Chinese Medicine for Essential Hypertension:
A Review of Available Treatment

INTRODUCTION

Essential hypertension is one of the most common diseases known today. It is divided by degrees of severity. This paper concentrates on what is referred to as hypertension. Hypertension is defined as diastolic blood pressure above 90 MM Hg. Hypertension has an ethnicity aspect:
1) Some studies try to link this to genetic predisposition
2) Other studies postulate increased salt retention and decreased rennin activity in blacks people as the cause for the high prevalence and morbidity of hypertension
3) There are studies showing the correlation between hypertension and stress being related to lower socio-economic status
4) And lower self-esteem
5) While there is definitely a higher prevalence and morbidity of this disease now than in the past from the epidemiological point of view, the cause of this has not yet been established with certainty by any studies.

Current conventional pharmacological treatment includes five kinds of drugs:
1) Antiadrenergics
2) Vasodilators
3) Calcium channel blockers
4) Diuretics, and
5) ACE inhibitors.
It is rare to use single drug therapy (6). Most regimens include a combination of at least two drugs. It is very common to see regimens of three and sometimes more drugs (7). Non-drug conventional therapy limits itself to diet counseling, exercises, and the cessation of smoking and drinking. Hypertension is conventionally treated with non-drug therapy despite the fact that literature advises otherwise. When first trial non-drug therapy of hypertension is shown to be ineffective, then drugs become necessary. The prognosis and morbidity in seven to ten years of non-drug therapy of mild hypertensives are the same as for those with severe hypertension. However, in recent years, more recently physicians who have treated hypertension with drug therapy are questioning the damage caused by side effects, which cause hypertension to become more and more difficult to control and which cause more complications. It comes down to the point of trying to establish what is worse, the cure or the disease (7)?

There are alternative therapies, such as acupuncture and herbology, which have started to take effect recently in the treatment of hypertension. Some of these can be used alone or combined with conventional pharmacological treatment. Since it is common practice not to use drug therapy in hypertensives, these alternative therapies can be used individually, or they can be combined with the drugs.

THE ROLE AND NEED OF ALTERNATIVE MEDICINE IN ESSENTIAL IN HYPERTENSION TODAY
Alternative medicine has found its way into the treatment of hypertension for a variety of reasons, most significantly
1) Non-drug treatment in cases of hypertension
2) Pharmacological side effects and ineffectiveness, and
3) Life dependency of current treatments (8).
As mentioned earlier, hypertension is usually not treated by drug therapy despite its prognosis and mortality. Alternative therapies will therefore provide an option for these patients (9). Patients with hypertension currently on medication suffer from a myriad of side effects, ranging from mild to severe. These side effects usually disappear soon after the drug is suspended. The problem is that, if the drug is suspended, it must be replaced with another, which will have its own side effects. Side effects include, but are not limited to: headaches, malaise, nausea, vomiting, impaired ejaculation, impotence, gynecomastia, hypercholesterolemia, hyperglycemia, fluid retention, etc. (10). Some literature describes depression as one of the side effects of diuretics. (11)

The ineffectiveness of pharmacological treatment also poses a problem, especially when managing patients. Some drugs seem to have no positive effect on these patients. ACE inhibitors shown a marked difference in effect when race is included as a variable (12). Antiadrenergics, casodilators and ACE inhibitors have been shown to be less effective in black people, possibly due to metabolic differences (13).

Finally, drug therapy in hypertensives has been shown necessary for life after diagnosis. In some studies, the effect of the drug after it has been withdrawn was shown to remain for less than six months (7). Considering the side effects, it is easy to imagine how difficult it could be for these patients to live with these drugs for the rest of their lives.

The modalities of Chinese medicine reviewed here provide a light at the end of the tunnel. For mild hypertensives that receive no treatment, there could be an option. For hypertensives on drug therapy, these modalities may lead to lower dosages of medication, thereby a reducing side effects. In some cases, they could mean the elimination of drug therapy and remaining normotensive. The alternative modalities reviewed here shown no significant side effects. (14)

ALTERNATIVE MODALITIES IN THE TREATMENT OF HYPERTENSION

ACUPUNCTURE
Eastern practitioners have used acupuncture extensively to control blood pressure. An experimental study, conducted by Chinese physiologists on dogs, showed that acupuncture could control the blood pressure regulatory system (15). Having established this, other studies went further to show marked improvement in the blood pressure of patients who underwent auricular acupuncture and auriculopressure (16,17,18,19 ). Another study of 70 people showed how matrix acupuncture lowered the blood pressure significantly in 50% of 70 the participants (20). Several other studies showed promising effects of acupuncture in the control of blood pressure with long term effects. Although most studies used different protocols (a different group of points), the effectiveness was similar. The different protocols used the stem from the Chinese Theory of disease. In Chinese Traditional Medicine (TCM) hypertension is not considered a disease entity, it is seen as a part of a syndrome. In Chinese diagnosis, the identification of the syndrome is based on symptoms: signs, pulse and tongue is are most important. In Chinese medicine, hypertension can be part of several different syndromes. Therefore, the treatment approach will vary according to the syndrome, not according to one specific sign; in this case hypertension. In Chinese Medical Theory every patient is considered individually and, although two patients may have the same syndrome, the treatment protocol may vary slightly to take into account individual conditions. This can get really complicated, and the important thing to remember is that every patient is different in the eyes of Chinese Medicine Theory. This poses a problem in terms of research validity.
There is no standard treatment for the condition known as hypertension in Western Medicine. So, how do we apply acupuncture with exclusive protocol to a group of people that might have different body imbalances? And, what body imbalance takes precedence over others to justify the choice of a particular protocol for studies? Theses are very difficult questions to answer. The fact is that these studies have shown long-term improvements in the blood pressure of the participants despite the protocol used (21,22,23). Perhaps the Western approach of standardizing treatments should be revised. Some drugs, such as ACE inhibitors, are usually not prescribed in the treatment of only hypertension . Why then is it not possible to accept that some acupuncture protocol has to be different for different patients?

