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Approccio integrato al trattamento dell’ipertensione arteriosa sistemica
Titolo Rivista: PNEI REVIEW 
Autori/Curatori: Carlo Dal Lin, Raffaele Migliorini, Marco Silvestro, Sabino Iliceto, Francesco Tona 
Anno di pubblicazione:  2017 Fascicolo: 2 Lingua: Italiano 
Numero pagine:  11 P. 91-101 Dimensione file:  1118 KB
DOI:  10.3280/PNEI2017-002009
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L’approccio integrato al trattamento dell’ipertensione arteriosa prevede il riconoscimento dei fattori ostacolanti il processo di guarigione del paziente, la definizione di un percorso di cura che incontri le esigenze del paziente determinando l’effettiva esigenza e la corretta tempistica di un intervento farmacologico. Occorre quindi raggiungere un corretto peso ideale agendo sull’alimentazione (dieta mediterranea) e sull’attività fisica aerobica (30 minuti di camminata al giorno per almeno 4 giorni a settimana); evitare fumo, alcol, sale e caffè; utilizzare tecniche mente-corpo per una adeguata gestione dello stress e modifica dei fattori psico-emotivi disfunzionali per il paziente. Nel caso di presenza di un’ipertensione moderata o severa è opportuno iniziare una terapia farmacologica che accompagni gli interventi incentrati sullo stile di vita del paziente.


Keywords: Medicina integrata, fitoterapia, stress, stile di vita, prevenzione cardiovascolare, riabilitazione cardiovascolare.

  1. Hasler C.M., Kundrat S. and Wool D. (2000). Functional foods and cardiovascular disease. Curr. Atheroscler. Rep., 2(6): 467-475.
  2. Anderson D.E., Bagrov A.Y. and Austin J.L. (1995). Inhibited breathing decreases renal sodium excretion. Psychosom Med., 57(4): 373-380.
  3. Appel L.J., Moore T.J., Obarzanek E., Vollmer W.M., Svetkey L.P., Sacks F.M., Bray G.A., Vogt T.M., Cutler J.A., Windhauser M.M., Lin P.-H., Karanja N., Simons-Morton D., McCullough M., Swain J., Steele P., Evans M.A., Miller E.R. and Harsha D.W. (1997). A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure. N. Engl. J. Med., 336: 1117-1124., 10.1056/NEJM19970417336160DOI: 10.1056/NEJM19970417336160
  4. Balzer J., Rassaf T., Heiss C., Kleinbongard P., Lauer T., Merx M., Heussen N., Gross H.B., Keen C.L., Schroeter H. and Kelm M. (2008). Sustained benefi ts in vascular function through flavanol-containing cocoa in medicated diabetic patients a double-masked, randomized, controlled trial. J. Am. Coll. Cardiol., 51(22): 2141-2149., 10.1016/J.JACC.2008.01.05DOI: 10.1016/J.JACC.2008.01.05
  5. Basler A.J. (2011). Pilot study investigating the effects of Ayurvedic Abhyanga massage on subjective stress experience. J. Altern. Complement. Med., 17(5): 435-440., 10.1089/ACM.2010.028DOI: 10.1089/ACM.2010.028
  6. Bhavanani A.B., Madanmohan and Sanjay, Z. (2012a). Immediate effect of chandranadi pranayama (left unilateral forced nostril breathing) on cardiovascular parameters in hypertensive patients. Int. J. Yoga, 5(2): 108-111., 10.4103/0973-6131.9822DOI: 10.4103/0973-6131.9822
  7. Bhavanani A, Madanmohan, Sanjay Z. and Vithiyalakshmi L. (2012b). Immediate cardiovascular effects of pranava relaxation in patients with hypertension and diabetes. Biochemical Human Kinetics, 4: 66-69., 10.2478/V10101-012-0012-DOI: 10.2478/V10101-012-0012-
  8. Blumenthal J.A., Sherwood A., Gullette E.C., Georgiades A. and Tweedy D. (2002). Biobehavioral approaches to the treatment of essential hypertension. J. Consult. Clin. Psychol., 70(3): 569-589., 10.1037/0022-006X.70.3.56DOI: 10.1037/0022-006X.70.3.56
  9. Bottaccioli F. e Bottaccioli A.G. (2017). Psiconeuroendocrinoimmunologia e scienza della cura integrata. Il Manuale. Milano: Edra.
