• "Your writing is very good, clear, concise and accurate." World-renowned cardiologist and expert researcher in CoQ-10, 2011
• "Once again, an outstanding resource for clinicians. Your contributions to the field are remarkable!" Clinician, University President, Journal Editor, 2011
• "I appreciate the resources you offer the profession. I use your books and articles regularly." Chiropractic Doctor, 2011
• "Thank you for exposing so many people to the results of our research on the treatment of hypertension. I hope you can pay us a visit during your next trip to our area so we can give you the tour of our new 50+ bed inpatient facility." Alan Goldhamer, D.C., Chief of Health Promoting Clinic, 2010
• "Dr. Vasquez artfully contends that chronic hypertension is a clinical finding of vascular dysfunction that is best managed with exercise and dietary measures, and that chiropractic doctors are uniquely positioned to provide such management. I wholeheartedly agree with him."  Joseph Brimhall, D.C. President, University of Western States, 2010
• "I attended your seminar at Western States University in June and have been utilizing your hypertension protocols. In that short time, I have seen some marked progress with various patients. I was wondering if you have or in the process of developing a new patient brochure that briefly explains the chiropractic, nutritional and exercise approach to hypertension. I think a folded brochure to add to my existing patient education brochures would be helpful and prompt potential patients to consult our offices." Chiropractic Doctor, 2010
• "As a 7th trimester student quickly approaching 8th trimester and student clinic, I know I will be utilizing your books often. Your "Chiropractic and Naturopathic Mastery of Common Clinical Disorders" book is referenced very frequently by many clinicians and faculty members at [our university]. Your work is highly regarded, and I look forward to clinically utilizing the information I will obtain from your writings." Chiropractic-Naturopathic Student, 2011
• new 5-book discount price

Sections:

1) Preamble, Introduction, and Forewords

 

2)  Integrative Medicine for Chronic Hypertension:

1. Introduction, epidemiology, pathophysiology

2. Differential diagnosis

3. Clinical presentation

4. Physical examination

5. Laboratory and imaging assessments

6. Management strategies and clinical pearls

7. Integrative treatments with nutritional, botanical, surgical, and pharmacologic drug treatments

8. Dr Vasquez's previously published essays related to hypertension

3) Wellness Promotion: Re-Establishing the Foundation for Health

 

4) Competencies and Self-Assessment

 

Index

Description:

Integrative Medicine and Functional Medicine for Chronic Hypertension provides healthcare professionals, policymakers, and the educated public more than a review of treatments for chronic hypertension; this book outlines and substantiates a paradigm shift that will broaden the reader’s perspective and enable a new approach to hypertension management and disease prevention. Further, in the process of exploring the topic of hypertension, readers will see how the functional medicine approach that is described herein can be applied to other important health problems commonly encountered in clinical practice and public health.

 

Hypertension—commonly known as high blood pressure—is the most common diagnosis in the practice of medicine, and it affects an estimated one billion people worldwide and at least 50 million people in the United States. The global prevalence is approximately 25%, meaning that 1 of every 4 persons in the world has high blood pressure. Because the underlying metabolic problems (dysfunctions) that cause hypertension are becoming more common, by the year 2025 the number of affected persons is estimated to reach 1.56 billion people worldwide. Clearly, everyone with a stake in healthcare and with concern about their own personal health—from physicians, to politicians, to the general public—can benefit from the approaches described in this book that promote optimal health and the prevention of diseases in general, hypertension in particular.

This textbook teaches the public and the healthcare communities how to (re)create the social and personal environments to promote optimal health—wellness—and then details the causes, respective assessments, lab tests, and the best treatment approaches for chronic hypertension. Patients with the condition and the doctors who care for them will all benefit from the information in this book, which is supported by hundreds of scientific publications, years of clinical experience, and Dr Vasquez’s unique perspective from his diverse training encompassing three doctoral degrees in three separate healthcare professions.

 

• Status: Published in March 2011; first edition published in February 2010 as Chiropractic Management of Chronic Hypertension; this revised edition contains more information and an updated index

• Page size: 8"x10"

