Blood Pressure

[Master Kim]

2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) - jama.jamanetwork.com/article.aspx?articleid=1791497



Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes.

There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes.

Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.

Hypertension remains one of the most important preventable contributors to disease and death. Abundant evidence from randomized controlled trials (RCTs) has shown benefit of antihypertensive drug treatment in reducing important health outcomes in persons with hypertension.1- 3 Clinical guidelines are at the intersection between research evidence and clinical actions that can improve patient outcomes. The Institute of Medicine Report Clinical Practice Guidelines We Can Trust outlined a pathway to guideline development and is the approach that this panel aspired to in the creation of this report.4

The panel members appointed to the Eighth Joint National Committee (JNC 8) used rigorous evidence-based methods, developing Evidence Statements and recommendations for blood pressure (BP) treatment based on a systematic review of the literature to meet user needs, especially the needs of the primary care clinician. This report is an executive summary of the evidence and is designed to provide clear recommendations for all clinicians. Major differences from the previous JNC report are summarized in Table 1. The complete evidence summary and detailed description of the evidence review and methods are provided online.



The panel members appointed to JNC 8 were selected from more than 400 nominees based on expertise in hypertension (n = 14), primary care (n = 6), including geriatrics (n = 2), cardiology (n = 2), nephrology (n = 3), nursing (n = 1), pharmacology (n = 2), clinical trials (n = 6), evidence-based medicine (n = 3), epidemiology (n = 1), informatics (n = 4), and the development and implementation of clinical guidelines in systems of care (n = 4).

The panel also included a senior scientist from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a senior medical officer from the National Heart, Lung, and Blood Institute (NHLBI), and a senior scientist from NHLBI who withdrew from authorship prior to publication. Two members left the panel early in the process before the evidence review because of new job commitments that prevented them from continuing to serve. Panel members disclosed any potential conflicts of interest including studies evaluated in this report and relationships with industry. Those with conflicts were allowed to participate in discussions as long as they declared their relationships, but they recused themselves from voting on evidence statements and recommendations relevant to their relationships or conflicts. Four panel members (24%) had relationships with industry or potential conflicts to disclose at the outset of the process.

In January 2013, the guideline was submitted for external peer review by NHLBI to 20 reviewers, all of whom had expertise in hypertension, and to 16 federal agencies. Reviewers also had expertise in cardiology, nephrology, primary care, pharmacology, research (including clinical trials), biostatistics, and other important related fields. Sixteen individual reviewers and 5 federal agencies responded. Reviewers’ comments were collected, collated, and anonymized. Comments were reviewed and discussed by the panel from March through June 2013 and incorporated into a revised document. (Reviewers’ comments and suggestions, and responses and disposition by the panel are available on request from the authors.)



This evidence-based hypertension guideline focuses on the panel’s 3 highest-ranked questions related to high BP management identified through a modified Delphi technique.5 Nine recommendations are made reflecting these questions. These questions address thresholds and goals for pharmacologic treatment of hypertension and whether particular antihypertensive drugs or drug classes improve important health outcomes compared with other drug classes.

1. In adults with hypertension, does initiating antihypertensive pharmacologic therapy at specific BP thresholds improve health outcomes?
2. In adults with hypertension, does treatment with antihypertensive pharmacologic therapy to a specified BP goal lead to improvements in health outcomes?
3. In adults with hypertension, do various antihypertensive drugs or drug classes differ in comparative benefits and harms on specific health outcomes?



The evidence review focused on adults aged 18 years or older with hypertension and included studies with the following prespecified subgroups: diabetes, coronary artery disease, peripheral artery disease, heart failure, previous stroke, chronic kidney disease (CKD), proteinuria, older adults, men and women, racial and ethnic groups, and smokers. Studies with sample sizes smaller than 100 were excluded, as were studies with a follow-up period of less than 1 year, because small studies of brief duration are unlikely to yield enough health-related outcome information to permit interpretation of treatment effects. Studies were included in the evidence review only if they reported the effects of the studied interventions on any of these important health outcomes:

Overall mortality, cardiovascular disease (CVD)–related mortality, CKD-related mortality

Myocardial infarction, heart failure, hospitalization for heart failure, stroke

Coronary revascularization (includes coronary artery bypass surgery, coronary angioplasty and coronary stent placement), other revascularization (includes carotid, renal, and lower extremity revascularization)

End-stage renal disease (ESRD) (ie, kidney failure resulting in dialysis or transplantation), doubling of creatinine level, halving of glomerular filtration rate (GFR).