  10. Brook R.D., Appel L.J., Rubenfi re M., Ogedegbe G., Bisognano J.D., Elliott W.J., Fuchs F.D., Hughes J.W., Lackland D.T., Staffi leno B. a, Townsend R.R. and Rajagopalan S. (2013). Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the american heart association. Hypertension, 61: 1360-1383., 10.1161/HYP.0B013E318293645DOI: 10.1161/HYP.0B013E318293645
  11. Camm A.J., Luscher T.F. and Serruys P.W. (2009). ESC Textbook of Cardiovascular Medicine Second Edition., Oxford: Oxford University Press.
  12. Chobanian A.V., Bakris G.L., Black H.R., Cushman W.C., Green L.A., Izzo J.L., Jones D.W., Materson B.J., Oparil S., Wright J.T. and Roccella E.J. (2003). Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension, 42: 1206-1252., 10.1161/01.HYP.0000107251.49515.CDOI: 10.1161/01.HYP.0000107251.49515.C
  13. Cohen D.L., Bloedon L.T., Rothman R.L., Farrar J.T., Galantino M.L., Volger S., Mayor C., Szapary P.O. and Townsend R.R. (2011). Iyengar Yoga versus Enhanced Usual Care on Blood Pressure in Patients with Prehypertension to Stage I Hypertension: a Randomized Controlled Trial. Evid. Based. Complement. Alternat. Med., ID 546428., 10.1093/ECAM/NEP13DOI: 10.1093/ECAM/NEP13
  14. Dal Lin C., Marinova M., Rubino G., Gola E., Brocca A., Pantano G., Brugnolo L., Sarais C., Cucchini U., Volpe B., Cavalli C., Bellio M., Fiorello E., Scali S., Plebani M., Iliceto S. and Tona F. (2017). Thoughts modulate the expression of infl ammatory genes and may improve the coronary blood fl ow in patients after a myocardial infarction. J. Tradit. Complement. Med., epub ahead of print., 10.1016/J.JTCME.2017.04.01DOI: 10.1016/J.JTCME.2017.04.01
  15. Dal Lin C., Poretto A., Scodro M., Perazzolo Marra M., Iliceto S. and Tona F. (2015a). Coronary microvascular and endothelial function regulation: Crossroads of psychoneuroendocrineimmunitary signals and quantum physics [Part A]. J. Integr. Cardiol., 1(5): 132-163., 10.15761/JIC.100013DOI: 10.15761/JIC.100013
  16. Dal Lin C., Poretto A., Scodro M., Perazzolo Marra M., Iliceto S. and Tona F. (2015b). Coronary microvascular and endothelial function regulation: Crossroads of psychoneuroendocrineimmunitary signals and quantum physics [Part B]. J. Integr. Cardiol., 1(5): 164-188., 10.15761/JIC.100013DOI: 10.15761/JIC.100013
  17. Dal Lin C., Poretto A., Scodro M., Perazzolo Marra M., Iliceto S. and Tona F. (2015c). Coronary microvascular and endothelial function regulation: Crossroads of psychoneuroendocrineimmunitary signals and quantum physics [Part C]. J. Integr. Cardiol., 1(5): 189-209., 10.15761/JIC.100013DOI: 10.15761/JIC.100013