• Text and graphics: Black/white/grayscale with text, diagrams,  and photographs

• Length: 286

• Citations: Approximately 1,150

• Used properly, this book will pay for itself within: The first morning of use

• 10-Digit ISBN: 1451515715

• 13-Digit EAN: 9781451515718

• Continuing education: See information here

• About the author: Dr. Alex Vasquez is a graduate of Western States Chiropractic College (Doctor of Chiropractic, 1996), Bastyr University (Doctor of Naturopathic Medicine, 1999), and University of North Texas Health Science Center, Texas College of Osteopathic Medicine (Doctor of Osteopathic Medicine, 2010). Dr Vasquez is the author of several textbooks—Integrative Orthopedics (2004, 2007) Integrative Rheumatology (2006, 2007), Musculoskeletal Pain: Expanded Clinical Strategies (published by the Institute for Functional Medicine, 2008), Chiropractic and Naturopathic Mastery of Common Clinical Disorders (2009), Chiropractic Management of Chronic Hypertension (2010)—and more than 75 letters and articles in professional magazines and medical journals such as The Lancet, BMJ—British Medical Journal, Annals of Pharmacotherapy, Nutritional Perspectives, JMPT—Journal of Manipulative and Physiological Therapeutics, JAMA—Journal of the American Medical Association, Original Internist, Integrative Medicine, Holistic Primary Care, Alternative Therapies in Health and Medicine, JAOA—Journal of the American Osteopathic Association, Dynamic Chiropractic, Journal of Clinical Endocrinology and Metabolism, and Arthritis & Rheumatism—Official Journal of the American College of Rheumatology.
  
  

Integrative Medicine and

 Functional Medicine for

Chronic Hypertension:

An Evidence-based Monograph on the Treatment of High Blood Pressure

Dietary, Nutritional, Botanical, Surgical, and Manipulative Therapeutics

with Concepts, Perspectives, Algorithms, and Protocols for

the Safe and Effective Management of Chronic High Blood Pressure

Dr. Alex Vasquez

Doctor of Osteopathic Medicine, graduate of University of North Texas Health Science Center, Texas College of Osteopathic Medicine (May 2010). Currently in training for Family Medicine

Doctor of Naturopathic Medicine, graduate of Bastyr University (September 1999). Licensed Naturopathic Physician with Additional Prescriptive Authority in Washington (2000-2002), Licensed Naturopathic Physician in Oregon (2004-present)

Doctor of Chiropractic, graduate of Western States Chiropractic College (March 1996.  Licensed Doctor of Chiropractic, Washington (1996-2002) and Texas (2002-present)

Adjunct Faculty (2004-2005, 2010) and Former Forum Consultant (2003-2007), The Institute for Functional Medicine in Gig Harbor, Washington

Adjunct Faculty, National University of Health Sciences in Lombard, Illinois

Affiliate Faculty, University of Western States in Portland, Oregon

Private practice of chiropractic and naturopathic medicine in Seattle, Washington (2000-2001) and Houston, Texas (2001-2006)

Former Adjunct Professor of Orthopedics (2000), Radiographic Interpretation (2000), and Rheumatology (2001) at Bastyr University in Kenmore, Washington

Former Editor (2006-2007), Naturopathy Digest

Author of approximately 75 articles and letters published in Annals of Pharmacotherapy, The Lancet, Nutritional Perspectives, BMJ (British Medical Journal), Journal of Manipulative and Physiological Therapeutics, JAMA (Journal of the American Medical Association), The Original Internist, Integrative Medicine: A Clinician's Journal, Holistic Primary Care, Nutritional Wellness, Dynamic Chiropractic, Alternative Therapies in Health and Medicine, Journal of the American Osteopathic Association, Evidence-based Complementary and Alternative Medicine, Journal of Clinical Endocrinology and Metabolism, and Arthritis & Rheumatism: Official Journal of the American College of Rheumatology

OptimalHealthResearch.com
 

 

Foreword to Integrative Medicine and Functional Medicine for Chronic Hypertension

Dr. Alex Vasquez comes to the question of the origins of hypertension with a perspective and set of tools that presage 21st century functional systems medicine. We currently have in place in the industrialized world a method of healthcare developed and based on the 20th century acute-care medical model. Such a model is characterized by rapid differential diagnosis—with an organ-system focus—aimed at prescribing a drug (or procedure) that will ameliorate the patient’s presenting symptoms and signs, averting the immediate threat.[1] It is a model that evolved in response to the primary causes of morbidity and mortality in the last century, namely acute infections and trauma. The experts within this organ-system model are the various specialists within conventional medicine, such as cardiologists, pulmonologists, endocrinologists, neurologists, and orthopaedic surgeons.

Inherently, this methodology minimises the involvement of the patient, who functions mostly as a passive recipient of the procedure or prescription. It is not a model that reimburses the practitioner for looking into why the patient became ill, the origins of illnesses. Instead, it prioritises immediate solutions to the most pressing problems. It is, of course, absolutely essential in emergency and hospital-based care of many kinds, but difficulties arise when this model is applied to ongoing, community-based care for the non-acute, chronic, complex conditions that represent 80% of the daily work of present day clinicians.[2]

This new book, Integrative Medicine and Functional Medicine for Chronic Hypertension, discusses the principles of functional integrative medicine and shows how they can be usefully applied to the frequently encountered clinical condition of chronic hypertension. In so doing, it illustrates the shift that will be required to enfold into 21st century medical practice the innovative clinical practises of patient-centred, personalised, systems-based medicine. A core principle of functional integrative medicine maintains that diagnosis is the starting point for the clinician’s primary set of responsibilities, not the last step before prescriptive interventions. The most complex of skills, clinical decision making and medical judgment, in the medical context of chronic, complex co-morbid illnesses such as chronic hypertension, require:
• A persistent exploration of the accretion of the relevant scientific evidence, tempered by…
• the wealth of knowledge and judgment inherent in clinical experience, along with…
• the creation of a real partnership with the patient in educing a lifestyle-based personalized, therapeutic plan.

