Page 940 - Cardiac Nursing

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916 PA R T V / Health Promotion and Disease Prevention
glucocorticoids, alfentanil (Alfenta), cisapride (Propulsid), fen- dairy and calcium supplements significantly and independently
tanyl (Sublimaze), lidocaine (Xylocaine), losartan (Cozaar), fex- reduce blood pressure. 94 Clinical trials have also supported the
ofenadine (Allegra), midazolam (Versed), the protease inhibitor use of calcium as a supplement to lower blood pressure, but the
saquinavir, and others. effects have been small. A 6-week randomized crossover study of
60 hypertensive patients showed an average reduction of only 1
Coenzyme Q10 to 2 mm Hg in blood pressure with calcium supplementation. 95
Coenzyme Q10 is a fat-soluble vitamin-like compound occur- More research is needed to establish if milk has properties that
ring naturally in the heart, liver, pancreas, and kidney. Some decrease blood pressure separate from calcium to strengthen the
foods such as soybean oil contain the compound. Commercial support of dairy in dietary recommendations for hypertensive
preparations are made from fermented beets, sugar cane, and patients.
yeast. Coenzyme Q10 has antioxidant properties and serves as a
cofactor in some metabolic cycles; it contributes to adenosine Other Dietary Recommendations
triphosphate (ATP) production. It is used extensively in Japan, Diets rich in magnesium may be linked with lower blood pres-
75
Europe, and Russia to treat cardiovascular diseases including sure and cardiovascular risk. The DASH diet was developed by
heart failure, angina, hypertension, and doxorubicin (Adri- the National Institutes of Health to improve cardiac health. It
amycin)-induced cardiotoxicity. Several studies suggest that emphasizes a high-fiber diet rich in fruits, vegetables, low-fat
coenzyme Q10 in combination with conventional therapy im- dairy; it is low in saturated fat, total fat, and cholesterol. It in-
proves quality of life, improves symptoms such as dyspnea, cludes six to eight servings of whole grains, four to five servings
edema, and insomnia, and decreases the number of hospitaliza- of fruit, four to five servings of vegetables, two to three servings
tions in patients with New York Heart Association class II–IV of low or non-fat dairy, three to six servings of lean meat, poul-
heart failure. 86,87 Other studies found no effect on exercise toler- try or fish, two to three teaspoons of oil, and less than two sweets
ance or on ejection fraction. 88 Coenzyme Q10 may enhance the per day; four to five servings of nuts, seeds, or beans weekly are
efficacy of antihypertensives in lowering blood pressure. 89 A recommended; it does not include recommendations related to
meta-analysis of 12 trials (three random control trials) supported omega-3 fatty acids. 96 The DASH diet was associated with 8 to
the conclusion that coenzyme Q10 has good potential to lower 14 mm Hg drop in systolic blood pressure. Reduced sodium in-
blood pressure in hypertensive patients. 90 Coenzyme Q10 may take ( 2.4 g sodium/day) and limiting alcohol consumption
be most effective when endogenous levels are low, as they are in (less than two drinks per day for men, less than one drink per day
some types of heart failure. Coenzyme Q10 has also been recom- for women) were also associated with minor reductions in blood
mended for some noncardiac diseases including Huntington dis- pressure. 97
ease, Parkinson disease, chronic fatigue syndrome, alopecia, and
topically for periodontal infection. Coenzyme Q10 is generally
considered safe; side effects include gastrointestinal symptoms MANIPULATIVE, BODY-BASED
and are typically minimal. It should be used cautiously in com-
bination with pharmaceutical antihypertensives because the ef- METHODS AND ENERGY
fects can be additive. THERAPIES
Protein Many cultures and religions believe that there is a life force, or en-
Several epidemiologic studies have reported lowering of the blood ergy moving within the body or emanating from the body, and
pressure with increased dietary protein. A meta-analysis of nine that this energy can be manipulated by conscious and uncon-
population-based cross-sectional studies supports an inverse associ- scious efforts. In Hindu philosophy this energy is prana, in Chi-
ation between protein intake and elevated blood pressure in men nese philosophy qi, in Japanese philosophy i i ki. These approaches
and women; a stronger effect is noted in men. Both human and an- are difficult to test and there are no large-scale trials of these ap-
imal studies show decreased blood pressure with increased dietary proaches. Manipulative and body-based methods (e.g., chiroprac-
protein, regardless of the protein type, although a greater effect is tic manipulation, massage therapy, reflexology) and energy thera-
91
noted with animal-based protein. In a randomized, double-blind, pies (e.g., reiki, therapeutic touch) could improve cardiac disease,
multicenter, controlled trial, soybean protein supplementation was possibly by promoting relaxation and blunting stress responses. A
associated with reduced diastolic (2.7 mm Hg) and systolic (4.3 study probed the feasibility of such a study of chiropractic adjust-
mm Hg) pressure after 12 weeks in persons with prehypertension or ments and massage. 98 A randomized controlled trial of frequent
hypertension; the effect was greater in those with hypertension. 92 massage (three times per week) given to hypertensive patients low-
Increasing fiber (in the form of psyllium) and protein (in the ered their blood pressure with increased effect noted with contin-
form of soy) was shown to have a cumulative effect lowering ued intervention. 99 Tai chi and qi gong, type of energy therapy,
blood pressure in a small randomized trial. Subjects on the com- have been prescribed as a low-impact exercise in cardiac rehabili-
bined diet showed a decrease in systolic pressure by about 8 mm tation; it is equivalent to approximately 3 metabolic equivalent
Hg and a decrease in diastolic pressure by 2 mm Hg. 93 Increasing tasks. 100
daily protein intake, regardless of source, has been associated with Acupuncture is another form of energy therapy; it may be
at least modest reductions in blood pressure. helpful in reducing blood pressure in patients with hyperten-
sion. 101 Acupuncture is associated with risk of transmission of
Calcium infectious diseases, including hepatitis, HIV infection, and
Calcium in the form of dairy products or as supplements may de- AIDS.
crease blood pressure in hypertensive adults. A cross-sectional, Healing touch is a nonverbal communication technique, a
population-based study conducted in France found that both mechanism used by care providers to be present in the moment