The panel limited its evidence review to RCTs because they are less subject to bias than other study designs and represent the gold standard for determining efficacy and effectiveness.6 The studies in the evidence review were from original publications of eligible RCTs. These studies were used to create evidence tables and summary tables that were used by the panel for their deliberations (see Supplement). Because the panel conducted its own systematic review using original studies, systematic reviews and meta-analyses of RCTs conducted and published by other groups were not included in the formal evidence review.

Initial search dates for the literature review were January 1, 1966, through December 31, 2009. The search strategy and PRISMA diagram for each question is in the online Supplement. To ensure that no major relevant studies published after December 31, 2009, were excluded from consideration, 2 independent searches of PubMed and CINAHL between December 2009 and August 2013 were conducted with the same MeSH terms as the original search. Three panel members reviewed the results. The panel limited the inclusion criteria of this second search to the following. (1) The study was a major study in hypertension (eg, ACCORD-BP, SPS3; however, SPS3 did not meet strict inclusion criteria because it included nonhypertensive participants. SPS3 would not have changed our conclusions/recommendations because the only significant finding supporting a lower goal for BP occurred in an infrequent secondary outcome).7,8 (2) The study had at least 2000 participants. (3) The study was multicentered. (4) The study met all the other inclusion/exclusion criteria. The relatively high threshold of 2000 participants was used because of the markedly lower event rates observed in recent RCTs such as ACCORD, suggesting that larger study populations are needed to obtain interpretable results. Additionally, all panel members were asked to identify newly published studies for consideration if they met the above criteria. No additional clinical trials met the previously described inclusion criteria. Studies selected were rated for quality using NHLBI’s standardized quality rating tool (see Supplement) and were only included if rated as good or fair.

An external methodology team performed the literature review, summarized data from selected papers into evidence tables, and provided a summary of the evidence. From this evidence review, the panel crafted evidence statements and voted on agreement or disagreement with each statement. For approved evidence statements, the panel then voted on the quality of the evidence (Table 2). Once all evidence statements for each critical question were identified, the panel reviewed the evidence statements to craft the clinical recommendations, voting on each recommendation and on the strength of the recommendation (Table 3). For both evidence statements and recommendations, a record of the vote count (for, against, or recusal) was made without attribution. The panel attempted to achieve 100% consensus whenever possible, but a two-thirds majority was considered acceptable, with the exception of recommendations based on expert opinion, which required a 75% majority agreement to approve.

The following recommendations are based on the systematic evidence review described above (Box). Recommendations 1 through 5 address questions 1 and 2 concerning thresholds and goals for BP treatment. Recommendations 6, 7, and 8 address question 3 concerning selection of antihypertensive drugs. Recommendation 9 is a summary of strategies based on expert opinion for starting and adding antihypertensive drugs. The evidence statements supporting the recommendations are in the online Supplement.

Box.
Recommendations for Management of Hypertension

Recommendation 1

In the general population aged ≥60 years, initiate pharmacologic treatment to lower blood pressure (BP) at systolic blood pressure (SBP) ≥150 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg and treat to a goal SBP <150 mm Hg and goal DBP <90 mm Hg. (Strong Recommendation – Grade A)
Corollary Recommendation

In the general population aged ≥60 years, if pharmacologic treatment for high BP results in lower achieved SBP (eg, <140 mm Hg) and treatment is well tolerated and without adverse effects on health or quality of life, treatment does not need to be adjusted. (Expert Opinion – Grade E)

Recommendation 2

In the general population <60 years, initiate pharmacologic treatment to lower BP at DBP ≥90 mm Hg and treat to a goal DBP <90 mm Hg. (For ages 30-59 years, Strong Recommendation – Grade A; For ages 18-29 years, Expert Opinion – Grade E)

Recommendation 3

In the general population <60 years, initiate pharmacologic treatment to lower BP at SBP ≥140 mm Hg and treat to a goal SBP <140 mm Hg. (Expert Opinion – Grade E)

Recommendation 4

In the population aged ≥18 years with chronic kidney disease (CKD), initiate pharmacologic treatment to lower BP at SBP ≥140 mm Hg or DBP ≥90 mm Hg and treat to goal SBP <140 mm Hg and goal DBP <90 mm Hg. (Expert Opinion – Grade E)

