HeartMath'Hypertension'Management by DR Childre Ehamh
HeartMath'Hypertension'Management by DR Childre Ehamh
HeartMath'Hypertension'Management by DR Childre Ehamh
One third of Americans have high blood pressure. It is therefore likely that
you or someone you love has this health problem (and may not even know
it). Do you know how high blood pressure happens? Wilson and Childre
teach us not only the causes of high blood pressure but how to take care of
it, with reduced medication or no medication at all. All Americans should
read this book.
Lee Lipsenthal, MD, ABHM, heart disease researcher and
president of the American Board of Holistic Medicine
The increasingly complex and ambiguous business world we now live in,
and the speed at which this world can change, can result in maladaptive
physiological responses in people. This often leads to a stress response
mechanism which can result in sustained hypertension, which in its
initial stages produces no symptoms. If sustained too long, it can result in
profound and serious future health effects. Whilst medication, with all its
potential side effects, has been the mainstay of treatment for several years,
HeartMaths research has been instrumental in demonstrating the role of
certain emotional states in our stress response mechanisms. HeartMath
philosophy and tools have shown that by influencing these emotional
states and their associated physiological mechanisms often responsible for
hypertension, patients can take control and positively improve their phys-
iology. This can result in preventing hypertension at an early stage,
avoiding or delaying medication, or significantly reducing the quantity
and dose of already prescribed antihypertensive medication.
Tony Yardley-Jones, MD, Ph.D., specialist in occupational
medicine at Chelsea & Westminster, London, UK,
and director of occupational health at the Royal
Berkshire Hospital, Reading, UK
Stress and its consequences remain major hurdles as people search for
ways to improve quality of life and reduce susceptibility to illness. Wilson
and Childre have put together a well-referenced, scientifically supported,
novel approach to the management of one of our nations biggest
killershypertension. Knowing how vulnerable we are to developing high
blood pressure is what makes the HeartMath approach so interesting and
helpful. Having tools that can positively influence our responses to the
stresses of daily life is critical in the battle against heart disease and
stroke. Taking charge of our life stressors has great potential to decrease
not only our blood pressure but reduce our susceptibility to other stress-
related health problems. Enjoy the book and take the message to heart.
Kathy Berra, MSN, ANP, FAAN, past president of the
American Association of Cardiovascular and Pulmonary
Rehabilitation Cardiovascular Medicine and Coronary
Interventions, Redwood City, CA
While there are hundreds of books on controlling high blood pressure, The
HeartMath Approach to Managing Hypertension clearly stands out
as breakthrough work. Unlike any authors before them, Wilson and
Childre have clearly recognized the role stress plays in elevating blood
pressure and have developed scientifically-proven techniques for reducing
stress and, thus, lowering blood pressure. This comprehensive book
explains the causes of hypertension, the pros and cons of medications used
to treat the condition, and looks at both conventional and alternative
treatments. But most importantly, what you learn in The HeartMath
Approach to Managing Hypertension works! And that is a major step
forward.
Charles B. Inlander, president of Peoples Medical Society
This book not only discusses the link between stress and high blood
pressure, but also serves as a great resource for how to break stress and its
toxic effects in all peoplenot just those with hypertension. As the CEO
of a large hospital, I am wholly supportive of the HeartMath method-
ology to reduce stress in the workplace and in our daily lives. I have seen
it work in my organization. The pace of our culture has increased dramati-
cally over the past few decades, and if we do not take control of the issues
that cause stress in our lives, we will not be able to perform the important
services expected of us in the health care industry.
Mary M. White, chief executive officer of the Swedish
Medical Center, Denver, CO
Bruce C. Wilson
Doc Childre
Care has been taken to confirm the accuracy of the information presented and to describe gener-
ally accepted practices. However, the authors, editors, and publisher are not responsible for errors
or omissions or for any consequences from application of the information in this book and make no
warranty, express or implied, with respect to the contents of the publication.
Some drugs and medical devices presented in this publication may have Food and Drug Adminis-
tration (FDA) clearance for limited use in restricted research settings. It is the responsibility of
the health care provider to ascertain the FDA status of each drug or device planned for use in
their clinical practice.
HeartMath, Heart Lock-In, and Inner Quality Management are registered trademarks of the In-
stitute of HeartMath. Quick Coherence and Freeze-Framer are registered trademarks of Quantum
Intech, Inc.
08 07 06
10 9 8 7 6 5 4 3 2 1 First printing
Dedication
Foreword ix
Acknowledgments xv
Introduction 1
Prevention and Control The HeartMath Approach
Chapter 1
What Is Blood Pressure? 11
Problems with Blood Pressure Measuring
Blood Pressure A Closed System
Chapter 2
Causes of High Blood Pressure 17
Genetics Hypertension in African-Americans
Obesity Lack of Physical Activity Excess Salt
in the Diet Age People at Increased Risk for
Development of Hypertension Secondary
Hypertension The Kidneys The Adrenal Glands
Other Problems
Chapter 3
Dangers of High Blood Pressure: 31
Why Should You Treat It?
The Heart The Brain Kidney Disease
Peripheral Arterial Disease (PAD) The Eyes
vi The HeartMath Approach to Managing Hypertension
Chapter 4
Drug Treatment of Hypertension 41
Diuretics Beta-Blockers Angiotensin Converting
Enzyme Inhibitors and Angiotensin Receptor Blockers
Calcium Channel Blockers Other Types of Drugs
Used to Treat Hypertension An Important Comment
on Drugs
Chapter 5
Lifestyle Changes That Help Lower 53
Blood Pressure
Diet Exercise Smoking Stress
Chapter 6
Stress and Hypertension 61
Our View of Stress The Human Stress Response
A Slower Set of ChangesThe Hormonal System
The World in the Twenty-first Century When
the Stress Button Gets Stuck
Chapter 7
Resetting Your Thermostat 75
Stories of Resetting Pressure Levels When Stress
Becomes an Addiction The Power to Change
Chapter 8
The Big Connection 81
The HeartMath Story, as Told by Founder Doc
Childre Understanding the Power of the Heart
A New Research ToolHRV The Three Levels
of the Human Brain The Heart-Brain Connection
Contents vii
Chapter 9
The HeartMath Tools 93
How Controlling HRV Can Reverse Stress First
Things FirstRecognizing That Your Stress Button
Has Been Pushed NeutralThe Most Basic Tool
Quick Coherence
Chapter 10
Rewriting Your Patterns 105
Writing New Patterns Heart Lock-In
Chapter 11
HeartMath Studies 115
Early Results Correlating Mood and Blood
Pressure Beyond the Corporate World HeartMath
in Health Care HRV Feedback Tools Creative
Stress
Chapter 12
The End Is Just the Beginning 129
APPENDIX
Classes of Drugs Used to 133
Treat Hypertension
References 145
Foreword
that if your belly is the first thing to pass through the door as
you enter a room, youre in trouble.