  18. Devries S. and Dalen J.E. (2011). Integrative cardiology. Oxford: Oxford University Press.
  19. Dhuri K.D., Bodhe P.V. and Vaidya A.B. (2013). Shirodhara: A psycho-physiological profile in healthy volunteers. J. Ayurveda Integr. Med., 4(1): 40-44., 10.4103/0975-9476.10955DOI: 10.4103/0975-9476.10955
  20. Dickinson H., Campbell F., Beyer F., Nicolson D., Cook J., Ford G. and Mason J. (2008). Relaxation therapies for the management of primary hypertension in adults: a Cochrane review. J. Hum. Hypertens., 22: 809-820., 10.1038/JHH.2008.6DOI: 10.1038/JHH.2008.6
  21. Estruch R., Ros E., Salas-Salvadó J., Covas M.-I., Corella D., Arós F., Gómez-Gracia E., Ruiz-Gutiérrez V., Fiol M., Lapetra J., Lamuela-Raventos R.M., Serra-Majem L., Pintó X., Basora J., Muñoz M.A., Sorlí J.V., Martínez J.A. and Martínez-González M.A. (2013). Primary prevention of cardiovascular disease with a Mediterranean diet. N. Engl. J. Med., 368: 1279-1290., 10.1056/NEJMOA120030DOI: 10.1056/NEJMOA120030
  22. Fioranelli, M., editor (2017). Integrative Cardiology. 1st ed., Cham: Springer International Publishing., 10.1007/978-3-319-40010-DOI: 10.1007/978-3-319-40010-
  23. Flachskampf F.A., Gallasch J., Gefeller O., Gan J., Mao J., Pfahlberg A.B., Wortmann A., Klinghammer L., Pfl ederer W. and Daniel W.G. (2007). Randomized trial of acupuncture to lower blood pressure. Circulation, 115: 3121-3129., 10.1161/CIRCULATIONAHA.106.66114DOI: 10.1161/CIRCULATIONAHA.106.66114
  24. Ghirlanda G., Oradei A., Manto A., Lippa S., Uccioli L., Caputo S., Greco A.V. and Littarru G.P. (1993). Evidence of plasma CoQ10-lowering effect by HMG-CoA reductase inhibitors: a double-blind, placebo-controlled study. J. Clin. Pharmacol., 33(3): 226-229., 10.1002/J.1552-4604.1993.TB03948.DOI: 10.1002/J.1552-4604.1993.TB03948.
  25. Giannoni A., Baruah R., Leong T., Rehman M.B., Pastormerlo L.E., Harrell F.E., Coats A.J.S. and Francis D.P. (2014). Do optimal prognostic thresholds in continuous physiological variables really exist? Analysis of origin of apparent thresholds, with systematic review for peak oxygen consumption, ejection fraction and BNP. PLoS One, 9(9): e105175., 10.1371/JOURNAL.PONE.008169DOI: 10.1371/JOURNAL.PONE.008169
  26. Ho M.J., Bellusci A. and Wright J.M. (2009). Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension. Cochrane database Syst. Rev., CD007435., 10.1002/14651858.CD007435.PUBDOI: 10.1002/14651858.CD007435.PUB
  27. Horvath K., Jeitler K., Siering U., Stich A.K., Skipka G., Gratzer T.W. and Siebenhofer A. (2008). Long-term effects of weight-reducing interventions in hypertensive patients: systematic review and meta-analysis. Arch. Intern. Med., 168(6): 571-580., 10.1001/ARCHINTE.168.6.57DOI: 10.1001/ARCHINTE.168.6.57
  28. Kim J.-I., Choi J.-Y., Lee H., Lee M.S. and Ernst E. (2010). Moxibustion for hypertension: a systematic review. BMC Cardiovasc. Disord., 10: 33., 10.1186/1471-2261-10-3DOI: 10.1186/1471-2261-10-3
  29. Lacy F., O’Connor D.T. and Schmid-Schönbein G.W. (1998). Plasma hydrogen peroxide production in hypertensives and normotensive subjects at genetic risk of hypertension. J. Hypertens., 16(3): 291-303., 10.1097/00004872-199816030-0000DOI: 10.1097/00004872-199816030-0000
  30. Langsjoen P., Langsjoen P., Willis R. and Folkers K. (1994). Treatment of essential hypertension with coenzyme Q10. Mol. Aspects Med., 15 [Suppl]: S265-S272., 10.1016/0098-2997(94)90037-DOI: 10.1016/0098-2997(94)90037-
  31. Lazarou J., Pomeranz B.H. and Corey P.N. (1998). Incidence of adverse drug reaction in hospitalized patients. A meta-analysis of prospective studies. JAMA, 279(15): 1200-1205., 10.1001/JAMA.279.15.120DOI: 10.1001/JAMA.279.15.120