Recommendation 5

In the population aged ≥18 years with diabetes, initiate pharmacologic treatment to lower BP at SBP ≥140 mm Hg or DBP ≥90 mm Hg and treat to a goal SBP <140 mm Hg and goal DBP <90 mm Hg. (Expert Opinion – Grade E)

Recommendation 6

In the general nonblack population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB). (Moderate Recommendation – Grade B)

Recommendation 7

In the general black population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or CCB. (For general black population: Moderate Recommendation – Grade B; for black patients with diabetes: Weak Recommendation – Grade C)

Recommendation 8

In the population aged ≥18 years with CKD, initial (or add-on) antihypertensive treatment should include an ACEI or ARB to improve kidney outcomes. This applies to all CKD patients with hypertension regardless of race or diabetes status. (Moderate Recommendation – Grade B)

Recommendation 9

The main objective of hypertension treatment is to attain and maintain goal BP. If goal BP is not reached within a month of treatment, increase the dose of the initial drug or add a second drug from one of the classes in recommendation 6 (thiazide-type diuretic, CCB, ACEI, or ARB). The clinician should continue to assess BP and adjust the treatment regimen until goal BP is reached. If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided. Do not use an ACEI and an ARB together in the same patient. If goal BP cannot be reached using only the drugs in recommendation 6 because of a contraindication or the need to use more than 3 drugs to reach goal BP, antihypertensive drugs from other classes can be used. Referral to a hypertension specialist may be indicated for patients in whom goal BP cannot be attained using the above strategy or for the management of complicated patients for whom additional clinical consultation is needed. (Expert Opinion – Grade E)

.....

[Master Kim]

Do You Really Have High Blood Pressure? - AARP.org
Unfortunately, "many doctors are ill-prepared to treat high blood pressure in older people," says Dr. Joseph L. Izzo, professor of medicine at the State University of New York at Buffalo and a leading expert on hypertension.
Some older people are being given blood pressure drugs that may be dangerous for them. Others are being undertreated — or overtreated.
"On the wrong dosages of medication, older people are at risk of fainting and falling," says Dr. Alexander G. Logan, a hypertension expert at Mount Sinai Hospital in Toronto. "And when a frail older person falls, it can be devastating."

Blood pressure normal? Maybe now it isn’t. - The Harvard Medical School
August 2003 Update
This spring the National Institutes of Health revised the guidelines for prevention and treatment of high blood pressure (hypertension) for the first time since 1997. The changes included a new definition of "normal" blood pressure. This meant that 45 million Americans who had gone to sleep with normal blood pressure woke up with higher-than-healthy blood pressure. Here are some of the highlights:
Normal is now not. What was classified as normal or high-normal blood pressure (a systolic pressure of 120-139 mm Hg and diastolic pressure of 80-89 mm Hg) is now categorized as prehypertension (see chart).
It's a little strange. All of a sudden, the experts are telling millions of people who thought they were healthy that they now have this condition called prehypertension. But the idea is to get Americans and their doctors to take action before the blood pressure climbs any higher - and into the range where the risks of heart disease, stroke, and other problems are pronounced.
In the prehypertensive range, taking action does not mean taking pills. It means, for example, regular aerobic activity, such as 30 minutes of brisk walking several days per week. That kind of exercise can lower your blood pressure by 4-9 mm Hg. If you're overweight, losing about 22 pounds is "worth" a 5-20 mm Hg subtraction in systolic pressure. Limit your sodium intake to 2.4 grams daily and the benefit is a 2-8 mm Hg reduction.

New Blood Pressure Guidelines Draw Fire - AARP.org
It sounded like great news for thousands of older people: New blood pressure guidelines might free them from the anxiety of taking powerful medications to control their blood pressure, and the side effects those pills sometimes brought.
But almost immediately, several members of the panel of medical experts recommending the change strongly dissented and warned that the new guidelines could endanger some people.
The result has been confusion similar to that created late last year with the muddled rollout of new guidelines for using cholesterol-lowering statin drugs.

Relaxed blood pressure guidelines cut millions from needing medication - ScienceDaily.com 03/29/2014
New guidelines that ease the recommended blood pressure could result in 5.8 million U.S. adults no longer needing hypertension medication, according to an analysis. The findings are the first peer-reviewed analysis to quantify the impact of guidelines' change to relax the blood pressure goal in adults 60 years and older to 150/90, instead of the previous goal of 140/90.