CHINESE HERBS
The basis of pharmacology used to be herbs. Herbs have been shown to work well in controlling blood pressure in adults (24). There are different herbs and combinations of herbs that can be used, depending on the syndrome diagnosed, of which, hypertension is a part. These herbs are usually prescribed as a tea to be taken from two to several times per day. The problem with herbs is compliance. It is difficult for the average person to prepare and drink ing tea throughout the day. Also, many herbs are not pleasing to the palate, which discourages a lot of patients from continuing treatment. Many studies have shown long- term effects in the management of hypertension with herbs (14). The validity of these studies has the same problem as the studies with acupuncture. There are no standard herbs to treat hypertension, but there are specific combination formulas to treat the syndrome involving hypertension. The Western world will not accept this concept yet.

ACUPOINT INJECTION THERAPY (AIT):
According to the differentiation of a patient's situation, we select suitable Chinese herbs for directinjection into specific acupuncture points to treat the hypertension. This therapy gains the benefits of acupuncture and herbs, more powerfully, effectively, conveniently and involves less herbs.

QI GONG:
This is a form of Chinese breathing therapy combined with low-impact exercise. In a Chinese study , hypertensive patients participated in a Qi Gong program. It was shown that, after three months in the program, the majority of patients (85%) had improved their ventricular function and microcirculation. These two factors are usually compromised in hypertensive patients. At the end of the program (six months) the participants had lower blood pressure (although not significantly for statistical purposes) than when they started (2-4 mm Hg lower) (25). The important aspect is that the blood pressure did not increase. The condition did not progress to full hypertension as it usually does for mild hypertensives.
[new line]Qi Gong is easy to learn. Patients can practice it in the convenience of their own home or wherever they are. The most important aspect is the breathing and concentration. There are number of variations to suit individual needs. Qi Gong should be practiced daily in 20-minute sessions and the result is long lasting.

TAI CHI CHUAN
This is another form of low-impact Chinese exercises. It is more active than Qi Gong and requires more skills. It can be practiced by patients of all ages. Its purpose is to balance the energy of the body. Studies correlate the relaxation obtained by this type of exercise to its effect in on blood pressure (24). The studies show an immediate effects in the blood pressure of participants, providing them with significant control of their blood pressure. It should practiced daily, at least once a day for 25-minutes. The effects are not permanent if the exercise is not performed routinely. Like all exercise programs, the difficulty here is compliance (24). Tai Chi Chuan requires dedication to learn and practice. Once mastered, it could be the difference between taking medication every morning or practicing for 25 minutes everyday. Since, it is an active exercise, it not only benefits your circulatory system, but it also helps in other conditions, such as arthritis.

NUTRITION COUNSELING
Diet modification has always been a part of the treatment for hypertension. Several diets are available to choose from according to the specific needs. Studies show that people who maintain a specific diet slow the return of hypertension after discontinuing medication (26). It has also been shown that a good diet combined with drug therapy maintains a well-balanced blood pressure and significantly reduces any side effects of the drug . This is probably due to the lower dosage needed (27). In a four-year study, it was demonstrated that people using a specific diet were able to control their blood pressure. Although some patients showed reduced blood pressure, they turned out to be not statistically significant . But, it was significant to see that the blood pressure was maintained, and no increases were seen among the patients at the end of the program (28). Again, the difficulty is diet compliance.

These modalities can be used separately, but is probably a good idea to combine some of them, i.e.: Acupuncture and herbs separately, or together. These therapies are relatively inexpensive as compared to the cost of medications. Some of them can be practiced at home.

CONCLUSION
Having defined hypertension and its treatment approach, it is easy to appreciate the problems. Hypertensive patients are usually not treated with drug therapy. Even if they are treated with drugs, side effects raise the question of which is worse, the treatment or the disease? Particularly with patients, in whom, some drugs, like the ACE inhibitors, do more harm than good. With alternative treatment modalities, patients with hypertension have an option for treatment. They may never get to the point of having to use medications if these therapies are used when a hypertensive condition is diagnosed. The alternative treatment has no significant side effects, and is moderately priced as compared to the use of medication.

Further research in Chinese medicine should be encouraged. Acupuncture, herbs and Acupoint Injection Therapy (AIT) should be explored more seriously. Acupuncture research studies in the treatment of essential hypertension should be organized. The protocol problem should be analyzed in order to get validity among the Western medical community. Solution to the protocol problems could include a review of the different syndromes of which hypertension is part. Perhaps a standard group of points can be obtained since, in many of the syndromes, there are overlapping points. By showing that acupuncture works in managing blood pressure, the reputation of the modality, as well as, the prestige of acupuncturists will be taken to the level it deserves.

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