P05.04. Essential Hypertension—A Cross-sectional Audit of Naturopathic Management Strategies in a Teaching Clinic

Focus Area: Integrative Approaches to Care A cross-sectional audit of patient charts was conducted in the Robert Schad Naturopathic Clinic (RSNC), the largest naturopathic teaching clinic in North America, to assess the management of essential hypertension (EH) compared to recommendations made by the Canadian Hypertension Education Program (CHEP). Objectives of this study included the assessment of adherence to 2012 CHEP guidelines, a survey of naturopathic modalities and treatments commonly used for EH in the RSNC, an analysis of efficacy of naturopathic interventions to reduce systolic and diastolic blood pressure (SBP and DBP), and the delivery of specific recommendations to improve EH management at the Canadian College of Naturopathic Medicine (CCNM) and the RSNC. Four hundred four patient charts were identified using the ICD-10 code assessment of I10 (Essential Hypertension). Two hundred eighteen files met inclusion criteria. Adherence to CHEP guidelines was measured using categories of (1) blood pressure measurements; (2) correct diagnosis/staging; (3) risk assessment, and (4) objective measures (including physical examination and laboratory investigation). Charts also were assessed for use of naturopathic interventions, for measures of SBP and DBP over time, and for laboratory markers of cardiovascular risk. Results demonstrate that common naturopathic modalities used were dietary interventions, lifestyle interventions, nutritional supplementation, and botanical medicine. Less frequently used modalities for the specific treatment of hypertension included traditional Chinese medicine, physical medicine, homeopathy, hydrotherapy, and counseling. Preliminary analysis indicates that supplementation of omega-3 fatty acids, coenzyme Q10, hibiscus, magnesium, hawthorne, and implementation of diet and exercise recommendations were most closely associated with significant reductions in SBP and DBP. Overall, audit data suggest that the RSNC clinical interns and naturopathic doctors fair well at utilizing and documenting a wide array of evidence-based naturopathic interventions with promising improvements in hypertension.