Controlling blood pressure is a big health investment with huge yields. Maintaining a normal blood pressure precludes a cascade of physiological problems, beginning with the cardiovascular system and, possibly, extending to the renal and pulmonary systems. The investment up front is to look after oneself; the yield is long-term health and well-being and, hopefully, a positive bank balance. Switching sides to view high blood pressure (hypertension) as a market, how attractive is the market and what does one need to “get in”?

Definitions and Treatment Modalities

High blood pressure is defined as >140/90 mm Hg diastolic pressure in adults. Often called the “Silent Killer,” the cause is unknown in 90-95% of cases and is designated essential hypertension. When underlying conditions or disease result in hypertension, it is classified as secondary hypertension. According to the American Heart Association, Dallas, “High blood pressure directly increases the risk of coronary heart disease and stroke.”

The organization's 1999 statistics indicate that uncontrolled blood pressure was the primary cause of death for 42,997 Americans and contributed to the deaths of about 227,000 others. More significantly, the Third National Health and Examination Survey indicates as many as 50 million Americans over the age of six are hypertensive. Per Advance Data 322, in 1999, some 32 million medical visits were made for the treatment of hypertension (www.cdc.gov/nchs/fastats/ docvisit.htm).

Depending upon risk factors determined during a medical evaluation, medication, a change in diet, or a combination of both, may be prescribed. With respect to secondary hypertension, the factors of obesity, inactivity, excessive alcohol consumption, smoking, or a combination of these factors, may be the underlying hypertension facilitators. Proactive intervention to decrease these risk factors constitutes medicine's primary approach, with diet—once again—playing a major role.

DASHing to a Heartbeat

So, can diet and nutrients play a pro-active role in hypertension management? The answer is a resounding “yes.” A supplement to the Journal of Clinical Cardiology, July, 1999, deemed the DASH diet “A Clinical Success Story.” DASH—Dietary Approaches to Stop Hypertension—is a dietary intervention rich in fruits, vegetables and low fat dairy, with a reduced total fat, saturated fat and sodium (<2400mg/d) component.¹ Research indicates the DASH intervention is actually more successful at controlling or preventing hypertension than a pure fruit and vegetable counterpart.² Could this suggest a synergy among the nutrients present?

The DASH diet is naturally rich in potassium, calcium and magnesium and, yet, dietary studies involving individual supplementation of these minerals yielded inconclusive evidence to suggest specific nutrient recommendations. On the other hand, a recent meta-analysis supports the premise that increased dietary intake of potassium can positively impact blood pressure. Additional research continues to investigate roles for omega-3 fatty acids (N-3 PUFA) and vitamin C. Omega-3 fatty acids may decrease vascular resistance, while vitamin C may reduce oxidative damage to vascular walls.

From a natural medicines perspective, several alternatives may be recommended for hypertension management, most notably garlic (Allium sativum) and, possibly, hawthorn (Crataegus laevigata). Review of scientific studies investigating the effect of garlic on lowering blood pressure has suggested some positive correlation, however, questions of methodology and degree of effectiveness remain.

Ingredients for Hypertension?

Milk- and whey-derived bioactive peptides have been the subject of intense research worldwide, most notably in Japan and Europe.³ Attributed to these peptides are a broad range of potential health benefits, including possible anti-hypertensive, anti-inflammatory, cholesterol-lowering activity—as well as inhibitory effects on platelet formation. When added to milk, the proteolytic activity of lactic acid bacteria (most notably Lactobacillus helveticus) releases peptides with anti-hypertensive activity. Research on a variety of food materials has demonstrated these bioactive peptides act as inhibitors to angiotensin converting enzyme (ACE). ACE catalyzes the degradation of angiotensin I to angiotensin II, a potent vasoconstrictor.

Research conducted by Hata, et. al., in Japan (1996), on 30 hypertensive outpatients ingesting 95ml sour milk daily for eight weeks demonstrated a significant reduction in both diastolic and systolic blood pressure. In Finland, the National Public Health Institute conducted two independent clinical studies with a fermented milk product, Evolus (Valio, Finland). These clinical studies demonstrated a blood pressure drop of 5-15% in 70-80% of the subjects. In November 2000, Evolus was officially launched on the market with the product labeling stating “helps to lower blood pressure.” Six months after release, sales had “exceeded expectations.” Japan has similar products.

Currently, in the U.S., there are no fermented milk products with hypotensive claims on the market. Conclusive evidence that milk- or whey-derived peptides have specific health benefits is still pending. The wait may not be long, though. Davisco Foods International, Inc., Le Sueur, Minn., has researched the role of whey protein peptides in hypertension. According to Chuck Hanson, director of sales, the company has just completed a clinical trial which investigates the anti-hypertensive activity of its hydrolyzed whey protein isolate.

Hypotensive Cousins in the Marketplace

Consistent with the theme that foods and beverages can be naturally functional, Tropicana's, Bradenton, Fla., Pure Premium juices carry the FDA-approved health claim stating: “Diets containing foods that are good sources of potassium and low in sodium may reduce the risk of high blood pressure and stroke.” To carry this claim, products must be a good natural source (minimum = 350mg) of potassium, and low in sodium, total fat, saturated fat and cholesterol. Other sample products which could carry the same claim: skim milk, low fat yogurt, cantaloupe.

Supplement counterparts abound and are more apparent to consumers because they are presented by health category/issue, and feature disease-specific labeling. On the shelf, Nature's Plus, Hypertrol Rx Blood Pressure (Natural Organics, Inc., Melville, NY) product features several ingredients, such as magnesium, garlic and hypertrol—“a proprietary botanical extract complex”. Nx Nutraceuticals, Sparks, Md., markets Veromax Opti Stolic, an “all-natural product to help stabilize blood pressure.” A key component of this formula is nitric oxide, a “relaxing factor” found in the endothelium (a type of human cell).

Attractive Investment?

Disease statistics and promising research leave little doubt that hypertension could evolve into an important destination market for functional foods. Should U.S. human clinical trials produce consistent hypotensive results using milk-derived peptides, we may then be primed for a whole new world of product formulations carrying hypotensive health claims.

And, if we don't move into this realm, keep a prudent investor's eye on the dairy market. According to Doug DiRienzo, Ph.D., president of nutrition research for the National Dairy Council, Rosemont, Ill., “Nutrients and ingredients from dairy—we're only at the tip of what they can do.” If formulated hypotensive products don't appeal to you, simply stick to some basic DASH principles.

On the Web: HYPERTENSION

• www.cdc.gov/nchs/nhanes.htm — Home page for the National Health and Examination Survey
• www.americanheart.org — American Heart Association
• www.nhlbi.nih.gov — National Heart Lung and Blood Institute