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Chiropractors Managing Hypertension 

Alex Vasquez, DC, ND, DO

This article was originally published in Dynamic Chiropractic – June 17, 2010 and has since been replaced by Inflammation Mastery 4th Editionthe complete work, book ISBN 0990620484, digital ebook ASIN B01KMZZLAQ and Textbook of Clinical Nutrition and Functional Medicine, Volume 2, ISBN 0990620441 digital ebook ASIN B01IFU4RQO

From my perspective, appropriate management of chronic hypertension relies on three primary premises:

  1. Nutritional, lifestyle, and manipulative interventions should be the treatments of choice for essentially all patients with chronic primary hypertension.

  2. As the only nationally licensed health care discipline with training in nutritional, lifestyle and manipulative interventions, the chiropractic profession could play a premier national role in the management of chronic hypertension.

  3. Pharmacosurgical interventions are important for medical causes and recalcitrant cases of hypertension. Since premises #2 and #3 are founded upon or associated with premise #1, I will provide some substantiation here for premise #1.

As a diagnosis and clinical disorder affecting approximately 25 percent of American adults, hypertension is the single most common diagnosis in family medicine. By "chronic hypertension," I am referring to the 90 percent of all hypertension cases labeled as "primary," "essential" or "idiopathic" - i.e., those that lack any routine "medical" cause, such as hypercalcemia, hyperaldosteronism, aortic coarctation, renovascular disease, renal parenchymal disease, systemic sclerosis, drug iatrogenesis, hyperthyroidism or hypothyroidism.


Chronic hypertension accelerates the development of atherosclerosis and is thus a major risk factor for stroke and myocardial infarction. Additionally, the physiologic consequences of sustained high blood pressure contribute to the development of congestive heart failure, hypertensive retinopathy, and hypertensive kidney disease. Of course, combining chronic hypertension with other risk factors such as smoking, diabetes mellitus, and dyslipidemia causes an exponential increase in the risk for catastrophic cardiovascular morbidity and mortality.

     Because management of hypertension is the single most effective means for reducing premature morbidity and mortality in developed nations, it ranks highly among the most important public health issues in America, Canada, Australia, Japan, England and most of Western Europe, while still being important in South America, the Middle East, and Asia. In other words, chronic hypertension is a worldwide health disorder of the highest clinical and public health importance.

     The safest, most effective and most appropriate treatments for the vast majority of cases of chronic hypertension fall within chiropractic scope of practice: nutritional intervention and manipulative therapy. Many dietary and nutritional interventions are impressively well-documented in the research literature; because these interventions are also preferred by patients and are preferentially utilized clinically by many doctors, all three criteria for evidence-based medicine are satisfied (research substantiation, clinician utilization, and patient preference).


Nutritional Treatment: Most chiropractors are probably unaware that the most effective nutritional treatment for chronic hypertension has been researched and documented by Dr. Alan Goldhamer, a chiropractic doctor and graduate of Western States Chiropractic College (now University of Western States). Writing in the June 2001 issue of the Journal of Manipulative and Physiological Therapeutics, Dr. Goldhamer and colleagues showed that the combination of improved diet and fasting normalized blood pressure in nearly 90 percent of 174 consecutive patients with hypertension. The average blood pressure reduction was -37/-13 mm Hg with the use of diet and fasting. In contrast, when hypertension is managed with drugs, achieving a reduction in blood pressure of -20/-10 mm Hg generally requires at least two medications. Patients with systolic blood pressure greater than 180 mm Hg or diastolic blood pressure greater than 110 mm Hg (or both) had an average reduction of 60/17 mm Hg by the end of the treatment period; again, these results are highly significant, both statistically and clinically. In October and December 2002 in the Journal of Alternative and Complementary Medicine, Dr. Goldhamer again showed that drug-free dietary intervention was highly effective and could save employers and insurers thousands of dollars per patient, with additional savings expected to result from improved overall health and the continued implementation of health-promoting dietary and lifestyle changes. Dr. Goldhamer's diet and fasting intervention was performed on an inpatient basis; with appropriate patient selection, variations on supplemented fasting can be performed on an outpatient basis with once or twice weekly clinical evaluation.

     The five-part "supplemented Paleo-Mediterranean diet" which I first detailed in the September 2005 issue of Nutritional Wellness, can also be used to promote and maintain long-term reductions in blood pressure and to enhance overall health.2 In addition to specific diet modifications, certain nutritional supplements should be used in the routine treatment of chronic hypertension. Nutritional supplements with evidence-based substantiation in the research literature include but are not limited to coenzyme Q10, vitamin D, magnesium, vitamin C, L-carnitine and acetyl-L-carnitine. 