As a society, we must face the music and stop this rapid
increase in the number of people who have hypertension by
preventing it, not just treating it. And it is preventable in
many cases.
Natural Help
There has been a major shift over the years to try to use
more natural therapies. Indeed, the understanding that the
human body has a great capacity to heal itself has been the
subject of many areas of research.
In this book we will first examine the current under-
standing of high blood pressure, its causes, and the problems
it can create. Then well discuss the pharmacologic treatments
of hypertension. We will see how various classes of medica-
tions work, as well as review some of the side effects that can
be experienced by people taking them. The middle section of
the book will explore the biology of stress and the many ways
it can harm you, even though your bodys response to stress
(physical threats) was originally designed to help you.
Finally, the chapters toward the end will be your education in
the HeartMath approach to lowering blood pressure by inter-
fering with this built-in stress response. Lowering your blood
pressure while reducing the stress in your life sounds like a
real bargain, doesnt it?
systolic pressure
diastolic pressure
A Closed System
The circulatory system is a closed system. This means that
there are no valves anywhere in the pipes to let blood out. In
addition to the pumping and filling of the heart, pressure is
maintained in this closed system by the tension in the walls
of the arteries.
Arteries have a layer of muscle in their walls. This mus-
cle layer can contract or relax and have a great impact on the
What Is Blood Pressure? 13
What Is Hypertension?
Hypertension is the medical term for high blood pres-
sure. Hyper means too much, and tension, of course, means
pressure. That part is easy. Whats not easy is figuring out
what causes it most of the time. Well get to that later.
Most people have been told that normal blood pres-
sure is 120/80. Every few years, experts in the field meet to
review scientific research and the current guidelines on blood
pressure in order to update them if necessary. Currently,
blood pressure is classified as:
Normal (optimal): less than 120 systolic and less than 80
diastolic
Prehypertension: 120139 systolic or 8089 diastolic, or
both
Stage 1 Hypertension: 140159 systolic or 9099 dia-
stolic, or both
Stage 2 Hypertension: greater than 160 systolic or
greater than 100 diastolic, or both (Chobanian et al.
2003)
So, if your systolic pressure is greater than 130, and
your diastolic pressure is over 80, you have some degree of
hypertension.
What Is Blood Pressure? 15
Symptoms of Hypertension
The majority of people who develop high blood
pressure are completely unaware of it. This means that it is
important to check blood pressure periodically because it can
be elevated, and often is, with no symptoms at all. In fact,
many symptoms that are commonly associated with hyper-
tensionheadache, nosebleed, dizziness, and faintingare
seen just as commonly in people with normal blood pressure.
Often these symptoms of hypertension are also associated
with complications from the disease (see chapter 3).
organs that keep you alive, like the heart and the brain. It is
obviously a life-threatening condition.
Milder drops in blood pressure that dont threaten life
are called hypotension (hypo means under, or too low). Some
people do just fine with blood pressures of 85/50, and doc-
tors treat some people with conditions such as congestive
heart failure to reduce their pressures down to these levels.
Other people feel terrible when their systolic pressure drops
from 150 down to 130. Like everything else in life, everyone
is different, and its not the number that counts; its how well
the person is doing and feeling.
In chapters 2 through 5, were going to discuss problems
related to hypertension and then the drugs and lifestyle
changes that help to lower blood pressure.
Feel free to jump directly to chapter 6 and the chapters
that follow to get to the heart of the matter and learn the
HeartMath tools. You can always come back to the technical
sections.
Chapter 2
Genetics
Not many years ago, the medical community felt that
researchers would find the gene responsible for high blood
pressure, just as theyve identified certain genetic markers for
other diseases. That turned out to be naive, since it seems
now that many genes are involved. It is true, though, that
hypertension can and does run in certain families. You are
more likely to develop high blood pressure if others in your
family have had it.
Hypertension in African-Americans
Over the years it has become obvious that high blood pres-
sure acts a little differently in the African-American popu-
lation. African-Americans have an increased incidence and
prevalence of hypertension, and higher complication rates,
including death, than whites or other ethnic groups. They
also have a higher incidence of kidney damage as a result of
high blood pressure, and more patients progress to the point
of kidney failure and dialysis.
Much speculation has been offered as to why this might
be the case. African ancestors lived in hot, dry climates,
which required their bodies to conserve salt (sodium) and
water internally. This worked well when their intake of
sodium was low, as was the case on the African continent.
But as the population migrated and time passed, the diets
became much higher in salt. Some researchers think that
African-Americans living in cultures with higher salt intake
may be more susceptible to sodium overload. It has been
20 The HeartMath Approach to Managing Hypertension
Obesity
Obesity is a very strong contributor to hypertension. Being
significantly overweight is an epidemic in many countries
today. Its an ongoing disease, not a cosmetic problem. It
affects you in many waysnot just how you look.
Obesity is a complex disease that is a consequence of
taking in more calories than you burn off. It is influenced by
many factors, such as family history, race, level of activity,
and environment. Portion size is a major contributor to over-
eating. Fast-food restaurants often give people more calories
in one meal than they need in an entire day.
As society progressed from a time when it was neces-
sary to do physical work all day (hunt for food, grow food,
and build dwellings) to the modern era, when most work is
done from a chair while staring at a computer screen, people
simply burned fewer calories. All of the modern conve-
niences have left people melting into the couch.
Obesity contributes to other diseases as well. Type 2
diabetes was usually seen in middle age as a direct conse-
quence of obesity. Now its showing up in children as they
Causes of High Blood Pressure 21
! Despite the fact that less than half of people are salt
sensitive, dietary salt restriction will lower blood
pressure in most people.
