Omega-3 index has long been regarded as a risk marker for the cardiovascular system and is calculated from the percentage sum of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) of the total fatty acid content in the blood. Higher concentrations of omega-3 fatty acids are associated with a lower incidence of cardiovascular disease, which is why this determination can make a valuable contribution to the prevention and treatment of a number of diseases. Numerous epidemiological studies have shown that an omega-3 index of >8 % compared to an index of <4 % is associated with a significant reduction in cardiovascular morbidity and mortality. At present, an omega-3 index of 8 to 12% is recommended to reduce cardiovascular risk. In haematocrit-correlated whole blood analysis the focus is on parameters such as calcium, potassium, magnesium, coenzyme Q10, EDTA and heparin. The concentrations of trace elements, which occur predominantly in the erythrocyte cell mass, vary greatly. For this reason, an increase in the haematocrit value results in an increase in intracellular trace elements, whereas the values of extracellular elements such as calcium and sodium are corrected downwards. There is an inverse correlation when reduced erythrocytic cell mass is present. Whole blood analysis without consideration of the hematocrit value has the same disadvantage as the statistical standard values given in the literature: the individual erythrocytic cell mass is not included. The consequence of this is that if the measured value is high, it is initially not possible to determine whether the micronutrient in question is actually increased or whether the proportion of cells in the blood is increased. This can be solved by directly correlating the micronutrient measurement result with the hematocrit measured at the same time. |
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| Therapy | |
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A healthy lifestyle is not only the best precaution, but is also an essential part of the therapy of hypertension. In most cases, a change in lifestyle is sufficient to reach a healthy blood pressure range with a slightly elevated blood pressure. The most important recommendations include the goal of normal weight, moderate alcohol consumption, low saline intake, a healthy diet, nicotine avoidance, stress reduction and regular physical activity. Several studies have already shown that regular exercise has a particularly positive effect, although it should be noted that overexertion can lead to an increase in blood pressure. Regular endurance training of 30 to 45 minutes three times a week can lower blood pressure by about five to ten mmHg. Which sport is suitable for the patient to lower blood pressure depends on several factors and should be discussed with the attending physician. If a change in lifestyle in the first three months does not lead to a lowering of the patient's blood pressure to safe levels, drug therapy is usually initiated. The German Society for Hypertension and Prevention recommends that when treating hypertension, the overall risk should be considered and factors that favour cardiovascular disease should also be taken into account. The more risk factors – family history, already existing organ impairments and diseases, such as diabetes –, the lower the blood pressure values should be (possibly lowered by medication). Despite these therapeutic measures, hypertension is considered incurable, so that many patients have to take medication for the rest of their lives to prevent life-threatening secondary diseases such as stroke and heart attack. |
| Nutritional measures | |
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The Dietary Approaches to Stop Hypertension (DASH) diet is a diet developed by the American National Institute of Health to lower blood pressure. The main focus lies thereby on the consumption of fresh fruit and vegetable, fat-reduced milk products, whole grain products as well as poultry, fish, nuts, beans and high-quality vegetable oils with a daily energy supply of 2.000 kcal. In contrast, foods rich in saturated fats (such as full-fat dairy products, processed meat, and tropical oils such as palm and coconut oil) and sugary sweets and beverages should be consumed only to a limited extent. However, the heart of the DASH diet is the reduction of sodium chloride (maximum 2,300 mg sodium per day), which in combination with the recommended foods can lead to a significant reduction in blood pressure. Research to date has shown that the DASH diet is an effective nutritional approach in the prevention and treatment of hypertension. One study suggested that a DASH diet with a lower sodium intake of 1,500 mg per day (800 mg less sodium per day than the standard DASH diet) could further lower blood pressure. In an eight-week clinical study with diabetics, the diet led to reduced cardiometabolic risk factors, particularly in terms of weight and cholesterol levels. This diet goes with the current European nourishing recommendations conformal and can as balanced nourishing strategy be described, which leads to a healthier life and nourishing style. |
| Construction of the intestinal mucosa with micronutrients | |
| Potassium associated with hypertension | |