3 Things to Know About the New Blood Pressure Guidelines - The New York Times 12/18/2013
First, the guidelines raise the systolic blood pressure (the top number of the blood pressure reading) threshold for drug treatment from 140 to 150 for people 60 and older.
Second, there is insufficient medical evidence to support a systolic blood pressure threshold for the drug treatment of people younger than 60.
Third, the guidelines recognize that the modification of a risk factor – in this case hypertension, which is a risk factor for heart attacks and strokes and premature death – by drug therapy does not necessarily mean that you have reduced someone’s risk for these adverse health events.

New Blood Pressure Guidelines Raise the Bar for Taking Medications - Consumer.Healthday.com 12/18/13
Fewer people should take medicine to control their high blood pressure, a new set of guidelines recommends.
Adults aged 60 or older should only take blood pressure medication if their blood pressure exceeds 150/90, which sets a higher bar for treatment than the current guideline of 140/90, according to the report, published online Dec. 18 in the Journal of the American Medical Association.
The expert panel that crafted the guidelines also recommends that diabetes and kidney patients younger than 60 be treated at the same point as everyone else that age, when their blood pressure exceeds 140/90. Until now, people with those chronic conditions have been prescribed medication when their blood pressure reading topped 130/80.
The recommendations are based on clinical evidence showing that stricter guidelines provided no additional benefit to patients, explained guidelines author Dr. Paul James, head of the department of family medicine at the University of Iowa Carver College of Medicine.
"We really couldn't see additional health benefits by driving blood pressure lower than 150 in people over 60 [years of age]," James explained. "It was very clear that 150 was the best number."

[Master Kim]

Blood pressure medication huge cash cow - blog.japantimes.co.jp/yen-for-living/blood-pressure-medication-huge-cash-cow/
July 25th, 2013 by Philip Brasor & Masako Tsubuku



Earlier this month Kyoto University revealed that a study one of its researchers carried out to evaluate the effectiveness of the drug Diovan, which lower blood pressure, was probably “erroneous.” Though the university did not say the drug itself was ineffective, it did admit that the data of “those involved in the research” did not always agree with the conclusions of the lead researcher, Hiroaki Matsubara, which said that Diovan is “more potent in reducing angina and brain strokes than any other hypertensive medicines.” There are suspicions that Matsubara may have changed some of his data. In December 2012 he asked that his papers on the study be withdrawn.

Diovan, which is also sold generically as valsartan, was developed by the Swiss pharmaceuital giant Novartis Pharma K.K., which reportedly gave Matsubara a ¥100 million grant for his study. It wouldn’t have the first time the company has been accused of bribing doctors. Diovan is one of the company’s biggest moneymakers, especially in Japan where it generates ¥100 billion in sales.

Novartis isn’t the only drugmaker who does well with high blood pressure medications in Japan. Sales of hypertensive drugs amounts to more than ¥1 trillion a year, so even if Novartis had been trying to get researchers to post better results for their medicine, it seems that there’s enough of a market for every pharmaceutical company to make a lot of money with HBP medication. Some doctors, in fact, question the ease with which their colleagues prescribe HBP drugs.

In his bestseller, Isha ni korosarenai 47 no kokoroe (“47 Tips to Prevent Being Killed by Your Doctor”), controversial radiologist Dr. Makoto Kondo points out that there are 40 million people in Japan being treated for high blood pressure compared to 16 million in 1998. Why the big increase? In 2000, the health ministry, on recommendation from a panel of blood pressure specialists, changed the index for diagnosing HBP from 160/95 to 140/90, which is more in line with world standards. The new index immediately added 21 million people to the ranks of patients with high blood pressure, and almost all were prescribed hypertensive medication. Before the change, sales of HBP medicines was about ¥200 billion a year. Revenues have since climbed by more than fivefold. Kondo claims in his book that the specialists association from which the advisory panel was selected received an “anonymous” donation from a group of pharmaceutical companies beforehand.