Age
As you get older, youll naturally lose stretch in many of
your tissues. Your blood vessels are no exception. Elasticity is
the word that describes how stretchable something is. As you
age, the elasticity in your arteries decreases. This means that
when the heart is pumping blood into the arteries, the pres-
sure will rise if the arteries have lost some of their ability to
expand. Picture arteries made of soft rubber. Each time the
heart squeezes, it ejects blood into the pipes to keep it circu-
lating around the system. As the pipes grow stiffer over time,
the pressure in the system will go up if the volume of blood
being pumped remains the same. This is sometimes referred
to as hardening of the arteries. This term is also used to
describe the buildup of plaque on the inside of the arteries,
especially the heart. But you get the ideaas the pipes lose
their ability to stretch over the years, they dont absorb the
shock of the pulse as well as they used to. Rigid pipes make
for higher pressure.
24 The HeartMath Approach to Managing Hypertension
Secondary Hypertension
Secondary hypertension is the name given to high blood pres-
sure that is known to be caused by something else. Only
about 5 percent of high blood pressure falls in this category.
Many other diseases can elevate blood pressure by a number
of mechanisms.
Causes of High Blood Pressure 25
The Kidneys
The kidneys are frequently the cause of hypertension for
many reasons. This is because the kidneys help to regulate
blood pressure. As blood is pumped out of the heart into the
main artery, the aorta, it travels throughout the body. The
aorta gives off many arteries that feed all of the organs,
muscles, and other structures. When blood goes through the
kidneys, it passes through the renal (kidney) arteries. The
kidneys are very complex filtering machines that filter out
toxins that will then leave the body via the urine.
Blood passes from the aorta through the renal artery
and into the kidney itself, where it is pushed through a fine
mesh of very small blood vessels that act like a sieve. After
going through this filter, the blood travels through a loop of
blood vessels that control salt and water balance. This allows
water to be reabsorbed back into your circulation to keep
everything in balance. Ultimately, toxins and whatever salt
and water you dont need pass from the kidneys down pipes
called ureters into the bladder, which you empty periodically
when the urge hits you. Now things get a little more compli-
cated. If you were to design a monitoring system to keep
track of blood pressure (too lowjust righttoo high), the
kidney might not be such a bad place to put this monitor.
After all, the blood has to circulate through the kidneys at the
proper pressure to filter out toxins and balance salt and
water.
If the kidney sees low pressure, it might get nervous
that not enough pushing pressure is present to adequately
filter out the bad stuff. This could be because the blood pres-
sure actually is low, or because there may be a partial block-
age of the renal artery with cholesterol, just as can happen in
the heart. Another condition related to this is called
26 The HeartMath Approach to Managing Hypertension
Other Problems
Weve seen how the kidney makes its own hormone, renin,
that raises blood pressure when it senses that the blood flow
lacks proper force. Its a built-in system to prevent you from
dying of too little blood pressure (also called shock). As
stated earlier, the kidney can be fooled by a partial blockage
Causes of High Blood Pressure 29
The Heart
The heart is known as the most important organ in the body
for obvious reasonsit pumps blood all through the body to
deliver oxygen and other nutrients for proper functioning.
32 The HeartMath Approach to Managing Hypertension
Some would argue that the brain is more important than the
heart, since it doesnt make much sense to be alive if your
heart is pumping away and you cannot function. But if the
heart goes, everything goes.
Many things can go wrong with the heart over time, but
hypertension exerts a particularly harmful influence on it.
Heart disease is the number-one killer of people in most
countries. But what do we mean by heart disease?
Heart Attack
The dangerous and often deadly consequence of CAD is
heart attack. The medical term for heart attack is myocardial
infarction (myo means heart; cardial means muscle; infarc-
tion means tissue death). Heart attack is a very specific
term; it means the sudden blockage of blood flow to the heart
muscle, resulting in the death of a segment of this muscle.
Heart attack doesnt mean dropping over, although some
people do drop over. In fact, about half of the people who die
of a heart attack do so before reaching a hospital.
Contrary to what you might think, heart attack doesnt
happen because more and more cholesterol builds up on the
inside of a coronary artery like rings on a tree. Instead, one of
the plaques actually ruptures. Why this happens all of a
sudden is the subject of a great deal of medical research.
into the air sacs of the lungs. That makes it harder to breathe,
because oxygen cant pass through the air sacs into the blood
vessels when the air sacs are flooded with water. The pres-
sure continues to back up into the right side of the heart,
which has the job of pumping blood into the lungs. Then
blood has trouble getting back into the heart from the body.
Eventually this backup causes edema, or swelling, in the
rest of the body, especially the ankles. When the heart cant
pump adequately, people get fatigued (there is inadequate
blood supply to muscles), and develop shortness of breath
when they try to exert themselves. As CHF gets worse, these
symptoms not only occur during times of exertion, but also
with less and less activity, and finally even while a person is
at rest.
Hypertension was the most common cause of congestive
heart failure up until the middle of the last century. Because
of this, there was finally a push to treat blood pressure and
return it to normal levels. More aggressive therapy for high
blood pressure has dropped it into second place as a cause of
CHF, but far too many people still suffer from this syndrome.
The Brain
The brain is very sensitive to high blood pressure, both
acutely (moment to moment) and chronically (over the long
term).
Stroke
Stroke is very much like a heart attack in that tissue dies
as a result of interrupted blood flow. In this case, its brain
tissue, not heart muscle. Stroke has therefore been called by
some a brain attack.
36 The HeartMath Approach to Managing Hypertension
Dementia
Dementia is a term used to describe decreased cognitive
mental function. It is an abnormal process. Although all of us
have a certain decline in brain function as we get older, many
people are quite sharp well into their nineties or even after
age one hundred.
Probably the best-known type of dementia is Alzheimers
disease. However, this type is not associated with hyper-
tension. Midlife blood pressure elevations are predictors of
other changes in the brain that lead to cognitive impairment
and decline, and the risk for the development of dementia
can be significantly reduced by normalizing the blood
pressure (Hershey 2003).
Hypertensive Encephalopathy
The term hypertensive encephalopathy (en-SEF-uh-
LAH-path-ee) describes a syndrome of severe hypertension
accompanied by brain dysfunction and neurologic impair-
ment. Complete resolution of this dangerous and frightening
problem can be achieved if the blood pressure is quickly
lowered, usually with intravenous medication in an intensive
care environment (Heistad, Lawton, and Talman 2003).
