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Old 8th August 2000 | 02:59
  #15 (permalink)  
Tinstaafl
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Unhappy

Can't find any reference to garlic in the health literature. FireDragon, your reference is?

However, from the Australian Heart Foundation I found the following concerning hypertension. Note carefully the their qualifications concerning the validity of various items.

Lots more available if you want it.
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Hypertension
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Of the variety of non-pharmacological measures claimed to reduce blood pressure in hypertensives, five have received widespread acceptance. These are weight reduction in the obese, dietary sodium restriction, regular exercise, a moderation of alcohol consumption and a vegetarian eating pattern. Effective use of these measures may abolish the need for antihypertensive drugs in some patients with mild hypertension.

The effectiveness of psychological techniques is more controversial. Their assessment is complicated by problems with study design, compliance, individual variability of blood pressure, the blood pressure lowering effect of familiarisation with repeated measurement, and variations in sensitivity to the different procedures. As a primary aim in treating patients with high blood pressure is to reduce overall cardiovascular risk a variety of other measures that reduce risk are important in patients with hypertension irrespective of effects on blood pressure. These include smoking cessation and an eating pattern low in saturated fat.

Weight reduction
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Weight reduction exceeding five kilograms effectively lowers blood pressure in most patients with mild-to-moderate hypertension. This effect is independent both of measurement artefacts due to arm girth changes and of changes in sodium consumption. (Nevertheless, all practitioners should have an 'outsize' arm cuff to reduce the tendency to over-estimate blood pressure when using a standard cuff in obese patients).


Nutritional measures
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Low sodium/high potassium eating patterns
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Several well-controlled studies have shown an average reduction in blood pressure of 5-7 mmHg in hypertensives where sodium intake is reduced below 90 mmol/day by a 'no-added-salt' low salt food eating pattern. The effect is more marked in systolic blood pressure, and on standing, and is greater in the elderly and in severe hypertensisves.

A no-added-salt eating pattern involves adding no salt to the plate without any compensatory addition in cooking. Highly salted foods should be avoided, such as salted chips, tomato ketchup and other sauces, as should take-away foods and many preserved foods. Many patients can readily adapt to this change, whereas greater sodium restriction requiring elimination of salt from bread, butter and margarine as well as from all cooking is much more difficult. A further benefit of moderate dietary sodium restriction is that it appears to potentiate the effect of diuretic and angiotensin converting enzyme inhibitor therapy, enabling the doses of these and other drugs to be minimised.

Potassium supplements can also lower blood pressure in moderate to severe hypertension. The use of special potassium-containing salt in cooking may facilitate this, as well as the consumption of more fruit and vegetables. Potassium supplements should not normally be used with potassium-sparing diuretics or angiotensin converting enzyme inhibitors, or in patients with renal insufficiency.


Vegetarian and similar eating patterns
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Ovo-lacto vegetarian eating patterns lower blood pressure in both normotensive and hypertensive subjects. The effects seems to depend not on meat protein per se, but a combination of low saturated fat, a relative increase in polyunsaturated fats and increased fibre from fruit and vegetables. A similar effect may be obtained by following NHF guidelines for hyperlipidaemia, which also include reducing total fat intake to 30 per cent of energy consumption. Substituting fish for meat will help reduce total fat and cholesterol consumption and by virtue of specific effects of fish oils may further reduce the risk of vascular disease. Fish oil supplements have been found to lower blood pressure in some studies.

Alcohol restriction
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There is a strong association between alcohol consumption and hypertension, and ex-drinkers have similar blood pressures to lifelong teetotallers. Those drinking the equivalent of three or more glasses of beer a day have three times the prevalence of hypertension compared with teetotallers. Controlled trials provide conclusive evidence that alcohol can raise blood pressure and interfere with the action of antihypertensive drugs. Patients should be advised to restrict their intake to one or two drinks per day with the hope or reducing the need for antihypertensive drug therapy.

Exercise
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Cross-sectional population studies suggest that those with greater exercise capacity have lower blood pressures. The effect seems independent of obesity by may be confounded by differences in lifestyle. Recent exercise trials suggest that there is a direct blood pressure lowering effect as physical fitness is attained. In hypertensives, in addition to effects on blood pressure, exercise training for sedentary hypertensives has the potential to make people feel better, will facilitate weight reduction in the obese and has metabolic benefits. Isometric exercise can cause severe rises in pressure and should be avoided. The sedentary coronary-prone patient with hypertension, who plans a rejuvenating exercise program in middle life needs careful evaluation. Guidelines are set out in the Foundation's policy statement Exercise and Heart Disease.

Cigarette smoking
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The effects of cigarette smoking on blood pressure levels per se are less important than those on vascular or coronary disease. Each time a cigarette is smoked there is an acute rise in blood pressure. However, giving up cigarette smoking may lead to an increase in weight with an associated rise in pressure. Nevertheless, the adverse effect of smoking on vascular disease and the reported higher incidence of accelerated hypertension in smokers, far outweighs the small effects that giving up smoking may have on blood pressure. Hypertensives who smoke have 3 to 4 times the risk of a heart attack compared with non smokers. Hypertensives should, therefore, be strongly advised against smoking with a view to reducing the very high risk of cigarette-associated coronary disease.

Pro-hypertensive drugs
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A variety of drugs may cause or accelerate hypertension, or lead to loss of blood pressure control in treated hypertensives. These include all oestrogen preparations, most non-steroidal anti-inflammatory drugs, analgesic excess, corticosteriods and sympathomimetic amines such as those found in a number of proprietary cough medicines, appetite suppressants, decongestants and eye drops. Avoiding these substances where possible may 'cure' hypertension or minimise the need for anti-hypertensive drugs. In perimenopausal women with no hypertension, hormone replacement therapy has no effect on blood pressure. Perimenopausal women with established hypertension who are on oestrogen HRT may suffer raises in blood pressure and should be monitored carefully. Low dose oral contraceptive agents may be continued in many hypertensive women but the effects should be monitored and smoking particularly avoided. Caffeine-containing beverages (coffee, strong tea) cause transient elevation in blood pressure but are probably more important as a cause of overestimation of true blood pressure (where ingestion precedes a visit to the doctor) than of sustained hypertension.

Psychological techniques
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Acute emotional stress raises blood pressure acutely, and relaxation may lower it. Relaxation, meditation/yoga and biofeedback techniques appear to be of decreasing order of effectiveness, although their value as specific blood pressure-lowering measures is still debateable. Whereas drugs have been shown to reduce blood pressures in hypertensives throughout the day and night there is no evidence that psychological techniques reduce pressures for other than short periods, particularly when the blood pressure is being recorded. Nevertheless, many tense hypertensives feel better with these techniques and therefore are more likely to comply with other advice, such as encouragement to lose weight and stop smoking.

Conclusion
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A reasonable expectation of blood pressure reduction can be offered to patients who can lose excess weight, avoid heavier alcohol consumption, reduce dietary salt and exercise regularly. Further benefit may occur by increasing dietary potassium, reducing total and saturated fat and increasing fruit, vegetable and fish consumption. The degree to which these various measures are additive or synergistic is unknown. Despite problems in modifying lifestyle, non-pharmacological measures deserve close attention by the practising physician with a view to reducing the burden of drug therapy to the 10 to 20 per cent of the adult community with hypertension. Nevertheless it should be remembered that these measures are often complementary to drug therapy, which to date is the only proven means of reducing cardiovascular morbidity and mortality from stroke and heart failure.


[This message has been edited by Tinstaafl (edited 07 August 2000).]