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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
  • 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
  • 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

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
  • 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
  • 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
  • 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:
  • 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:
  • 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
  • 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
  • Reverse effect after taking Nifedipine
  • Adverse effect of beta-blockers on level of melatonin
vitamin d
Vitamin D:
  • 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:

Ultraviolet B light waves trigger endogenous vitamin D production.

Vitamin D toxicity is very rare.

mind body approaches
Mind-body approaches:

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:

Autonomic dysfunction in patients with DM

Effect of Transcendental meditation on BP:

----Mantra

acupuncture
Acupuncture:

A treatment based on non-Western system of diagnosis

Comparison of REAL and SHAM Acupuncture

conclusion
Conclusion:
  • Economical effects
  • Necessity of investigations by GOVERNMENTS and INSURERS
  • The largest BP reduction was seen with use of coenzyme Q10.
slide31
داروهای گیاهی کاهنده فشار خون:
  • 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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