38 The HeartMath Approach to Managing Hypertension
Kidney Disease
It is difficult to separate the cart and the horse when it comes
to hypertension and kidney disease, because hypertension
both contributes to and accelerates kidney disease and is also
a consequence of kidney disease. As kidney function deterio-
rates, doctors use the term renal insufficiency. When kidney
function is extremely poor, and eventually absent, its called
renal failure. At this point, the patient will die in the course of
a couple of weeks if he or she does not undergo kidney dialy-
sis, a complicated but routine procedure whereby the blood is
withdrawn from a vein, sent through a series of external
filters to remove toxins and water, and returned to the circu-
lation. People can live for years while undergoing dialysis,
although their quality of life is usually significantly dimin-
ished. The other option for a patient with end-stage kidney
disease is to undergo a kidney transplant operation.
Hypertension is the most important risk factor for pro-
gressive loss of kidney function. People with normal blood
pressure and kidney disease usually develop high blood pres-
sure as their kidney function deteriorates, creating a vicious
cycle of worsening kidney function and ever-rising blood
pressure, ending often in renal failure (Anderson 2003).
the release of the kidney hormone renin, which then sets the
chain reaction in motion that ends with salt and water
reabsorption in the kidney and squeezing of the arteries, thus
raising the blood pressure.
Other blood vessels including the aorta itself can be
victimized by hypertension. Aortic aneurysms can form along
any part of this main blood vessel, or one of its branches. An
aneurysm, as discussed earlier in this chapter, is a weakened
and expanded segment of artery, much like that seen in an
inner tube of a tire before a blowout. As higher blood pres-
sure pounds against the lining of the aorta or any other
artery, it can cause a rupture, most often leading to rapid
death. Sometimes the force of blood under high pressure will
rip the lining of the aorta. This is called aortic dissection, or a
dissecting aneurysm if it occurs in one of the enlarged areas.
This can be catastrophic, since rupture can occur if pressure is
not lowered. Quite often, urgent surgery is required to repair
the aorta. Also quite often, there isnt time.
When cholesterol narrows the carotid (cuh-RAH-tidd)
arteries that go north from the aorta up to the brain, stroke is
a potential problem. When the arteries that go down into the
legs are narrowed by this process, known as atherosclerosis,
people may develop pain in their calf muscles when they
walk. The medical name for this is claudication, and it is
relieved by stopping for a short time. In severe cases, the toes
and feet, being the farthest things downstream, lose their
blood supply and turn black, a condition known as gangrene.
Amputation is required.
Hypertension is a very important culprit in all of these
problems. When it is combined with diabetes and smoking,
the likelihood of developing peripheral arterial disease is
much higher.
40 The HeartMath Approach to Managing Hypertension
The Eyes
When you visit your doctor and she places an ophthalmo-
scope against her eye to look into yours, she is looking for
signs of hypertension, among other things. The eye is the
only human organ where the blood vessels can be directly
visualized. A number of changes can occur in the arteries, the
veins, and the optic nerve that connect to the eye, and the ret-
ina, where vision is detected on the back surface of the
eyeball. These changes are graded in terms of severity, and
give the physician valuable information about the duration
and extent of hypertension. High blood pressure accelerates
eye problems caused by diabetes. Treatment for severe
diabetic eye complications is more successful when blood
pressure is normal.
So now that youve been to medical school (we left out
gynecology, orthopedics, and a few other topics), youve seen
how far-reaching the effects of high blood pressure are. This
is why it is so important to know what your blood pressure
is, and to treat itone way or anotherto return it to the
normal range and avoid the complications youve been read-
ing about. In the next chapter, well review the options for
treatment.
Chapter 4
Drug Treatment of
Hypertension
Diuretics
Diuretics are drugs that cause the kidney to put out more
water. Getting rid of more urine is known in the medical
business as diuresis, so diuretics are compounds that make
people visit the restroom more frequently.
The diuretics were the first of the modern drugs for
blood pressure, and were developed in the 1950s. The way
they work is to cause more sodium to be excreted into the
urine. Remember that water follows salt. The bodys balanc-
ing mechanisms ensure that water goes out, too.
The most commonly used drug in this category is hydro-
chlorothiazide, more easily referred to by both doctors and
patients as HCTZ. Others are listed in the appendix.
Some people are particularly sensitive to the actions of
diuretics. African-Americans, the elderly, diabetics, as well as
people with metabolic syndrome (obesity, lipid disorders,
hypertension, early or established diabetes, and early
Drug Treatment of Hypertension 43
Beta-Blockers
The beta-blocker drugs have been around since the 1970s. The
Greek letter b is the symbol for beta, so doctors use it
frequently when referring to these drugs: b blockers. These
drugs decrease the force of contraction of the heart. Recall
that with each squeeze of the heart (systole), blood is ejected
44 The HeartMath Approach to Managing Hypertension
into the aorta and eventually into all the branching arteries.
Arteries possess the quality of elasticity, and therefore stretch
a little with each beat of the heart. Beta-blockers, by reducing
the force of the hearts contraction, lower the pressure trans-
mitted into the blood vessels. Beta-blockers also reduce heart
rate, so it is common for people taking them to notice a
slower pulse. In fact, they are often used to slow the heart
rate in people who suffer from rhythm disorders character-
ized by rapid heartbeats.
There are a number of other ways by which beta-blocker
drugs may lower blood pressure. Some of them lower resis-
tance in the walls of blood vessels, causing them to dilate,
and thus pressure falls. They also blunt some of the signals
coming out of the brain and central nervous system. In addi-
tion to their use in hypertension, they have widespread appli-
cation in the treatment of a myriad or different heart
conditions. See the appendix for a list of commonly used
beta-blockers.
Angiotensin Converting
Enzyme Inhibitors and
Angiotensin Receptor Blockers
Back in chapter 2 we talked about causes of high blood
pressure. You may recall that the kidney, when it sees (or
thinks it sees) low blood pressure, makes a hormone called
renin, which triggers a series of reactions that result in higher
pressure.