Kondo believes that the dangers of high blood pressure have always been exaggerated, since blood vessels naturally become less elastic as people age and therefore the heart has to pump harder to achieve proper circulation. Reducing blood pressure too much can actually be dangerous, he says, since that could mean blood not reaching the brain and extremities in proper amounts, which may lead to senility and chronic loss of equilibrium. He cites a study in Finland that found elderly men with blood pressure over 160 lived longer than did those with blood pressure under 140. (Though it should also be noted that a more recent study in Finland found that people diagnosed with HBP who fail to take their meds have a higher chance of stroke.)

Kondo’s theories are generally dismissed by the medical community, but the Kyoto University scandal highlights an inconvenient truth about the financial connections between medical providers and pharmacuetical companies. Kondo says he has studied the literature extensively and cannot find reliable data that actually shows that a reduction in blood pressure leads to a reduction in the incidence of heart disease and stroke. Meanwhile, the Japanese government spends ¥37 trillion a year on medical care in the form of taxes and insurance payments, ¥6.14 trillion of which goes to drugs. That means hypertension medications account for one-sixth of all prescription drug sales in Japan.

[Master Kim]

How To Lower Blood Pressure Using Ginger Tea

According to comments on this video, people say not to use powder ginger.
Following are quoted comments on this video:

• I want to thank you and your excellent team at Dekalb Medical Center. I am doing much better and I am not coughing as much. When I left the hospital my bp - blood pressure was 150/97 and the next day my bp was 122/75. Today my bp is 151/108. To lower my bp I take my blood pressure medication at night and i also have 2 cups of ginger tea with lemons. I have noticed that all vegetables are not the same. In the frozen food area usually in the back of the mall or supermarket the vegetable have sodium. But the vegetables that are not bagged in the front of the store near the fruit section have no sodium and are the vegetables you want to eat. I am being very careful with my diet and I am trying to keep my bp (blood pressure) low. My blood pressure history 213/148 - Before hospital and poor diet 202/153 - before hospital and diet 189/97 - With Ginger tea and no hospital 150/97 - the day I left the hospital 122//75 - The next day after leaving the hospital 150/99 - Two days after leaving 151/108 - Today The NEXT Day Dr. Khan Yesterday I sent you a report card on the history of my blood pressure. Today for the first time my blood pressure declined going down and not up. At bed time I had 2 cups of ginger tea and my medicine and this morning I saw a decline in my blood pressure. Ginger tea works and has help with the decline. But ginger tea take about 20 hours or all night to work. Ginger tea works and I would like to thank you for your video. It made a difference in my blood pressure. Thank you for your video
• I can't thank you enough for making this very comprehensive report/links/video. At first I was a little skeptical because I have already taken a pinch of powdered ginger along with cinnamon in my coffee in the morning, but powder is not very effective, it just enables me to make my coffee weaker. Well, after using your well explained method for three nights my blood pressure became stable at 120/71/55, which was a miracle. Thank goodness I did not visit my doctor otherwise I may have been put on debilitating medication for the rest of my life. Over nine months I dropped 30 points with lifestyle changes, but then nothing would drop it below 150 until I tried this technique. The side effects of ginger are so so positive, if you would like to increase the benefit add in some celery seed as this will make your joints feel relaxed. Well done and now I will spread the word and back to more herbal research.
• Just build up the biggest spliff you can, smoke it, chill out and watch your BP drop. I was on 10mg Ramipril, 10mg Amlodipine, 7.5mg Bisoprolol and still my average BP was at worst 210/100 at best 174/ 80. NOW my BP monitor is reading 110/60. What more can i say?
• what about powder ginger? - no good...But the actual ginger in the fruits and vegetable section, grate it, and let it soak for 5 to 20 mins...I just added lemon juice since I was on a water diet for 4 days and felt the sugar from the honey would hinder the flushing effect on the water diet..Its slightly bitter so just sip but not nasty...
• I tried a morning smoothie (ginger, lemon and honey) to strengthen my inmune system, but after prolonged consumption (after six months of drinking it daily) I did noticed my allergies were gone and would let my body rest from the smoothie for a couple of months and then resume. So I haven't had the flu for years now, and overall my health is a lot better, BUT I started noticing that right after drinking the smoothie, my blood pressure was going as high as 140/95, I was diagnose with hypertention 2 years ago so I'm on medication; once I realize this side effect, I stopped taking the smoothie and well, as strange as it may seem, my blood pressure is back to normal and even sometimes, after taking the medication, it would be low...My point here is BE CAREFUL.
