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Complementary and alternative medicine approaches to blood pressure reduction (An evidence-based review). Richard Nahas MD Canadian Family Physician J. vol54:November2008 Presentation:Nader Nowshad MD. Introduction. Hypertension :a main risk factor of cardiovascular diseases

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Complementary and alternative medicine approaches to blood pressure reduction(An evidence-based review)

Richard Nahas MD

Canadian Family Physician J.

vol54:November2008

Presentation:NaderNowshad MD


Introduction
Introduction pressure reduction

  • Hypertension :a main risk factor of cardiovascular diseases

  • Efficacy of drug therapy for achieving optimal BP

  • Effect of reduction of BP on public health


5 lifestyle changes for controlling hypertension
5 Lifestyle changes for controlling hypertension pressure reduction

  • 1- Reducing Na-intake

  • 2-Increasing exercise

  • 3-Moderating alcohol consumption

  • 4-Losing weight

  • 5-Following dietary approaches to stop hypertension(DASH) eating plan


Role of complementary and alternative medicine
Role of complementary and alternative medicine pressure reduction

Users of complementary and alternative medicine antihypertensive therapies in Canada and U.S:

36% of Population

Some examples in our country


Quality of evidence in this study
Quality of evidence in this study pressure reduction

  • Reviewing Medline and EMBASE :1966-May 2008

  • Prospective studies and human clinical trials

  • Availability of level 1 evidence

  • Methodologic limitations of nondrug clinical trials


Dark chocolate
Dark chocolate pressure reduction

  • Cacao bean(Theobroma cacao)

  • Flavonoid polyphenols---- procyanidins

  • Ancient usage for treating pain and inflammation

  • A prospective study for 15 years in Germany

  • Consumption of 100 gr daily for 2 weeks:Reduction of BP about 4.7/2.8 mmHg


Dark chocolate1
Dark chocolate pressure reduction

  • Effect of chocolate on both hypertensive and normotensive patients

  • Consumption of 6.3 gr of dark chocolate for 18 weeks: Reduction of BP about 2.9/1.9 mmHg

  • Effect on rising of S-nitrosoglutathione

  • Improving vascular function in diabetic patients

  • Dark chocolate is better than White one!


Coenzyme q10
Coenzyme Q10: pressure reduction

  • UBIQUINONE

  • First isolation : Beef mitochondria

  • Integral component of mitochondrial electron transport chain

  • Reduction of lipid peroxidation

  • Benefits :CHF,DM type 2,Atherosclerosis,Migraine,Parkinson

  • Interaction with statin therpay


Coenzyme q101
Coenzyme Q10: pressure reduction

  • Best effect for reducing BP(abou16.6/8.2)

  • <It would seem acceptable to add CoQ10 to conventional anti-hypertensive therapy.>

  • Over-the-counter drug

  • Dosage:60 to 120 mg daily

  • Side effect : mild gastrointestinal upset in long-term trials


Melatonin
Melatonin pressure reduction

  • Pineal production of melatonin in absence of light

  • Indications : sleep aid, treating jet lag

  • Night time BP is more predictive of cardiovascular outcomes than daytime BP

  • Impairment of dependent vasodilation in patients with low level of melatonin

  • Decreasing BP about 3.77/3.63 mmHg after consumption of 3 mg melatonin daily


Melatonin1
Melatonin pressure reduction

  • Reverse effect after taking Nifedipine

  • Adverse effect of beta-blockers on level of melatonin


Vitamin d
Vitamin D: pressure reduction

  • Effects on cancer , immunity and cardiovascular diseases

  • 1,25,hydroxyvitamin D inhibits renin production and vascular smooth muscle proliferation

  • BP rises with increasing distance from the equator

  • Low level of activated vitamin D in serum increase the risk of hypertension an myocardial infarction


Vitamin d1
Vitamin D: pressure reduction

Ultraviolet B light waves trigger endogenous vitamin D production.

Vitamin D toxicity is very rare.


Mind body approaches
Mind-body approaches: pressure reduction

Side effects of emotional and psychological stress on BP

Qigong; traditional Chinese medicine:Movement,breathing,meditation.

Slow , controlled breathing can increase parasympathetic and decrease sympathetic nervous system activity, which are important factors controlling BP.


Mind body approaches1
Mind-body approaches: pressure reduction

Autonomic dysfunction in patients with DM

Effect of Transcendental meditation on BP:

----Mantra


Acupuncture
Acupuncture: pressure reduction

A treatment based on non-Western system of diagnosis

Comparison of REAL and SHAM Acupuncture


Conclusion
Conclusion: pressure reduction

  • Economical effects

  • Necessity of investigations by GOVERNMENTS and INSURERS

  • The largest BP reduction was seen with use of coenzyme Q10.


داروهای گیاهی کاهنده فشار خون: pressure reduction

  • برگ گل و گل زالزالک

  • دانه و برگ شنبلیله

  • پیاز گیاه سیر

  • برگ و ساقه گیاه دارواش

  • ساقه و برگ جعفری

  • تخم کرفس

  • برگ زیتون


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