Search SAFM

Pulmonary Hypertension: Where to Focus?

(This is a sample entry from our Q&A Treasure chest, a database with hundreds of entries to support students with their patient and client work.  Unlimited access is included as part of our Core 101 Semester program.)

Student Question:

A potential client of mine was just diagnosed with pulmonary hypertension and given a depressing prognosis. Are you familiar with this??  I would appreciate some guidance on where to begin in terms of focus.   Thanks so much!

Tracy’s Response:

I am!  Pulmonary hypertension is different than traditional high blood pressure in that pulmonary hypertension (PHTN) is high blood pressure that occurs specifically in the arteries of the lungs.  It is a different measurement altogether from systemic blood pressure and reflects the pressure the heart must exert to pump blood from the heart through the arteries of the lungs specifically.

The human body has two separate arms of the circulatory systems.   Typically “blood pressure” and a diagnosis of “high blood pressure” or “hypertension” refer to the systemic blood pressure throughout your body. This is typically measured in the brachial artery of your arm.  Pulmonary blood pressure refers to the blood flow in your lungs, essentially a separate “loop” in the circulatory system.   The right side of the heart receives the oxygen-emptied blood as it returns from the body and pumps this blood into the blood vessels of the lungs, where the blood gathers oxygen again. From there, blood leaves the lungs and enters the left side of the heart to carry the oxygen-rich blood to the body again.   This is an excellent overview clinical paper.

You may learn more about typical symptoms of PHTN here.

Because blood vessel dysfunction in the lungs can have a dramatic effect on the entire body, conventional treatment often  involves common hypertension drugs as well as blood thinners (e.g. warfarin).   Supplemental Oxygen is recommended to maintain oxygen saturation greater than 90% in those patients who are more compromised.   There are more advanced drugs used for those who have acute reduction in oxygen availability.

Lifestyle modifications that avoid putting too much pressure on the lungs are usually recommended.  For example, avoiding lifting objects that weight more than 15-20 lbs. and avoiding all strenuous exercise and avoiding travel to higher altitude destinations (where there is less oxygen in the air).  Regular mild or gently moderate exercise (e.g. walking), however, is critical for retaining lung function.  Activities such as yoga and tai chi can help to build and retain muscle mass without an intense cardio effect.

Persistently higher pressure of the blood coming from the lungs into the heart puts pressure on the heart to work harder.  This can cause hypertrophy of the heart, and over time without abatement, PHTN can lead to heart failure simply due to lack of oxygenation.  However, as with so many other diagnoses in the body, it is just as key in PHTN as in regular hypertension to get to the true root causes of dysfunction in the blood vessels.   These are common factors to consider:

  • As with systemic hypertension, insulin resistance may be a significant contributor, and as such is a critical mediating factor.  Remember that insulin resistance is often undiagnosed .  Ideal fasting insulin is probably about 5 mIU/ml and HbA1c should be less than 5.3%.  A study found women with a fasting insulin level around 8 had twice the risk of developing prediabetes as women with fasting insulin near 5.0.   (As an aside, note that this is another great example of there being an optimal place to be within a typical reference range; in this case, it’s quite low, around the ~20%ile (typical reference for fasting insulin is <25).)  If this is an issue, there are many avenues for improving insulin sensitivity (e.g. apple cider vinegar , berberine).  A low-glycemic diet is critical, and acceptable carbohydrate intake can vary dramatically from person to person.  We have an entire course available on reversing diabetes and insulin resistance.
  • A primary reason why magnesium has a strong effect on blood pressure is because of its role in controlling the amount of potassium that flows into our cells.  It’s critical that we boost potassium via diet with a rich variety of vegetables and fruits.  We tend to think primarily of bananas to boost potassium, but dark leafy greens, winter squash, avocado, cantaloupe, tomatoes, and many other foods are quite high as well.   In fact, avocado has twice as much as banana.
  • Avoid both caffeine and alcohol.  
  • Drink plenty of plain, clean water.  Simple hydration is vital for normal blood pressure.
  • Sleep 8 hours nightly.   This may sound like a saccharine suggestion, but it’s absolutely critical (and probably should be at the top of the list given so many of our patients and clients devalue sleep).  In particular, ensure that there is no sleep apnea, as there is a high correlation in sleep apnea and the incidence of PHTN (and CPAP therapy improved functions and symptoms dramatically).  Ensure that all drivers and contributors to  insomnia  or poor, restless sleep are addressed overtly.  (Beyond this one link, there are many posts on the SAFM site about sleep, so feel free to do some further searching on the site if this a significant issue.)
  • Most hypertension is caused by endothelial dysfunction, and we know that both insulin resistance and low magnesium (as above) can be key players.  However, high oxidative stress, persistent “simmering” infections and chemical toxicity are also often major players in this dynamic.  This is a fascinating article that I highly recommend you both read.  Fully exploring all of these avenues is beyond the scope of a single topical post, but I would encourage anyone with this diagnosis to fully explore these avenues.  In particular, ensuring strong daily intake of anti-inflammatory essential fats including EPA, DHA, and GLA (e.g. 1500mg O3s and 500mg GLA, both twice daily).   There are also some key plant extracts which have been shown in clinical study to improve endothelial function specifically toward improving or reversing pulmonary hypertension:

P.S. If you know that healthcare must be transformed to be sustainable and effective, and you believe strongly that Functional Medicine is key to making that happen, we urge you to learn about our semester program.

If you haven’t done so already, sign up to receive weekly clinical tips like this via email, and you’ll also get automatic access to a free mini clinical course.

Like us on Facebook to get more great clinical tips and to get notifications of my next Facebook Live!

Ask a Question

Practitioner clarification questions are welcome! Please do not post personal case inquiries.