• Honey contains high potassium too as well as being sweet. Potassium in high levels will increase bp. So be careful.
• Thank you Usuff . My BP was a shocker as I visited my doctor for an repeat script for my usual med I could not believe as it was 170/84 . She asked me if my electronic Omron was in good working order , and advised that if I get the same readings over the next few days I must contact her for a adjustment of my script, Once home , I checked it 3 hours after med that evening. Yet another shock . It was 198/80. The next morning was not so much better . By the following evening I was worried and thought of the possibility of going into hospital. I started surfing the Internet and remembered how I googled " the fastest way to get BP down . I watched you tube on your Ginger tea and remembered my grandmother in South Africa adding ginger to our tea and how good her Ginger cookies was . With faith in my heart I brewed a cup as you suggested. I took my BP 4 hours after that . It was amazing 133/76. I could not believe my eyes. The next morning was 125/68. This afternoon my reading is 116/62 !!!! Those who have no success with this probably take other stuff that interacts with ginger. I have a red wine every day, I also have thyroid med and BP med . I walk 3 km every day , vice days per week and try and eat healthy That's it! I am so , so, stoked
• My blood pressure was high 157/104 I was very concerned, so I had to change some things. I done a lot of research, I changed my eating habbits no more cheese, salad dressings, fast foods. Breakfast now shredded wheats, with nuts, dried cranberrys, wheat germ, flax seed, springled on top. Lunch, half cup of yogurt with fruits. For dinner, I added plenty green vegetables with 1 Garlic clove. Hit the treadmill 10 to 15 min 3 to 5 times a week, and bathe or shower with epson salt to relax your body for a good night sleep. I also went to GNC and got some Super Magnessium 400 mg just in case I was magnesium deficient. My blood pressure 132/79 all this in two weeks I also lost ten pounds, I was so excited, I had my wife to try this, she has been on Blood Pressure Med. Losartan for years and it wasn't working, her blood pressure stayed at 150/100 to 145/96 even after taking the medicine every day and she hardly ever eat. She changed her diet, and started doing what I'm doing, including taking the magnesium supplement. It's been 1 week since she started this diet her last reading was 111/74 thank God for research. She's done everything I have, accept the Garlic, she said I can have that Stuff, it stinks LMAO. Being that It's been a week she still takes the Losartan It does make you Pee (urinate) a lot and you get rid of water weight. Were still a work in progress, but this has been nothing short of a miracle. I haven't been the weight I am now since 2001, my highest weight 294 pounds i'm now 252 pounds. For anybody that's reading my story it's really a life style change, think about it, if you need to be on blood pressure pills for life, you really not solving the problem which is causing it, you just now have a drug problem, (You need it to live) Fight for your life get motivated We love you Let's go!
• I tried this today....I waited for my blood pressure to creep to 160/91 after being in the normal range. I made the ginger tea from fresh root (including the skin) as instructed. My pressure just 2 hours later dropped to 121/73 all without taking my BP pills. I understand one time is not a good test but I am encouraged to try it again. I will certainly try it on the overnight to see what that does. Off to the store to buy more fresh ginger!
• Earlier today I bought a small raw ginger root. Over and hour ago, I cut a small piece of it off, then chopped it up into little bits, then made tea with it and drank it. I couldn't wait until morning so I checked an hour later and I was 135 over 70. Which is pretty good for me. Especially since I was not on my meds. Yesterday I was 190 over 100 in the emergency room.
• Gday mayt, I am 50 yo and last 6 months panicking with HBP. Tried medics and they offered medication Nirvasc. side effects were terrible. then they suggested another. worst side effects. 1 hr on the toilet and complete stop of your metabolisms. Only yesterday I tried your formula, I went down from 15 10 to this morning 12 8 OMG. Natural ways only for me. Together with pomergane juice each morning for 1 week careful diet, exercise - found the solution. Thank you for sharing your experience.

Please leave your kind comment here once you try this.

Others will appreciate your kindness.

[Master Kim]

The TRUTH about Blood Pressure and Cholesterol
Published on Sep 9, 2013

The TRUTH about Blood Pressure and Cholesterol.

High blood pressure is not DANGEROUS, it is not a Disease!

IT is a symptom of a greater underlying problem!

50-65% of people who have heart attacks have normal levels of cholesterol

Marketing plays a huge role in how the drug companies portray the need for a product

At Owners-Guide.com we strive to educate people on natural solutions to health.