Excerpt from the ACNEM Journal (September 2021)
BY GABRIELLA JOHNSON – ACNEM STUDENT MEMBER
Gabriella Johnson completed her bachelor’s degree in medical radiation science in 2012 and works as a radiation therapist in Newcastle NSW. She is currently completing a bachelor dree in health science, Naturopathy at Torrens University Australia. She is passionate about nutrition and herbal medicine, with a special interest in education around the role of diet, lifestyle and environment in the prevention of disease.
In 2017-2018 1 in 3 Australians aged 18 years and over were estimated to have hypertension. Hypertension equated to 5.8% of Australia’s total disease burden in 2015 (AIHW, 2019). Fine particulate matter (PM2.5) air pollution is associated with increased risk for cardiovascular (CV) diseases due to the release of pro-oxidative and inflammatory vasoconstriction mediators (Giorgini et. Al, 2016 Zhang, 2014, Du et al. 2016). Systemic hypertension is multifactorial condition that is the result of consistent high blood pressure (BP) readings of systolic >140mmHg and diastolic 90mmHg (See appendix 1.1) (Carretero & Oparil, 2000, Nascimento et al, 2017). A diagnosis of hypertension is a significant risk factor for developing coronary heart disease, heart failure stroke and other degenerative health complaints contributing to premature death in 1 in 4 men and 1 in 5 women worldwide (“Hypertension”, 2021). Mild hypertension may be improved with environmental, nutritional, diet and lifestyle improvements. Phytotherapeutic and nutritional medicine is well evidenced to aid in lowering mild hypertension and can provide adjunct therapeutic support to conventional treatment. This literature review will discuss nutritional and phytotherapeutic support such as Panax notoginseng (PNG) and taurine in the therapeutic management of mild hypertension.
A range of environmental, genetic, lifestyle and epigenetic factors contribute to mild hypertension (Kuneš & Zicha, 2009). Individually and in combination with air pollution, these factors contribute to inflammation, endothelial dysfunction and insulin resistance, creating surges in peripheral resistance and blood volume (Craft, Gordon & Tiziani, 2011). Sympathetic nervous system stimulation causes an increase in heart rate as well as systemic vasoconstriction. Long term vasoconstriction leads to vascular remodelling and narrowing of vessels causing vasospasm of the arteries.
In addition, the renin-angiotensin-aldosterone system regulates the release of natriuretic hormones that further promote the retention of sodium, leading to increased blood volume and consequently high blood pressure (Craft, Gordon & Tiziani, 2011). Further inflammation in the endothelial walls of vessels release inflammatory cytokines, causing a decrease in vasodilators such as nitric oxide (NO) and increasing endothelin, a vasoconstricting molecule. Furthermore, insulin resistance is associated with decreased endothelial release of NO as well as over activity of the renin- angiotensin-aldosterone system (Craft, Gordon & Tiziani, 2011).
Mild hypertension is a major contributing factor to heart disease and death globally. According to the World Health Organisation, an estimated 1.13 billion people worldwide have hypertension. Genetic variants are thought to be a chief key player in its development alongside internal environmental factors such as obesity, insulin resistance, sedentary lifestyle, stress, low mineral intake (such as potassium, magnesium and calcium), high sodium consumption and high alcohol intake (Carretero & Oparil, 2000). External environmental factors are also noted such as fine particulate matter (PM2.5) air pollution (Giorgini et. Al, 2016 Zhang, 2014, Duet al. 2016). particulate matter air pollution is emitted when burning fuel in cars, pollution can come from cars, combustion of wood in wood heaters or during bushfires for example. Once inhaled, these particles can influence heart, lung, and haematological health.
The objective of hypertension treatment is to reduce elevated blood pressure readings to <140/90 mm Hg and ≤130/80 mm Hg in those with comorbidities such as diabetes or renal disease (Chobanian et al, 2003, Howes, 2012). The most effective early intervention is lifestyle modifications; however, if there is no change in behaviour, pharmacology drug therapy is needed. First line medications include angiotensin- converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), diuretics, beta blockers, calcium channel blockers (CCBs) to reduce overall blood pressure (Nguyen, Dominguez, Nguyen, & Gullapalli, 2010). More than one-third of hypertensive patients require greater attention to compliance, combination therapy and more intensive lifestyle interventions (Leenen et al., 2008).
Read Gabriella’s full article here which includes therapeutic intervention, literature review and conclusion.
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