Clinical decision making, when exercised at the most efficacious level, drills deeply into the “why” of every diagnosis. Pursuit of the elusive network of causality in the deeper intersections of genetic individuality, within each client’s unique context of living, is an essential responsibility of the clinician. This clinical guide focused on chronic hypertension illustrates, using step-by-step illustration, how to achieve more satisfying outcomes through an integrated clinical assessment and treatment program.

Stepping out of the shadow of conventional poly-pharmacology and procedure-based interventions, into the bright sunlight afforded by 21st century breakthroughs in personalised medicine, systems biology, and systems medicine re-enchants and illuminates the practice of clinical medicine. The blending of the foundational sciences of genomics (unique genes embedded in a unique environment) with the intellectual architecture of functional, integrative, systems-thinking enables the creation of a more comprehensive portfolio of clinical service for the patient. The author’s careful explanations in this volume illustrate how clinical practice, coupled with skills learned through rigorous training in both conventional medicine and functional, integrative systems medicine can successfully bring to the therapeutic relationship real patient-centred answers for chronic, complex illnesses.

The most powerful motivator for changes in our behavior as physicians is listening attentively to compelling stories brought to the clinic by our patients. The intense satisfaction of successfully resolving their hitherto unanswered questions about the root causes of chronic hypertension, by applying a different lens for evaluation and assessment, is transformative. Functional, integrative, systems medicine provides such a lens. Hence, Integrative Medicine and Functional Medicine for Chronic Hypertension will prove to be an important publication about functional and integrative medicine in clinical practice.

David S Jones, MD
President, Institute for Functional Medicine
August, 2010


[1] Ely JW, Osheroff JA, Gorman PN, et al. A taxonomy of generic clinical questions: classification study. BMJ 2000;321:429-32
[2] Holman H. Chronic disease—The need for a new clinical education. JAMA 2004;292(9):1057-1059
 

Foreword to Integrative Medicine and Functional Medicine for Chronic Hypertension

In his newly updated publication, Dr. Vasquez’s expanded volume encourages and challenges clinicians to further re-imagine their roles in the delivery of health care services.  His particular focus on the care of patients with chronic hypertension emphasizes that high blood pressure is both an indicator of underlying functional disorders and a contributor to other serious health problems.

As Dr. Vasquez notes, heart disease and vascular disorders cause tremendous losses in quality of life for a large segment of the population and are the primary causes of death in our society.  Chronic high blood pressure is both a cause of and an indicator of vascular dysfunction and disease.  For the most part, these health problems are self-inflicted, meaning that they are the result of how we live, what we eat, and how we view health (and healthcare) in general.  Consequently, Dr. Vasquez submits that patients with vascular problems as indicated by chronic hypertension are best managed through dietary changes, nutritional interventions, exercise and other lifestyle modifications.  These natural approaches are almost always more safe and effective than conventional drug-based therapies.

Throughout his series of patient-management reference texts for functional integrative clinicians, Dr. Vasquez promotes a simple yet profound principle; “The art of co-creating wellness while effectively managing common health disorders.” Chiropractic physicians, as with other functional integrative clinicians, are uniquely positioned to implement this advice.  The methods he recommends are specifically designed to optimize function and facilitate health.  As healthcare professionals, we can provide no higher service than that of addressing the needs of those patients who seek our care by treating them as individuals, and by seeing them as whole people and not just as hosts of disease.

Clinical evaluation and management of patients with chronic hypertension should and can be done by all functional integrative clinicians, and Dr. Vasquez’s text shows how this can be accomplished. The benefits of this protocol extend beyond reduced hypertensive morbidity and mortality to include the alleviation of comorbid conditions such as depression, migraines, and back pain and the enhancement of vitality and sense of well-being.

Dramatic change in health care delivery is in the air; it is the clinician’s responsibility to ensure that the conversation centers on the care of the patient.  In placing as first priority the needs and preferences of the patient, functional integrative clinicians demonstrate capacity to improve health care choices for individuals while also positively impacting the entire healthcare delivery system by reorienting it toward health optimization rather than symptom suppression and disease treatment.

The quest for a better way to achieve and maintain a healthy life compels us to adapt, to modify, and to transform. Such is the path of advancement and growth.  I commend Dr. Vasquez’s excellent work and encourage functional integrative clinicians to embrace and apply his recommendations.

 

Joseph Brimhall, D.C.

President, University of Western States

http://uws.edu/

September 2010

 

Click here to view book cover.

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]

 

Image from: Integrative Medicine and Functional Medicine for Chronic Hypertension. Copyright 2011 by Dr Alex Vasquez

 

 

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.