Update: All new orders will be held until the new publication is ready in early March.

1. The chiropractic profession should play a major if not dominant role in the clinical management of chronic hypertension. At present, chiropractic care of the hypertensive patient is marginalized to an “alternative and complementary” role. The medical profession has taken a leadership position on the management of hypertension based on a wealth of drug research and the establishment of evidence-based clinical protocols and professional standards of care. In contrast, the chiropractic profession, although it has within its scope of practice the most effective treatments for hypertension, has not until now had a cohesive evidence-based guide for the clinical management of the hypertensive patient. This monograph serves to fill that void by providing clinicians an overview of the disease, its differential diagnoses and assessment and then by providing clear evidence-based treatment options.

CME/CEU credits are being applied for.

2. Drug management of hypertension is by no means a panacea, leaving significant numbers of patients untreated, undertreated, or mistreated. The expenses and adverse effects of drug management leave many patients untreated. Furthermore, according to recent peer-reviewed research, shortcomings in the medical management of hypertension place patients at risk of adverse effects, inefficacy, and unnecessary expense. Lastly, by failing to address the underlying causes of high blood pressure, and by failing to treat the constellation of comorbid conditions (e.g., insulin resistance, overweight, hyperuricemia, and nutritional deficiencies), medical suppression of elevated blood pressure cannot be viewed as optimal therapy.

Evidence sample from New England Journal of Medicine: The data from this study show that the medical profession leaves many hypertensive patients untreated and undertreated. Specifically, profession-wide deficiencies were noted in the following areas:

1. Lifestyle modification for patients with mild hypertension: underused
2. Change in treatment when blood pressure is persistently uncontrolled: underused
3. Pharmacotherapy for uncontrolled mild hypertension: underused

The authors wrote, "METHODS: We telephoned a random sample of adults living in 12 metropolitan areas in the United States and asked them about selected health care experiences. We also received written consent to copy their medical records for the most recent two-year period and used this information to evaluate performance on 439 indicators of quality of care for 30 acute and chronic conditions as well as preventive care. We then constructed aggregate scores. RESULTS: Participants received 54.9 percent (95 percent confidence interval, 54.3 to 55.5) of recommended care. … CONCLUSIONS: The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public. Strategies to reduce these deficits in care are warranted."

McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. N Engl J Med. 2003 Jun 26;348(26):2635-45
 

Evidence sample from Milbank Quarterly—A Multidisciplinary Journal of Population Health and Health Policy in 1998: The authors review pertinent literature on healthcare quality and note that among Americans only “41%–54% of patients had their hypertension controlled (mean blood pressure (150/90).” By weak criteria of HTN control, 55% of people with hypertension had blood pressure “under control” with pressures of 160/95 treated with at least one antihypertensive medication; when using strict criteria (medicated blood pressure of 140/90) only 21% of Americans were properly treated.  "Studies over the past decade show that some people are receiving more care than they need, and some are receiving less. Simple averages from a number of studies indicate that 50 percent of people received recommended preventive care; 70 percent, recommended acute care; 30 percent, contraindicated acute care; 60 percent, recommended chronic care; and 20 percent, contraindicated chronic care. These studies strongly suggest that the care delivered in the United States often does not meet professional standards."

Schuster MA, McGlynn EA, Brook RH. How good is the quality of health care in the United States? Milbank Q. 1998;76(4):517-63

 

3. Because hypertension is a major patient-centered and public health concern, the chiropractic profession must have an evidence-based protocol for its management. Chronic hypertension is “disease” of epidemic and indeed pandemic proportions in America and increasingly in other nations. The lifetime incidence of high blood pressure among Americans is 90%, while on any given day, approximately one in four Americans has high blood pressure. These patients and potential patients would benefit more from integrative chiropractic care and the nutrition-based protocols in this document than they can hope to benefit from drug-only treatment. The evidence supporting the dietary and nutritional prevention and treatment of hypertension and cardiovascular disease is irrefutable. Adding to this the recent evidence that chiropractic spinal manipulation is as effective as two-drug treatment for hypertension makes the case for the chiropractic profession’s assumption of a leadership role timely and of paramount importance. This document not only serves to provide individual clinicians with practical protocols, by perhaps more importantly this document is a call to action for the chiropractic profession. The chiropractic profession must stand and deliver the quality healthcare that our patient population needs and deserves.