     Beyond the direct and collateral benefits provided by dietary and nutritional supplementation are the synergistic benefits obtained when dietary improvement is combined with nutritional supplementation (rather than diet alone or supplementation alone). Chiropractic doctors need to know how to use these nutritional interventions safely and effectively. Important clinical characteristics of a given treatment include: 1) expected blood pressure reduction from each treatment; 2) collateral benefits,; 3) drug interactions; 4) risks of therapy; 5) identification of responsive or resistant patient groups; and 6) how to implement nutritional interventions in patients taking pharmaceutical drugs.


Spinal Manipulation: Documentation of the effectiveness of chiropractic spinal manipulation in the treatment of chronic hypertension was most recently published in the May 2007 issue of the Journal of Human Hypertension by Bakris and colleagues. In this randomized trial with 50 hypertensive patients, blood pressure reductions were -17/-10 mm Hg in the treatment group receiving upper cervical chiropractic spinal manipulation versus -3/-2 mm Hg in the placebo group. The importance of this research is at least threefold. First, obviously it shows that elevated blood pressure can be normalized without drugs; not all health professionals respect this fact. Second, it shows specifically that upper cervical chiropractic treatment can lower blood pressure to a clinically meaningful degree in patients with chronic hypertension. Third and perhaps most important, by showing that cervical spine manipulation can reverse hypertension, this research delivers a paradigm shift in the understanding of the pathophysiology of hypertension. Up until recent years, most of the pathophysiology of chronic hypertension was ascribed to "idiopathic," neurohormonally mediated changes in renal handling of salt and water; this formed the basis for the medical treatment of chronic hypertension, which was and remains largely focused on the use of diuretics to increase excretion of salt and water. By showing that upper cervical manipulation substantially alleviates chronic hypertension, we have a new paradigm for expanding our concept of the phenomenon of chronic hypertension, namely that chronic hypertension appears to be mediated in part by neurovascular compression at the brainstem.  Although successful treatment of this apparently common neurovascular or "neurogenic" hypertension can be accomplished surgically, I am sure that most clinicians would appreciate the value and safety of a nonsurgical (manipulative) approach, especially one that can be delivered within an integrative clinical context of dietary improvement, nutritional supplementation and wellness coaching. By virtue of being the only nationally licensed health care profession with training in spinal manipulation/adjusting, diet therapy, nutritional supplementation, and wellness coaching, the chiropractic profession is poised to deliver a packaged solution to the public health catastrophe known as chronic hypertension. The additive and synergistic benefits of such an approach hold enormous promise to improve the health of patients in America, and worldwide.


Conclusions: Given that about one in four adult Americans has hypertension and that the chiropractic profession is poised to deliver evidence-based, comprehensive care for these patients, 65 million hypertensive American patients and potential patients stand to benefit from integrative chiropractic care. The question that now remains is, will the chiropractic profession stand and deliver the science-based integrative care these patients need?

Citations: Janetta, et al., in the Annals of Surgery, March 1985; and Geiger, et al., in Lancet, Aug. 8, 1998. For the updated protocol and citations, see Inflammation Mastery 4th Editionthe complete work, book ISBN 0990620484, digital ebook ASIN B01KMZZLAQ and Textbook of Clinical Nutrition and Functional Medicine, Volume 2, ISBN 0990620441 digital ebook ASIN B01IFU4RQO

Earlier books specific to hypertension:

  1. Chiropractic Management of Chronic Hypertension (March 2010)

  2. Integrative Medicine and Functional Medicine for Chronic Hypertension (March 2011)

  3. Integrative Chiropractic Management of High Blood Pressure and Chronic Hypertension: Second Edition (Sept 2011)

These books have been replaced by an updated monograph on hypertension and the differential diagnosis of high blood pressure; the new monograph is available in print and digital ebook versions in the following titles:

FOR CLARITY: Part of Chapter 5 from Inflammation Mastery 4th Edition was published separately as

Pain Revolution in color and later as

Brain Inflammation in discounted grayscale; the digital versions are identical.