Theres an enzyme we need to talk about called angio-
tensin converting enzyme. Since thats such a long name, lets
just call it ACE. In general, enzymes are chemicals found all
over the body that help certain reactions take place, sort of
like little biochemical helpers.
When renin is released by the kidney, it acts on another
substance that is floating around in your bloodstream that
was manufactured in the liver. The result is a chemical called
angiotensin I. ACE converts angiotensin I to angiotensin II, a
very powerful substance that has the job of constricting blood
46 The HeartMath Approach to Managing Hypertension
Aldosterone Blockers
We reviewed the physiology of aldosterone in chapter 2.
Aldosterone is made in the adrenal gland and travels to the
Drug Treatment of Hypertension 49
Alpha Blockers
If there was a beta, there has to be an alpha, right? Alpha
refers to the constrictive effect of norepinephrine (noradrena-
line) on blood vessels. Alpha blockers interfere with this.
They are also used for other conditions like frequent night-
time urination in men with enlarged prostate glands.
Sympatholytic Drugs
These are older drugs with numerous side effects, and
therefore are rarely used. Sympatholytic refers to decreasing
the outpouring of nervous system hormones (sympatho means
sympathetic, or your fight-or-flight chemistry; lytic means
to cut).
Direct Vasodilators
Vasodilator medicines dilate the blood vessels. These
meds act directly on the arteries. They are used only in
special situations.
Diet
We discussed in chapter 2 the fact that salt is an important
contributor to hypertension. Some people are salt sensitive,
meaning that they have a significant rise in blood pressure
when they take in moderate or large amounts of sodium, the
component in table salt that we measure and monitor. As we
said earlier, even if a person is not particularly salt sensitive,
blood pressure still falls when sodium intake falls. But is it all
about salt?
54 The HeartMath Approach to Managing Hypertension
Saturated Fat
Fats come in three main categories. Saturated fat is found
in butter, lard, cream cheese, and coconut oil (also called
palm oil on the containers of many foods). These are fats that
raise your cholesterol and clog your arteries.
Polyunsaturated and monounsaturated fats are the other
types of fats. More of the fats you eat should come from the
monounsaturated (olive oil, canola oil) and polyunsaturated
(corn oil, safflower oil) categories. A recent controversy has
popped up because health experts have been recommending
monounsaturated fats over polyunsaturates. It appears that
some of the studies these recommendations are based on may
Lifestyle Changes That Help Lower Blood Pressure 55
Exercise
Regular exercise is good for you in so many ways. It feels
good. It helps to reduce your weight (even a ten-pound
weight loss can lower blood pressure). It changes your
metabolism. It also blunts big swings in blood pressure seen
in inactive or deconditioned people, often known as couch
potatoes. It even improves your mood.
The important thing about exercise is that it should be
done regularly. That means almost every day. Everyone has
days when they just cant make time for it, but if your rule of
thumb is to exercise every day, then it isnt so bad if you miss
a day or two here and there. And you should exercise for
58 The HeartMath Approach to Managing Hypertension
Smoking
The nicotine in cigarette (and also cigar and pipe) smoke
causes a faster heartbeat and constricts blood vessels, both of
which cause blood pressure to go up, at least temporarily.
Smoking also causes the platelets in your blood, whose job it
is to stick to the walls of blood vessels to start the process of
blood clotting if you get a cut, to stick to cholesterol plaques
on the insides of the coronary arteries that feed the heart. The
platelets then become involved in the process of making the
plaques grow. On occasion, the platelets can trigger a blood
clot in an artery, which could block it off completely and
cause a heart attack. Everybody knows that cigarettes cause
cancer as well as emphysema and many other health prob-
lems. If you are a smoker and need help quitting, call the
Quitline of the American Cancer Society at (800) ACS-2345.
60 The HeartMath Approach to Managing Hypertension
Stress
In most books and articles about hypertension, there is
usually only a paragraph or two about stress. Thats mostly
due to the fact that stress had not been measurable in the
past. Yet most people feel that stress is contributing to their
high blood pressure, and then the stress of the struggle to
manage it also weighs on them. Dr. Stewart Wolf was one of
the first researchers to examine the role of stress in hyperten-
sion, in his seminal book Life Stress and Essential Hypertension
(1955, Williams and Wilkins).
We have a lot of compassion for the stress most people
feel today. Tremendous progress has been made over the last
ten or fifteen years to understand the underpinnings of stress.
Thats why Doc Childre, one of the authors of this book,
started the nonprofit Institute of HeartMath, to research the
mechanisms of mental and emotional stress and find solu-
tions. The science behind stress has led to the development of
effective tools to help people change their stress habits. Lets
take a journey together and learn what your stress wiring
is doing to you, and what you can do to reprogram it.
Chapter 6
Well, now were down to the core issue, arent we? Thus far
we have defined normal blood pressure and hypertension.
Weve looked at other diseases that cause high blood pres-
sure, as well as things that contribute to it. We spent some
time going over medications and lifestyle changes that can
help to bring blood pressure down. Its time now to tackle the
mysteries of stress.
Have you ever been driving your car along a quiet residential
street when a young child rides his bike down a driveway and
out in front of your car? Did you notice how fast that prickly
sensation spread all over your skin, and how quickly your
heart was pounding? These alterations in sympathetic and
parasympathetic functioning occur very rapidly because
whether its a tiger, a mugger, or a kid on a bike, your ability
to react is directly related to how fast your switch is thrown.
Cortisol
Cortisol is known by some as the mother of all stress
hormones. Thats because cortisol is released in large quanti-
ties when you perceive or feel stress. We talked in chapter 2
about the adrenal glands on top of the kidneys, how they
produce adrenaline (also known as epinephrine), and how
adrenaline can raise blood pressure. While adrenaline is pro-
duced in the central core of the adrenal gland, cortisol is
produced in one of the three outer layers. Once it is released
into the bloodstream, one of cortisols main actions is to raise
blood sugar or glucose. It does so by helping to break down
stored sugars from places like your liver and your muscles.
Its critical that your blood sugar stays high enough because
the brain only knows how to use one type of fuel, and
thats glucose. The rest of your body also needs glucose to be
readily available as an energy source.
Back to our story. A tiger just bit you, remember? Since
its unlikely that youll be able to get to a mango tree for a
sugar rush any time soon, your body will need to break down
its stored sugars to make glucose so your brain can think
about what to do next. Your muscles will need more fuel to
respond. So, its a neat design of nature to have a built-in
cortisol system to raise blood sugar.
