Blood Pressure Effectively Controlled with Naturopathic Medicine

Recent Survey Finds Blood Pressure Effectively Controlled with Naturopathic Medicine

Hypertension can lead to cardiovascular disease, including myocardial infarction and stroke. Lifestyle counseling recommendations are important in managing hypertension; however, the National Ambulatory Medical Care Survey reports that fewer than 50% of patients are given these recommendations.1 In contrast, naturopathic (ND) medicine includes health promotion counseling, nutritional supplementation, and pharmacologic treatment options. ND physicians have been reported to include diet counseling, exercise prescription, and stress management advice for 69-100% of their patients with diabetes.2-4 These authors evaluate ND clinical care for the treatment of hypertension, describe the use of nutritional supplementation in practice, and estimate the change in clinical risk.

The authors performed a retrospective, observational study of hypertension care in an outpatient ND clinic, the Bastyr Center for Natural Health in Seattle, Washington. They sought to describe the patient population using ND care for hypertension, describe practice characteristics, and estimate the changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP).

Data were abstracted from medical charts between December 2006 and June 2007. Patients were included if they met the following criteria: an ICD-9 assessment of hypertension made by the ND provider and at least 6 months of ND care specifically for hypertension between 2001 and 2006. The following data were collected: patient characteristics (race, gender, age, and current antihypertensive medications); care characteristics (primary versus adjunctive care, duration of care, presence of care gaps, and number of visits during the care period); BP measurements during care; and treatment recommendations (lifestyle counseling, nutritional supplementation, and the initiation of new antihypertensive prescription medications). The charts of 85 patients were identified for detailed data abstraction. Mean age of the patients was 60.6 years; 59% were women.

The authors report that on average, patients attended 8.7 ND visits during 13.8 months of care. At least one 6-month gap in ND care was seen in 32 patients. ND care was mostly adjunctive; however, 23.5% of patients used ND care as primary care.

Eighty-three patients (97.6%) received dietary counseling, and 58 (68.2%) received counseling to increase physical activity. Nearly all patients were given educational handouts. All patients were recommended to take nutritional supplements, with omega-3 oil from fish being the most commonly recommended supplement (55.3%).

The authors report improvements in BP readings for both the patients with stage 1 and those with stage 2 hypertension. Overall average reductions for patients in both stages were -16.1 mm Hg mean reduction in SBP (P<0.0001) and -7.4 mean reduction in DBP (P<0.0001).

Stage 2 patients achieved greater mean reductions: -26 mm Hg (P<0.0001) in SBP and -11 mm Hg (P<0.0001) in DBP. These reductions suggest that "ND treatment is either effective at various risk stages and/or that treatment is tailored depending on risk at presentation," write the authors.

At baseline, only 14% of the patients had controlled SBP and DBP, compared with 44% at the last measurement.

The results of this study suggest that BP is significantly reduced during ND care and that the dietary advice given by ND physicians is evidence-based. Dietary recommendations can potentially reduce a patient's risk for multiple chronic diseases, not just hypertension.5

Among the study's limitations is a lack of a natural history control group, the fact that other health care services used may not have been included, and because the patients self-selected ND care, they are likely motivated for health improvement.

ND practice appears to have several positive qualities: clinical engagement on reducing risk factors for cardiovascular disease, a high prevalence of guideline-recommended lifestyle counseling, and the use of evidence-based dietary recommendations.


Bradley R, Kozura E, Kaltunas J, Oberg EB, Probstfield J, Fitzpatrick AL. Observed changes in risk during naturopathic treatment of hypertension. eCAM Advance Access. 2010: [epub ahead of print]doi: 10.1093/ecam/nep219.

References
1Heaton PC, Frede SM. Patients’ need for more counseling on diet, exercise, and smoking cessation: results from the National Ambulatory Medical Care Survey. J Am Pharm Assoc. 2006;46-364-369.

2Bradley R, Oberg EB. Naturopathic medicine and type 2 diabetes: a retrospective analysis from an academic clinic. Alt Med Rev. 2006;11:30-39.

3Bradley R, Shen E, Buckle H, et al. Description of clinical risk factor changes during naturopathic care for type 2 diabetes. J Altern Complement Med. 2009;15:633-638.

4Chinnock JCE, Tippens K, Calabrese C. Survey of naturopathic treatment of diabetes. Poster presentation at the American Association of Naturopathic Physicians Annual Convention. Palm Springs, CA; August 2007.

5Eyre H, Kahn R, Robertson RM, et al. Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. Stroke. 2004;35:1999-2010.

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