| Potassium is considered an important pillar for the sustainable reduction of hypertension, especially in the context of the evidence-based DASH diet (Dietary Approaches to Stop Hypertension). According to the American Heart Association, the intake of potassium-rich foods should lead to a 17% reduction in the incidence of hypertension and increase the lifespan by 5.1 years. Meta-analyses prove the antihypertensive effect of potassium: the reduction of systolic blood pressure by 5.9 mmHg and diastolic blood pressure by 3.4 mmHg. Long-term supplementation results in an even greater reduction of 8.2 mmHg systolic and 4.5 mmHg diastolic. Various studies confirm that this reduction is clinically relevant: a reduction in blood pressure of 2 mmHg reduces the mortality rate from coronary heart disease by 4 % and that from stroke by 6 %. A meta-analysis from 2015 statistically summarized the data of both normotensive and hypertensive subjects without concomitant medication: Potassium supplementation resulted in an average blood pressure reduction of 4.7 mmHg systolic and 3.5 mmHg diastolic in all subjects. In subjects diagnosed with hypertension, the reduction was even greater. Their blood pressure decreased by 6.8 mmHg systolic and 4.6 mmHg diastolic. The authors of this study also mentioned the importance of the interaction of potassium and sodium and thus support the positive changes through a potassium-rich and low-sodium diet. But why does potassium affect hypertension at all? Acutely, increased potassium concentrations are associated with endothelial-dependent vasodilatation triggered by the stimulation of sodium-potassium ATPase and the opening of potassium channels in smooth muscle cells and adrenoreceptors. Long-term supplements increase the total number of sodium-potassium ATPases and the associated potassium turn-over. In addition, increased sodium excretion, modulation of baroreceptor sensitivity, reduced sensitivity to catecholamine-associated vasoconstriction, improved insulin sensitivity, and reduction of oxidative stress also play a role. |
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| Magnesium in connection with hypertension | |
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A substitution with magnesium to balance the mineral balance is recommended, as an undersupply of this micronutrient is associated with hypertension, among other things. In the smooth muscle cells of the vessels, magnesium acts as a light calcium blocker. An increase in extracellular magnesium is associated with a decrease in intracellular calcium concentration, which in turn reduces angiotensin-induced synthesis of aldosterone. One consequence of this is the lowering of blood pressure. Diseases such as endothelial dysfunction and coronary heart disease are associated with magnesium status, which also explains the therapeutic success of magnesium substitution in hypertension patients. The drugs prescribed for these diseases often additionally promote the loss of magnesium. Diuretics prescribed for congestive heart failure or hypertension, for example, can increase magnesium excretion through the urine. In addition, chronic stress also leads to magnesium depletion in the cells, which is seen as a cause of endothelial dysfunction in arteriosclerotic changes. There is therefore a negative correlation between magnesium intake and hypertension. Magnesium supplementation has been shown to reduce systolic and diastolic blood pressure, with a higher effect on systolic blood pressure. Especially during pregnancy, a magnesium deficiency manifests itself in an increase in diastolic blood pressure, which can be prevented by supplementation. The global magnesium supply is inadequate. Due to the linear dose-response relationship (higher magnesium intake = lower risk of hypertension), the mineral is an adequate means of prevention. A careful diet covers the daily magnesium requirement of a healthy person. If additional physical stress – such as illness, medication, increased physical activity or chronic high stress – is present, the magnesium status should be analyzed in the laboratory to rule out inadequate supply. Due to the important role of magnesium in maintaining blood pressure, this is particularly recommended for potential hypertension patients. |
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| Other relevant micronutrients | |
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The black seed (Nigella sativa) is a promising medicinal plant with a variety of therapeutic properties. The extract from Nigella sativa shows diuretic activity, inhibits the hyperactivity of the sympathetic nervous system in in-vivo studies and has antioxidant properties so that it has a potential benefit as an adjuvant antihypertensive. Green tea, derived from the plant Camellia sisensis, is one of the most important sources of flavonoid uptake. The main health effects of green tea are attributed to catechins, known as flavonoid-like polyphenols or flavonols. Several studies suggest that green tea consumption can significantly reduce systolic blood pressure and induce a significant reduction in diastolic blood pressure.
Hypertension is associated with changes in the nitric oxide (NO) pathway, in the renin-angiotensin system (RAS), and with oxidative stress. Studies show that the amino acid L-arginine reduces insulin resistance and aging, increases NO production, reduces oxidative stress, and improves endothelial function. Ideally, a lifestyle change with a balanced diet such as the DASH diet, which is low in salt and rich in antioxidants and arginine containing proteins such as meat, fish, soy, nuts, whole grains, lentils and beans, may be useful to get the most out of nutrients with antihypertensive properties. Long chain, polyunsaturated omega-3 fatty acids such as docosahexaenoic acid (DHA), which is sometimes abundant in oily fish, can have a variety of health-promoting effects and protect the immune, nervous and cardiovascular systems. Furthermore, omega-3 fatty acids are potent antioxidants and important for the flexibility and permeability of cell membranes and protect the heart with their antiarrhythmic and antithrombotic effects. |