Chiropractic Management of Chronic
Hypertension: An Idea who’s Time Has Arrived in Print
Alex Vasquez DC ND DO
The version below is the
original; a modified version was published in Dynamic
Chiropractic on-line in May 2010 initially available here:
http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54700
The chiropractic profession now has a
clinically oriented handbook thoroughly referenced to peer-reviewed
publications detailing the evaluation and management of chronic
hypertension. Up until now, the profession in general and
practitioners as individuals had no specific outline for the
integrative chiropractic management of high blood pressure, and thus
the profession’s claim to “primary care” in this respect carried
little authoritative weight. With this new clinical handbook,
clinicians can confidently navigate the steps that constitute the
clinical evaluation, differential diagnosis, physical/laboratory
examination, and then implement (as appropriate) the nutritional and
manipulative treatments that are essential components of successful
hypertension management. [1]
After several years of integrative chiropractic
and naturopathic practice, I decided to attend medical school for my
third doctoral degree. Many reasons inspired me to take on this
challenge; but one of the major ones has been that of continually
challenging my own perspectives, opinions, and paradigms with regard
to the clinical management of various diseases, disorders, and
conditions. Four years later and after scoring in the top 1-5% on
national medical exams and performing very well at one of the
nation’s top medical schools, my perspective on the appropriate
management of chronic hypertension remains steadfast in three of its
primary components: 1) Nutritional, lifestyle, and manipulative
interventions should be the treatments of choice for essentially all
patients with chronic primary hypertension. 2) As the only
nationally licensed healthcare discipline with training in
nutritional, lifestyle, and manipulative interventions, the
chiropractic profession should play a premier national role in the
management of chronic hypertension. 3) Pharmacosurgial
interventions are important for medical causes and recalcitrant
cases of hypertension. Since premises #2 and #3 founded upon or
associated with premise #1, I will provide some substantiation here
for premise #1; details and citations are provided in the textbook.
As a diagnosis and clinical disorder affecting
approximately 25% of American adults, hypertension is the single
most common diagnosis made in the general practice of Family
Medicine. In this article as in my recent textbook, the term
“chronic hypertension” refers to the 90% of all hypertension cases
labeled as “primary” or “essential” or “idiopathic” hypertension,
i.e., those that lack any routine “medical” cause, such as
hypercalcemia, hyperaldosteronism, aortic coarctation, renovascular
disease, renal parenchymal disease, systemic sclerosis, drug
iatrogenesis, hyperthyroidism or hypothyroidism. Chronic
hypertension accelerates the development of atherosclerosis and is
thus a major risk factor for stroke and myocardial infarction.
Additionally, the physiologic consequences of sustained high blood
pressure contribute to the development of congestive heart failure,
hypertensive retinopathy, and hypertensive kidney disease. Of
course, combining chronic hypertension with other risk factors such
as smoking, diabetes mellitus, and dyslipidemia causes an
exponential increase in the risk for catastrophic cardiovascular
morbidity and mortality. Because treatment of hypertension is the
single most effective means for reducing premature morbidity and
mortality in developed nations, the management of hypertension ranks
highly among the most important public health issues in America,
Canada, Australia, Japan, England and most of Western Europe while
still being important in South America, the Middle East, and the
rest of Asia. In other words, chronic hypertension is a worldwide
health disorder of the highest clinical and public health
importance.
The safest, most effective, and most
appropriate treatments for the vast majority of cases of chronic
hypertension are within the chiropractic scope of practice; these
treatments are nutritional intervention and manipulative therapy.
As reviewed in Chiropractic Management of Chronic
Hypertension, many dietary and nutritional interventions
are impressively well-documented in the research literature; because
these interventions are also preferred by patients and are
preferentially utilized clinically by many doctors, all three
criteria for evidence-based medicine are satisfied (i.e., research
substantiation, clinicians’ utilization, and patient preference).
Most chiropractors are probably unaware that the most effective
nutritional treatment for chronic hypertension has been researched
and documented by Dr Alan Goldhamer, a chiropractic doctor and
graduate of Western States Chiropractic College (now University of
Western States). Writing in the June 2001 issue of
Journal of Manipulative and Physiological
Therapeutics, Dr Goldhamer and his colleagues showed
that the combination of diet improvement along with fasting
normalized blood pressure in nearly 90% of 174 consecutive patients
with hypertension. The average blood pressure reduction was -37/-13
mm Hg with the use of diet and fasting; in contrast, when
hypertension is managed with drugs, achieving a reduction in blood
pressure of -20/-10 generally requires at least two medications.