  32. Linneberg A., Jacobsen R.K., Skaaby T., Taylor A.E., Fluharty M.E., Jeppesen J.L., Bjorngaard J.H., Åsvold B.O., Gabrielsen M.E., Campbell A., Marioni R.E., Kumari M., Marques-Vidal P., Kaakinen M., Cavadino A., Postmus I., Ahluwalia T.S., Wannamethee S.G., Lahti J., Räikkönen K., Palotie A., Wong A., Dalgård C., Ford I., Ben-Shlomo Y., Christiansen L., Kyvik K.O., Kuh D., Eriksson J.G., Whincup P.H., Mbarek H., de Geus E.J.C., Vink J.M., Boomsma D.I., Smith G.D., Lawlor D.A., Kisialiou A., McConnachie A., Padmanabhan S., Jukema J.W., Power C., Hyppönen E., Preisig M., Waeber G., Vollenweider P., Korhonen T., Laatikainen T., Salomaa V., Kaprio J., Kivimaki M., Smith B.H., Hayward C., Sørensen T.I.A., Thuesen B.H., Sattar N., Morris R.W., Romundstad P.R., Munafò M.R., Jarvelin M.-R. and Husemoen L.L.N. (2015). Effect of Smoking on Blood Pressure and Resting Heart Rate: A Mendelian Randomization Meta-Analysis in the CARTA Consortium. Circ. Cardiovasc. Genet., 8: 832-841., 10.1161/CIRCGENETICS.115.00122DOI: 10.1161/CIRCGENETICS.115.00122
  33. López-Miranda J., Pérez-Jiménez F., Ros E., De Caterina R., Badimón L., Covas M.I., Escrich E., Ordovás J.M., Soriguer F., Abiá R., de la Lastra C.A., Battino M., Corella D., Chamorro-Quirós J., Delgado-Lista J., Giugliano D., Esposito K., Estruch R., Fernandez-Real J.M., Gaforio J.J., La Vecchia C., Lairon D., López-Segura F., Mata P., Menéndez J.A., Muriana F.J., Osada J., Panagiotakos D.B., Paniagua J.A., Pérez-Martinez P., Perona J., Peinado M.A., Pineda-Priego M., Poulsen H.E., Quiles J.L., Ramírez-Tortosa M.C., Ruano J., Serra-Majem L., Solá R., Solanas M., Solfrizzi V., de la Torre-Fornell R., Trichopoulou A., Uceda M., Villalba-Montoro J.M., Villar-Ortiz J.R., Visioli F. and Yiannakouris N. (2010). Olive oil and health: Summary of the II international conference on olive oil and health consensus report, Jaén and Córdoba (Spain) 2008. Nutr. Metab. Cardiovasc. Dis., 20(4): 284-294., 10.1016/J.NUMECD.2009.12.00DOI: 10.1016/J.NUMECD.2009.12.00
  34. McCormack J., Vandermeer B. and Allan G.M. (2013). How confidence intervals become confusion intervals. BMC Med. Res. Methodol.,13: 134., 10.1186/1471-2288-13-13DOI: 10.1186/1471-2288-13-13
  35. McIntyre M., Bohr D.F. and Dominiczak A.F. (1999). Endothelial function in hypertension: the role of superoxide anion. Hypertension, 34: 539-545., 10.1161/01.HYP.34.4.53DOI: 10.1161/01.HYP.34.4.53
  36. Mori T.A., Burke V., Puddey I., Irish A., Cowpland C.A., Beilin L., Dogra G. and Watts G.F. (2009). The effects of ω3 fatty acids and coenzyme Q10 on blood pressure and heart rate in chronic kidney disease: a randomized controlled trial. J. Hypertens., 27(9): 1863-1872., 10.1097/HJH.0B013E32832E1BDDOI: 10.1097/HJH.0B013E32832E1BD
  37. Nayak D.U., Karmen C., Frishman W.H. and Vakili B.A. (2001). Antioxidant vitamins and enzymatic and synthetic oxygen-derived free radical scavengers in the prevention and treatment of cardiovascular disease. Heart Dis., 3(1): 28-45., 10.1097/00132580-200101000-0000DOI: 10.1097/00132580-200101000-0000
  38. Obarzanek E., Velletri P.A. and Cutler J.A. (1996). Dietary protein and blood pressure. JAMA, 275(20): 1598-1603., 10.1001/JAMA.1996.0353044007804DOI: 10.1001/JAMA.1996.0353044007804
  39. Pescatello L.S., Franklin B.A., Fagard R., Farquhar W.B., Kelley G.A. and Ray C.A. (2004). American College of Sports Medicine position stand. Exercise and hypertension. Med. Sci. Sports Exerc., 36(3): 533-553., 10.1249/01.MSS.0000115224.88514.3DOI: 10.1249/01.MSS.0000115224.88514.3