 

Double-blind, placebo-controlled pilot study of chiropractic manipulation for treatment of hypertension: Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients (n=50): The authors introduce this study by writing, “Anatomical abnormalities of the cervical spine at the level of the Atlas vertebra are associated with relative ischemia of the brainstem circulation and increased blood pressure (BP). Manual correction of this mal-alignment has been associated with reduced arterial pressure.” The authors used a double-blind, placebo-controlled design at a single center among 50 drug naïve (n=26) or washed out (n=24) patients with Stage 1 hypertension; patients were randomized to receive a National Upper Cervical Chiropractic (NUCCA) procedure or a sham procedure. Significant findings included the following, “At week 8, there were differences in systolic BP (-17 mm Hg, NUCCA versus -3 mm Hg, placebo) and diastolic BP (-10 mm Hg, NUCCA versus -2 mm Hg). … No adverse effects were recorded. We conclude that restoration of Atlas alignment is associated with marked and sustained reductions in BP similar to the use of two-drug combination therapy..” Link to full-text

 

Excerpt from “The Council on Chiropractic Education's New Wellness Standard: A call to action for the chiropractic profession” by Marion W Evans Jr and Ronald Rupert (Parker College of Chiropractic Research Institute) published in open-access format in Chiropractic & Osteopathy 2006: Excerpt provided here in accordance with open access terms and conditions  http://www.chiroandosteo.com/content/14/1/23 

Health Status of Spine Patients

“A review of some of the co-morbidity issues that accompany musculoskeletal conditions like low back pain, will demonstrate why chiropractors need to become aggressively active in addressing patient lifestyle and other health promotion and wellness issues. The impact of spine problems on health status has been examined through co-morbidity analysis. In 2000, Fanuele and colleagues [5] reported an observational study of 17,774 patients from the 25 National Spine Network agencies or academic centers. Their goals were to quantify the impact of spinal problems on physical function and to better understand the effects of co-morbid conditions on physical function. In their study population, 46.6% of spine patients had at least one other non-spinal condition or illness. When smoking was considered a co-morbid condition it was number one with hypertension 2nd, obesity 3rd and diabetes 4th. Fifty-two percent of patients had a primary diagnosis of lumbosacral symptoms and 82% had experienced three or more months of pain. They concluded that society bears a heavy economic burden from patients with spinal conditions and physicians need to recognize that spine patients have significantly more physical morbidity than the US population in aggregate. Fanuele and colleagues stated, "It is likely that the spinal diagnosis, in itself, is mostly responsible for the significant functional disability, expressed by low physical component scores."

A study published in Pain by Von Korff and others [6] concluded that after controlling for demographic variables and for co-morbidities, chronic spinal pain was significantly associated with role disability, other pain conditions, chronic diseases and mental disorders. Their information was derived from the household face-to-face National Co-morbidity Survey Replication which was a nationally representative sample (n = 9,282) of respondents age 18 or older. Almost 20% of the US population was estimated to have chronic spinal pain in the prior 12 months with about 30% reporting lifetime prevalence of chronic spinal pain. This chronic spinal pain was more than three times higher in patients who reported other chronic pain as those without these conditions and it was twice as high in patients with a mental disorder. Chronic physical disease associated with chronic spine pain included stroke, hypertension, asthma, COPD, irritable bowel syndrome, ulcers, HIV/AIDS, epilepsy and vision problems. After adjusting for demographic variables the increased risk of a co-morbid chronic physical disease associated with chronic spine pain was 2.0. Among the 40 million Americans who suffer chronic spine pain, 22 million had a co-morbid physical ailment (87% with chronic spine conditions had at least one co-morbid condition). Therefore, spine patients are in need of health education messages at a rate that may exceed that of non-spine patients.

