Good evidence for CAM approaches to lowering blood pressure.
|Publication:||Name: Australian Journal of Medical Herbalism Publisher: National Herbalists Association of Australia Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2008 National Herbalists Association of Australia ISSN: 1033-8330|
|Issue:||Date: Winter, 2008 Source Volume: 20 Source Issue: 4|
Nahas R. 2008. Complementary and alternative medicine approaches to
blood pressure reduction, a clinical review. Canadian Fam Phys
In this review the author looks at the quality of scientific evidence supporting interventions other than medical drugs to reduce blood pressure (BP). This is important given that only about one-third of patients achieve optimal BP control using drug therapy and because a reduction of 5 mm Hg in systolic BP has been associated with a 7% reduction in all-cause mortality.
Medical literature was searched from January 1966 to May 2008 combining the key words hypertension or blood pressure with acupuncture, chocolate, cocoa, coenzyme Q10, ubiquinone, melatonin, vitamin D, meditation and stress reduction.
Level I evidence (randomised controlled clinical trials as well as meta-analyses and systematic reviews of such trials) was available for most of the interventions. The author notes that some studies had methodologic limitations that are inherent to nondrug clinical trials. This was most relevant to acupuncture and mind-body trials.
The best evidence exists for dark chocolate, coenzyme Q10, qigong (working with energy), slow breathing techniques and meditation. All are supported by systematic reviews. The largest BP reduction was seen with the use of coenzyme Q10. Two RCTs support BP reduction by treating vitamin D deficiency using UVB light or supplementation. Serum vitamin D levels have also been associated with risk of cardiovascular events in large prospective cohort studies.
Short term supplementation reduced BP in one randomised trial. Two small trials support the use of melatonin, but other studies suggest caution when combining it with calcium channel blockers or ?blockers. The evidence from 3 acupuncture trials is mixed but this might be related to some therapeutic effect of the placebo chosen in the one negative trial. Dark chocolate was effective in a meta-analysis of 5 RCTs. Increased consumption was associated with significantly reduced risk of cardiovascular events and all-cause mortality in one prospective cohort study.
It should be noted however that the studies looked mainly at the effects of these therapies on intermediate end points such as blood pressure lowering, rather than on cardiovascular outcomes such as cardiac events or death. The author states that these interventions can be considered for all hypertensive patients, particularly those with an interest CAM.
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