What else does cortisol do? Both directly and indirectly
(by interacting with other hormones) it raises blood pressure
by causing constriction of the arteries and interacting with
the kidneys to save salt and water. (Remember that these
functions also elevate blood pressure.) That seems like a
rather bright idea right about now because you-know-who
just bit your leg, and if youre bleeding away on the river
bank, your blood pressure is dropping. When blood pressure
gets dangerously low and cant push the right amount of
Stress and Hypertension 69
DHEA
Before you experience despair just from reading this,
take heart! (Oohgreat linewere getting close to the best
part.) Nature has a habit of keeping everything in balance.
Theres a yin and a yang in almost every system. That little
adrenal gland has a whole bunch of other tricks up its sleeve,
but probably the coolest one is the production of another
hormone called DHEA. Since those letters dont make a
word, they must stand for something long and complicated:
dehydroepiandrosterone (no pronunciation help needed, since
not even the scientists who work on this stuff every day call it
anything other than DHEA).
DHEA is more difficult to explain because it hasnt been
studied for as long or in as much depth as cortisol, its adrenal
cousin. DHEA seems to counteract some of the effects of
cortisol. Although cortisol is a necessary hormone for every-
day function, by providing DHEA to counteract cortisol, its
as if Mother Nature knew that you were only supposed to get
an extra dose of cortisol every now and again, and only in
times of real danger when theres a physical threat to your
survival. Its good to limit your exposure to things like tigers.
Now that weve taken a look into how the body and emotions
respond to all sorts of stress triggers, whether real or imag-
ined, and read some case histories of people who have
learned to reset their blood pressure thermostats, its time
to delve into the HeartMath story. It provides some very
exciting information that offers real hope. HeartMath
research has everything to do with your heart, and how your
heart talks to your brain.
Understanding the
Power of the Heart
Scientists have known for many years that electromagnetic
waves are generated by many structures in the body. Brain-
waves are a good example. The machine that measures brain-
waves is called the electroencephalograph, or EEG. Your
stomach and intestines generate electromagnetic waves as
they contract and relax at regular intervals. This helps to
optimize the absorption of nutrients and water so you have
the fuel to run the machinery of your body.
The hearts electromagnetic waves were first measured
in 1903 with the development of the electrocardiograph, usually
referred to as the ECG or EKG. A fact that can seem very
surprising is that the hearts electrical signal (ECG) is actually
about fifty times stronger (in electrical amplitude) than the
brains signal (EEG). Although this had been observed for
over a hundred years, nobody wondered about the signifi-
cance of ituntil recently.
The observation that the hearts waves are stronger than
the brains sort of goes against how scientists and the rest of
us view the human system. Most scientists have been taught
84 The HeartMath Approach to Managing Hypertension
the zone also can occur when you are working, communi-
cating, or creating. Its characterized by clarity, a sense of
timelessness, effortlessness, and positive mood.
Pattern Matching
The notion of a left brain and right brain with entirely
separate functions is fading. Researchers now realize that its
not quite as simple as one function coming from one side of
your brain, and another coming from the opposite side.
Theres a lot of crossover. Dr. Karl Pribram, while head of the
Neuropsychological Laboratory at Stanford University, found
90 The HeartMath Approach to Managing Hypertension
You can learn to shift your emotions and change your HRV
pattern to reverse stress and improve your health. Dr. Grant
Slinger, director of Keystone Wellness Clinic in Rockefeller
Plaza, New York, and a licensed HeartMath provider, teaches
his patients how to do just that.
A. P. was referred to Keystone Wellness by his
primary care physician because he was hypertensive,
obese, prediabetic, and unable to lose weight.
A highly successful owner of a company in the
high-stress construction industry, A. P. had a lot
of anxiety and anger. He harbored a kitchenette
and vending machine in his private office, where he
ate chocolate bars and other goodies. When he went
to a restaurant, he couldnt resist emptying the entire
bread basket. A. P. had tried controlled eating plans,
but was unable to follow them. He knew what to do
but couldnt stick to it. He knew that a lot of his
problem was due to the stress he was under. He was
in fear for his health, which he knew was in danger.
When A. P. came to us, his blood pressure was
160/80, Dr. Slinger reported. We explained how the
HeartMath program works and that he did have
94 The HeartMath Approach to Managing Hypertension
Heart Focus
When you feel your stress button being pushed, recog-
nize it. Then shift your attention from all that internal noise
and chatter in your head down to the center of your chest
the area around your heart. (After all, if youre going to use
this master pendulum, youll need to engage it by focusing in
that area.)
1. Simply let your attention drop gently down to
your chest, and try to focus there. The next step
will help you keep your focus in this area so
youll be able to maintain it.
Heart Breathing
Imagine that you are slowly breathing in and out
through your heart. Of course, you cant actually breathe
through your heartthats what your lungs are for. But
The HeartMath Tools 99
Quick Coherence
Quick Coherence is a rapid three-step technique to shift your
emotional state and have positive emotions running through
your system. This helps you get the coherence pattern going
on your big signal generator so that all of the functions in
your body synchronize, and all the stress chemical pathways
reverse. Youve already learned the first two steps of Quick
Coherence (Heart Focus and Heart Breathing); theyre the
same as the Neutral tool.
Now lets add the third step, Heart Feeling. In this step,
you will engage a positive emotion to shift into coherence.
Back in the early 1990s, when the team of researchers at
the Institute was experimenting with various triggers to
switch over to coherence, they listened carefully to Docs
earlier research findings and personal experiences. He had
found that intentionally generating sincere, positive feelings
of love, care, gratitude, and appreciation gave people more
mental clarity. These happen to be the same positive emo-
tions that all the worlds major religions have asked people to
practice over hundreds and even thousands of years. Perhaps
their founders intuitively knew that these positive emotions,
sincerely felt, change the heart in some way.
That smooth, rhythmic, orderly pattern of coherence
gets broadcast by your heart, your most powerful beacon.
That signal goes north up to your brain, hitting the emotional
centers in the midbrain, like your amygdala. This coherent
pattern helps override negative emotional programming and
gets transmitted all the way to the frontal lobes of your brain.
