Pulmonary Hypertension: Where to Focus?

(This is a sample entry from the SAFM Q&A Treasure Chest, a tool with hundreds of entries to support students with their client needs. Students get unlimited access as part of SAFM’s functional medicine training 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 system.  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 an 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 weigh 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 of 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.

• Magnesium is critical for maintaining optimal blood pressure in all vessels, and many of our clients and patients have suboptimal levels.   In fact, magnesium has been used directly as a vasodilator in infants with PHTN.  Insulin resistance further depletes magnesium, and a state of low magnesium encourages the development of insulin resistance.  RBC magnesium is optimally in the upper third of the reference range or even outside the upper range.   I’ve written many times before about magnesium, its functions, and how to supplement.

• 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, an avocado has twice as much as a 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 is 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 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 that have been shown in clinical studies to improve endothelial function specifically toward improving or reversing pulmonary hypertension:
  • Curcumin, 500mg twice daily, preferably the Meriva form, or one including piperine to enhance absorption.
  • Resveratrol, 250mg/day, ideally in the transveratrol form.
  • Quercetin, 500mg/day (increase to 2-3x/day if/when a client also has allergies affecting respiratory function).  In fact, in rat studies, quercetin reverses pulmonary hypertension!

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