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 New publication 2016:  Inflammation Mastery 4th Edition

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Textbook of Clinical Nutrition and Functional Medicine, vol. 2: Protocols for Common Inflammatory Disorders

  • Full-color ISBN: 9780990620440

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  • ISBN/EAN13:1530527112 / 9781530527113

  • Retail: US$120-160 plus shipping and handling

  • Discounted pricing available per the above hyperlink and discount code only.

  • This book is both 1) a stand-alone VOLUME TWO to follow the 2014 editions of Inflammation Mastery / Functional Inflammology, VOLUME ONE, and an excerpt from Inflammation Mastery 4th Edition, which is considered the "master work" of the updated and integrated protocols. Clearly, if you already have Inflammation Mastery 4th Edition then you do not need this book, because you already have it in Inflammation Mastery 4th Edition.

  • This work is written for clinicians already conversant in:

    • Chapter 1) Patient assessment, laboratory interpretation, risk management, hypothyroidism, hemochromatosis, 

    • Chapter 2) Wellness, Lifestyle-based Medicine, 

    • Chapter 3) Integrative pain management using nutrition, botanicals, and manipulative medicine, 

    • Chapter 4) Functional Inflammology Protocol: Diet, Polydysbiosis, Viral infections, nutritional immunomodulation, mitochondrial dysfunction, mTOR, ERS-UPR, orthoendocrinology, xenobiotic detoxification.

  • This most recent publication from ICHNFM.ORG is "Functional Medicine Clinical Protocols for Inflammatory Disorders: Functional Inflammology, Volume 2" (2016), which extends Volume 1 printed in color as "Functional Inflammology" (ISBN 0990620409) and grayscale as "Inflammation Mastery" 2014 (ISBN 1500545945); also updated and published in color in 2016 as a single volume as "Inflammation Mastery, 4th Edition" (ISBN: 0990620484). This work is the culmination of several thousand research publications combined with Dr Vasquez’s many years of clinical experience and teaching graduate/doctorate-level students and clinicians worldwide. With radiographs, photos, acronyms, illustrations, flowcharts, and detailed-yet-simplifying explanations, Dr Vasquez makes it easier than ever for clinicians to grasp important concepts in integrative care and functional medicine and then to translate the basic science research and molecular biology into treatment plans that can be explained and used in “the real world” of clinical practice with patients. 

  • Contents: The updated version of Chapter 5 from Inflammation Mastery, 4th Edition, starting with page 713
     1) Hypertension...727
     2) Diabetes Mellitus...819
     3) Migraine & Headaches...863
     4) Fibromyalgia...901
     5) Allergic Inflammation...984
     6) Rheumatoid Arthritis...1019
     7) Psoriasis and Psoriatic Arthritis...1038
     8) Systemic Lupus Erythematosus...1053
     9) Scleroderma & Systemic Sclerosis...1074
     10) Vasculitic Diseases...1094
     11) Spondyloarthropathies & Reactive Arthritis...1108
     12) Sjögren Syndrome/Disease...1119
     13) Raynaud's Syndrome/Phenomenon/Disorder...1127
     14) Clinical Notes on Additional Conditions: Behçet's Disease, Sarcoidosis, Dermatomyositis and Polymyositis...1131


  • The associated video tutorials and recorded live conference presentations further help students and clinicians “get it” via Dr Vasquez’s effective teaching style which embraces complexity while always emphasizing clinical applicability and psychosocial context. The Inflammation Mastery & Functional Inflammology series of books and videos translates important concepts and nutritional/biomedical science into easy and practical clinical applications for the prevention and treatment of disorders of sustained inflammation, which Dr Vasquez describes as “patterns of metabolic disturbance and inflammatory dysfunction” existing in three sequential and overlapping categories: 1) metabolic inflammation, 2) allergic inflammation, 3) autoimmune inflammation. This book includes access to video presentations which introduce the origin and components of the Functional Inflammology Protocol and FINDSEX® acronym. Post-publication updates to this information and important social and clinical contextualization are made available in videos and online repositories (access provided in the book), and the e-newsletter available from ICHNFM.ORG. This textbook also provides access, via reprints or hyperlinks, to Dr Vasquez’s published articles—an example of which is his recent paradigm-shifting editorial published in the journal Alternative Therapies in Health and Medicine (2014 January). Updated section on pain management allows students and clinicians to understand and apply manual, pharmacologic, nutritional/botanical medicine treatments for musculoskeletal pain, thereby providing better relief for patients and avoiding the hazards of NSAIDs, coxibs, steroids, opioids, immunosuppressants and biologics.

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