Thats when you can actually choose, with that smarter part
of your brain, to respond more intelligently to the situation
youre in. You experience cortical facilitation and are likely to
102 The HeartMath Approach to Managing Hypertension
your life that makes you feel good by just remembering it.
See if you can pick one of those times right now. It doesnt
matter what it isa warm beach, a sunset, a mountaintop,
being with someone you love, a pet, or even a favorite meal.
Its not thinking about that experience that helps you get
coherent, its the actual feeling you have from recalling it. Its
not a picture to be imaginedits your positive emotional
memory of the experience.
As you gain experience with the HeartMath tools, you
will want to build a file of these positive moments in your
past that you can recall when stress is triggered, to help you
activate a positive feeling. Remember, youre switching feel-
ings to get into coherence, not to get an A on a test. As you
get into more coherence, youll have more intelligence avail-
able to you on how to best respond to a situation.
What youll find as you practice Neutral and Quick
Coherence is that things that used to give you stress wont
bring about those same reactions anymore. Those frenzied,
reactive feelings will increasingly be replaced by more
balance, calm, and clarity. Thats because coherence is
becoming a dominant pattern in your system more and
more of the time. Your brain function is changing. You enjoy
a broader field of perception, and youre more open to the
many things going on all around you that bring you sincere
appreciation. You develop a keen awareness of when youre
coherent and when youre not. When your stress physiology
is in gear, youll notice that your field of vision is narrowed,
as if youre looking through a straw, and only at the
enemy, not realizing that enemy is your own limited
perception.
So its time to try all three of the Neutral and Quick
Coherence steps:
104 The HeartMath Approach to Managing Hypertension
again. Foot off the gas; now gently apply the brake. Now,
hand-over-hand, turn the steering wheel. Now recover, back to
straight again. Now more gas.
Exhausting! And that was just learning how to make a
turn. Ultimately you had to learn how to do something as
complicated as parallel parking. It required lots of focus, and
attention, and calculation, and experience, and repetition.
If you were asked today how you drive your car to
work or to the grocery store, youd probably name the route
you take. But if asked specifically how you operate your car
to get from point A to point B, youd have no recollection of
all those steps. Now you are able to drink your cup of coffee,
answer your cell phone, and speak to the other person, all
while driving a two-ton machine, often at high speeds and
with multiple manipulations. And you get to work just fine.
How does that happen?
After performing the same tasks over and over, repeat-
ing each step many times, these actions eventually become
automatic. They are performed by a lower portion of your
brain, saving your cognitive areas for matters such as evalu-
ating driving conditions, or navigating through unfamiliar
territory.
When actions become automatic, they have imprinted a
pattern that has become familiar. Once this happens, mes-
sages are sent much more quickly and easily along the path-
ways of the nervous system. More traffic along the familiar
pathways creates easier travel. We refer to this as rewriting the
neural architecture.
Fortunately, you can rewrite the neural architecture in
your stress response system, even if youve had the same
responses to situations multiple times. Once the research
team at the Institute of HeartMath learned how the brain and
the heart were interacting, we saw the potential for grooving
Rewriting Your Patterns 109
Heart Lock-In
The final technique you will learn in this book is called Heart
Lock-In. While there are a number of other HeartMath tools
and techniques, the use of Neutral, Quick Coherence, and
Heart Lock-In will be the most helpful to you in lowering
your blood pressure.
The Heart Lock-In technique is to be used daily, to help
sustain coherence to rewrite your pathways and make a
psychological and physiological habit out of more beneficial
responses. This technique builds on the steps that youve
already learned, with slight modification.
1. Shift your attention to the area of the heart and
breathe slowly and deeply.
2. Activate and sustain a genuine feeling of
appreciation or care for someone or something
in your life.
3. Send these feelings of appreciation or care
toward yourself and others.
After shifting your attention to the center of your chest,
and breathing slowly in and out through your heart, send
these feelings of appreciation or care to yourself and others.
Sending feelings may seem strange at first, but everyone
112 The HeartMath Approach to Managing Hypertension
health, your home life, and your work life). Now appreciate
yourself for practicing these tools. Youre taking the time, and
doing something for yourself, as simple as it may seem.
After appreciating yourselfreally feel that appreciative
attitudejust shift a little and radiate that appreciation out to
others. You might pick members of your family for this
exercise today. Tomorrow you might pick people who have
helped you out in times of need. Or your book club, or your
tennis group, or people you are close to at work or at your
church. Simply expand the focus of your appreciation
outward from yourself to those around you.
Sustaining Coherence
Try to sustain appreciative feelings and attitudes in a
Heart Lock-In for five minutes or longer. The longer you can
do this and hold it, the better it is for you and your system.
Youre learning to sustain coherence.
Remember, if your thoughts wander or you are dis-
tracted in some other way, its not a problem. Just go back to
Heart Focus and Heart Breathing. Once youve gotten back
into your heart breathing rhythm, simply return to appreciat-
ing yourself and then radiate appreciation out to your chosen
group for this session.
the e-mails start flooding your in-box. Why not start the day
with a coherent program playing in your system?
Most people find that doing a Heart Lock-In a couple of
times a day helps to accumulate energy and recharge their
emotional system. It cushions the impact of day-to-day stress
and reduces energy drain. Doing a short, midday Lock-In is
very effective for offsetting the feeling of afternoon drag. That
drag results in less focus and motivation. Its also a time
when you might be tempted to snack or grab another cup of
coffee to pump up your energy level. Let Heart Lock-In
reenergize your emotional system instead.
Another time to use Heart Lock-In is just before sleep.
Many have found that doing the Heart Lock-In technique at
this time promotes a more restful sleep and is especially help-
ful with insomnia.
Practicing the Heart Lock-In technique while listening to
background music that lifts your spirit can increase its
positive effects (McCraty et al. 1996; McCraty et al. 1998;
McCraty, Atkinson, and Tomasino 2001). Coauthor Doc
Childre has created two music CDs that are designed to be
used with Heart Lock-In to facilitate coherence and emotional
regeneration (see Learn More About HeartMath).
Heart Lock-In helps to rewrite the old, automatic pro-
gramming and to lock-in a new pattern so that when you
need to quickly use Neutral or Quick Coherence in the heat of
the moment, the coherent pattern and pathway becomes more
accessible, and eventually preferred.