The association of spinal disease with smoking and obesity is also fairly well established [7,8]. Obesity is associated with more severe pain syndromes among spine patients and they suffer greater impairment in functional status [7]. As previously stated, smoking is often the most frequently found condition associated with spine disease [5,8]. These factors should be important to chiropractors as they primarily see back pain and neck pain patients [9]. The average case mix of DCs tends to include a significant amount of chronic spine patients although there is an indication that DCs utilize certain health promotion measures with them such as; exercise recommendations, ergonomic advice and advice on dietary changes [9]. DCs need to place a greater emphasis on the use of common prevention and health promotion methodologies in their practices. It is our opinion that an emphasis on wellness and health promotion is compatible with either the primary care or the "spine care model" of chiropractic and is congruent with national health initiatives and the chiropractic tradition of holism and self-reported prevention practices [9]. This will be described in more detail but should include cancer prevention dietary recommendations, proper exercise recommendations, appropriate screening procedures that are within scope of practice including, but not limited to cardiovascular disease, hypertension, diabetes, breast, prostate and skin cancer screening.”
 

 

 

The following is a partial list of atherosclerosis-promoting recipes listed under the title “Stay Young at Heart: Cooking the Heart-Healthy Way” advocated on the website of the NHLBI in December 2009. Notice the lack of nutrient density, the emphasis on simple carbohydrates, the frequent use of baking with oil to create the effect of frying, the lack of raw foods, and the scarcity of phytonutrients:

• “Stir-fried beef” with boiled potatoes and white rice

• “Beef stroganoff” with 6 cups of cooked macaroni pasta

• “Crispy oven-fried chicken” cooked in cornflakes and buttermilk

• “Classic macaroni and cheese”

• “Candied yams” with brown sugar, margarine, white flour, and orange juice

• “Oven French fries” (white potatoes oven-fried in vegetable oil)

• “Potato salad”

• “Wonderful stuffed potatoes”

• “White rice” cooked with vegetable oil and salt

• “Sunshine (white) rice” cooked with vegetable oil, orange juice, and lemon juice

• “Homestyle biscuits” made from white flour, salt, and sugar

• “Banana-nut bread” made from mashed ripe bananas, low-fat buttermilk, packed brown sugar, margarine, all-purpose white flour, egg and salt.

• “Apricot-orange bread” made from dried apricots, margarine, white sugar, egg, white flour, dry milk powder, salt and orange juice

• “Apple coffee cake” made with peeled apples (please note that >90% of the antioxidants contained in apples are in the peel—thus when the peel is removed, virtually all that remains is antioxidant-poor carbohydrate), one cup of sugar, one cup of dark raisins, one-quarter cup vegetable oil, 1 egg, and two-and-a-half cups of sifted all-purpose white flour

• “Frosted cake” with 2 1/4 cups cake flour, 4 tablespoons margarine, 1 1/4 cups sugar, 4 eggs, low fat cream cheese, and 2 cups sifted confectioners sugar!!

• “Topical fruit compote” with sugar

• “Peach cobbler” with sugar, white flour, margarine, canned peaches “packed in juice”, peach nectar, and cornstarch

• “Rice pudding” with white rice, 3 cups of skim milk, and 2/3 cup sugar
   

The list goes onto include many other proatherosclerotic and prodiabetic meals. Now ask yourself why and how the US government by way of the National Heart, Lung, and Blood Institute is promoting a diet plan that is ensured to contribute to the pandemics of hypertension (affecting 25% of American adults), obesity, and diabetes mellitus. 

“It's not a matter of whether the war is not real, or if it is, Victory is not possible. The war is not meant to be won, it is meant to be continuous. … The war is waged by the ruling group against its own subjects and its object is not the victory over [the purported enemy], but to keep the very structure of society intact.” George Orwell, 1984

 

 

Click here to access Stay Young at Heart Recipe Collection

Copyright 2009 Alex Vasquez