Patients with systolic blood pressure greater than 180 mg Hg or
diastolic blood pressure greater than 110 mg Hg (or both) had an
average reduction of 60/17 mm Hg by the end of the treatment period;
again, these results are highly significant, both statistically and
clinically. In October and December 2002 in Journal of
Alternative and Complementary Medicine, Dr Goldhamer again
showed that drug-free dietary intervention was highly effective and
that it saved employers-insurers thousands of dollars per patient,
with additional savings expected to result from improved overall
health and the continued implementation of health-promoting dietary
and lifestyle changes. Dr Goldhamer’s diet and fasting intervention
was performed on an inpatient basis; with appropriate patient
selection, variations on supplemented fasting can be performed on an
outpatient basis with once or twice weekly clinical evaluation.
The five-part “supplemented Paleo-Mediterranean diet” which I first
detailed in September 2005 issue of Nutritional Wellness
[2] can also be used to promote and maintain long-term reductions in
blood pressure and to enhance overall health.
In addition to specific diet
modifications, certain nutritional supplements should be used in the
routine treatment of chronic hypertension. Nutritional supplements
with evidence-based substantiation in the research literature
include but are not limited to coenzyme Q-10, vitamin D, magnesium,
vitamin C, L-carnitine and acetyl-L-carnitine. Beyond the direct
and collateral benefits provided by dietary and nutritional
supplementation are the synergistic benefits obtained when dietary
improvement is combined with nutritional supplementation (rather
than diet alone or supplementation alone). Chiropractic doctors
need to know how to use these nutritional interventions safely and
effectively. Important clinical characteristics of a given
treatment include: 1) expected blood pressure reduction from each
treatment, 2) collateral benefits, 3) drug interactions, 4) risks of
therapy, 5) identification of responsive or resistant patient
groups, and 6) how to implement nutritional interventions in
patients taking pharmaceutical drugs.
Documentation of the
effectiveness of chiropractic spinal manipulation in the treatment
of chronic hypertension was most recently published in the May 2007
issue of Journal of Human Hypertension by Bakris and
colleagues. In this randomized trial with 50 hypertensive patients,
blood pressure reductions were -17/-10 in the treatment group
receiving upper cervical chiropractic spinal manipulation versus
-3/-2 in the placebo group. The importance of this research is at
least three-fold. First, obviously this research shows that elevated
blood pressure can be normalized without drugs; not all health
professionals respect this fact. Second, it shows specifically that
upper cervical chiropractic treatment can lower blood pressure to a
clinically meaningful degree in patients with chronic hypertension.
Third and perhaps most important, by showing that cervical spine
manipulation can reverse hypertension, this research delivers a
paradigm shift in the understanding of the pathophysiology of
hypertension. Up until recent years, the most of the
pathophysiology of chronic hypertension was ascribed to “idiopathic”
neurohormonally-mediated changes in renal handling of salt and
water; this formed the basis for the medical treatment of chronic
hypertension, which was and is largely focused on the use of
diuretics to increase excretion of salt and water. By showing that
upper cervical manipulation substantially alleviates chronic
hypertension, we have a new paradigm for expanding our concept of
the phenomenon of chronic hypertension, namely that chronic
hypertension appears to be mediated in part by neurovascular
compression at the brainstem. Although successful treatment of this
apparently common neurovascular or “neurogenic” hypertension can be
accomplished surgically (see Janetta et al in Annals of
Surgery March 1985 and Geiger et al in The Lancet
August 8, 1998), I am sure that most clinicians would appreciate the
value and safety of a nonsurgical (manipulative) approach,
especially one that can be delivered within an integrative clinical
context of dietary improvement, nutritional supplementation and
wellness coaching. By virtue of being the only nationally licensed
healthcare profession with training in spinal
manipulation/adjusting, diet therapy, nutritional supplementation,
and wellness coaching, only the chiropractic profession is poised to
deliver a packaged solution to the public health catastrophe known
as chronic hypertension. The additive and synergistic benefits of
such an approach hold enormous promise to improve the health of
patients in America, and worldwide.
Given that about 1 in 4 (25%
of total) adult Americans has hypertension, and that the
chiropractic profession is poised to deliver evidence-based
comprehensive care for these patients, 65 million hypertensive
American patients and potential patients stand to benefit from
integrative chiropractic care. The question that now remains is,
“Will the chiropractic profession stand and deliver the
science-based integrative care these patients need?” The profession
now has a guidebook for the achievement of this important goal.
Dr. Alex Vasquez is a
member of the Research Team at Biotics Research Corporation. His
two most recent books are “Chiropractic and Naturopathic Mastery of
Common Clinical Disorders” and “Chiropractic Management of Chronic
Hypertension”, both of which are available from
http://OptimalHealthResearch.com.
Readers of this article can
access special discount pricing on the hypertension monograph by
entering code “MY8UPSMN”
at
https://www.createspace.com/3428931.
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