In a short while, and with some regular practice, you
wont have to stop and recall all the steps of the tools. For
example, with Heart Lock-In, all youll need to remember are
the key words: shift, activate, and send. Your switch will be
readily available to you. You will find that simply shifting
your attention to your heart will start the cascade of positive
Rewriting Your Patterns 115
HeartMath Studies
Early Results
Forty-eight employees at three levels within Motorola were
selected to participate in a HeartMath stress-management
course. Nine executives, nine software engineers, and thirty
factory workers attended, but blood pressure recordings were
only available in the first two groups (executives and
engineers). Five of the participants were found to have
hypertension.
Six months after the subjects participated in the pro-
gram where they learned HeartMath tools and were encour-
aged (but not mandated) to practice them daily, the blood
pressure readings had dropped significantly in all five of the
subjects. In addition, further reductions were seen immedi-
ately after the participants were asked to practice a variation
of the Quick Coherence technique while their blood pressure
was being monitored.
Its important to realize that this program was not
designed to lower blood pressure, but rather to give the
participants tools to reduce their own levels of stress and
enhance their enjoyment of work. Blood pressure was simply
one of the variables being measured in the process. Follow-up
testing six months later found that contentment, job satisfac-
tion, and communication all improved in the group as a
whole. Not surprisingly, feelings of tension and anxiety were
reduced, as were physical symptoms of stress.
HeartMath Studies 119
Figure 2: Systolic and diastolic blood pressure in males and females practicing
HeartMath tools vs. those waiting to be trained.
Intervention
230 48 160 110
220 150
46 105
mg mg mg mg
210 *** 140 ***
/dL /dL /dL /dL **
44 100
200 130
42 95
190 120
180 40 110 90
Pre Post Pre Post Pre Post Pre Post
112 74 64
Pre Post Pre Post Pre Post
N = 43
126 The HeartMath Approach to Managing Hypertension
But there I sat, a heart doctor who had passed all the tests
along the way, having my nearly-etched-in-stone model of
how the heart and brain worked turned literally upside down.
I was fascinated by how the heart rhythm shifts into the
coherent state when you feel positive emotions, such as
appreciation or care. I immediately saw how this coherent
state would be important for my patients, because their
cardiovascular systems would operate much more efficiently.
Getting synchronization between all systems in the body
makes them all more efficient, using less energy to accom-
plish more. Thats really what the word efficiency means.
The early HeartMath studies told me that just shifting
into this state of coherence could reduce most peoples blood
pressure around eight to ten points. If they practiced regularly,
they could reduce it more. I could see that by teaching my
patients how to make this shift, they might not only reduce
their stress, but with practice they could retrain their internal
pathways so that coherence would become more familiar to
their hearts and brains. This in turn might very well return
the set point or thermostat that controls their blood pressure
to more normal baseline levels and, potentially, lead to
long-term reductions in their blood pressure readings.
As I mentioned in the introduction, it wasnt long before
my thoughts turned to helping the caregivers in hospitals as
well. Their own stress levels often get in the way of giving sin-
cere care, despite all the boxes being checked in the charts.
With a lot of ingenuity and careful listening, the HeartMath
team developed a Health Care Division and a program for
hospitals to help nurses and other staff to manage their own
stress better and deliver care from the heart. Nurses have to
have lots of brain power, too, but having reached this point in
the book, you are now well aware of what happens when neg-
ative emotions and stress prevent coherence from the heart.
HeartMath Studies 127
Creative Stress
Stress, at times, can make some people more productive. It
can motivate themfor awhileuntil they lose focus and
their energy drops. But when stressful attitudes and feelings
continue day after day, month after month, they take a toll.
Its the unmanaged stress reactions to people, issues, and sit-
uations that contribute to unhappiness, strained relationships,
accelerated aging, and physical diseases. Blood pressure
happens to be just one of the diseases, and a very common
one at that.
The practice of HeartMath tools has helped people all
around the globe. You have now seen the results: People who
use the HeartMath techniques have gained an understanding
about how they react to small or annoying events and
changed their responses. This practice has helped them to
then change their responses to bigger events. They have
learned that the ability to throw their master switch to
HeartMath Studies 129
TABLE I: Diuretics
Generic Name Trade Name
Bumetanide Bumex
Chlorthalidone Hygroton
Ethacrynic acid Edecrin
Furosemide Lasix
Hydrochlorothiazide (HCTZ) HydroDIURIL, Microzide
Indapamide Lozol
Metolazone Zaroxolyn, Mykrox
Torsemide Demadex
Acebutolol Sectral
Atenolol Tenormin
Carvedilol Coreg
Labetalol Normodyne, Trandate
Metoprolol Lopressor, Toprol
Nadolol Corgard
Pindolol Visken
Propranolol Inderal
Classes of Drugs Used to Treat Hypertension 137
ACE Inhibitors
Benazepril Lotensin
Captopril Capoten
Enalapril Vasotec
Fosinopril Monopril
Moexipril Univasc
Perindopril Aceon
Quinapril Accupril
Ramipril Altace
Trandolapril Mavik
ARBs
Candesartan Atacand
Eprosartan Teveten
Irbesartan Avapro
Losartan Cozaar
Olmesartan Benicar
Telmisartan Micardis
Valsartan Diovan
138 The HeartMath Approach to Managing Hypertension
Amlodipine Norvasc
Diltiazem Cardizem, Tiazac
Felodipine Plendil
Nicardipine Cardene
Nifedipine Procardia, Adalat
Verapamil Calan, Isoptin, Verelan
Eplerenone Inspra
Spironolactone Aldactone
Doxazosin Cardura
Prazosin Minipress
Terazosin Hytrin
Classes of Drugs Used to Treat Hypertension 139
Clonidine Catapres
Guanabenz Wytensin
Methyldopa Aldomet
Hydralazine Apresoline
Minoxidil Loniten
Learn More About
HeartMath
emWave PC
Powered Stress Relief System (formerly known as the
Freeze-Framer )
The emWave PC is a patented interactive learning system
with a heart rhythm monitor and pulse sensor. This soft-
ware-based program allows you to observe your heart
rhythms in real time and assists you in increasing coherence
to reduce stress and improve health and performance
Learn More About HeartMath 143