  40. Price S. and Price L. (2012). Aromatherapy for Health Professional., 4ed. London: Churchill Livingston Elsevier.
  41. Rakel D. (2012). Integrative Medicine. 3rd Edition. Philadelphia: Elsevier Saunders.
  42. Seer P. and Raeburn J.M. (1980). Meditation training and essential hypertension: a methodological study. J. Behav. Med., 3(1): 59-71., 10.1007/BF0084491DOI: 10.1007/BF0084491
  43. Siasos G., Tsigkou V., Kokkou E., Oikonomou E., Vavuranakis M., Vlachopoulos C., Verveniotis A., Limperi M., Genimata V., Papavassiliou A.G., Stefanadis C. and Tousoulis D. (2014). Smoking and atherosclerosis: mechanisms of disease and new therapeutic approaches. Curr. Med. Chem., 21(34): 3936-3948., 10.2174/09298673213414101516153DOI: 10.2174/09298673213414101516153
  44. Taubert D., Roesen R., Lehmann C., Jung N. and Schömig E. (2007). Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial. JAMA, 298(1): 49-60., 10.1001/JAMA.298.1.4DOI: 10.1001/JAMA.298.1.4
  45. Terés S., Barceló-Coblijn G., Benet M., Alvarez R., Bressani R., Halver J.E. and Escribá P.V. (2008). Oleic acid content is responsible for the reduction in blood pressure induced by olive oil. PNAS, 105(37): 13811-13816., 10.1073/PNAS.080750010DOI: 10.1073/PNAS.080750010
  46. Vaidya Bhagwan Dash (2001). Herbal Treatment for Heart Diseases. Noida: B Jain Publisher Pvt Ltd.
  47. Vasan R.S., Beiser A., Seshadri S., Larson M.G., Kannel W.B., D’Agostino R.B. and Levy D. (2002). Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study. JAMA, 287(8): 1003-1010., 10.1001/JAMA.287.8.100DOI: 10.1001/JAMA.287.8.100
  48. Whelton P.K., He J., Appel L.J., Cutler J.A., Havas S., Kotchen T.A., Roccella E.J., Stout R., Vallbona C., Winston M.C. and Karimbakas J. (2002). Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. JAMA, 288(15): 1882-1888., 10.1001/JAMA.288.15.188DOI: 10.1001/JAMA.288.15.188
  49. Xiong X.J., Li S.J. and Zhang Y.Q. (2015). Massage therapy for essential hypertension: a systematic review. J. Hum. Hypertens., 29: 143-151., 10.1038/JHH.2014.5DOI: 10.1038/JHH.2014.5
  50. Xun P., Hou N., Daviglus M., Liu K., Morris J.S., Shikany J.M., Sidney S., Jacobs D.R. and He K. (2011). Fish oil, selenium and mercury in relation to incidence of hypertension: a 20-year follow-up study. J. Intern. Med., 270(2): 175-186., 10.1111/J.1365-2796.2010.02338.DOI: 10.1111/J.1365-2796.2010.02338.

Carlo Dal Lin, Raffaele Migliorini, Marco Silvestro, Sabino Iliceto, Francesco Tona, in "PNEI REVIEW" 2/2017, pp. 91-101, DOI:10.3280/PNEI2017-002009

   

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