Macronutrient and micronutrient deficiencies are very common in the general 
population and may be even more common in patients with hypertension and 
cardiovascular disease due to genetic, environmental causes and prescription 
drug use. The Hypertension Institute in Nashville, TN, has evaluated 
micronutrient deficiencies and oxidation status, in a group of hypertensive 
versus normotensive patients. There are significant differences in numerous 
intracellular micronutrients and oxidation status between these two groups. 
Replacement of the micronutrient deficiencies, as well as high-dose therapy of 
selected nutraceuticals in combination with optimal diet, exercise and weight 
management resulted in control of blood pressure to goal levels in 62% of the 
hypertensive population (as defined by JNC 7) over a period of 6 months with 
complete tapering and discontinuation of antihypertensive drugs. These 
deficiencies will have an enormous impact on present and future cardiovascular 
health and outcomes such as hypertension, myocardial infarction, stroke and 
renal disease and overall health costs. It is estimated that the annual savings 
in drug costs alone for the treatment of hypertension could be as much as US$10 
billion. Diagnosis and treatment of these nutrient deficiencies and improvement 
in oxidation status using functional intracellular assessments will reduce blood 
pressure, improve vascular health, endothelial dysfunction, vascular biology and 
cardiovascular events. Vascular biology assumes a pivotal role in the initiation 
and perpetuation of hypertension and target organ damage sequelae. Endothelial 
activation, oxidative stress, inflammation and vascular smooth muscle 
dysfunction are initial events that start hypertension. Nutrient-gene 
interactions determine a broad array of phenotypic consequences such as vascular 
problems and hypertension. Optimal nutrition, nutraceuticals, vitamins, 
antioxidants, minerals, weight loss, exercise, smoking cessation and moderate 
restriction of alcohol and caffeine in addition to other lifestyle modifications 
can prevent and control hypertension in many patients. An integrative approach 
combining these lifestyle suggestions with the correct pharmacologic treatment 
will best achieve new goal blood pressure levels, reduce cardiovascular risk 
factors, improve vascular biology and vascular health, reduce cardiovascular 
target organ damage and reduce healthcare expenditure. The expanded scientific 
roles for nutraceutical supplements are discussed in relation to the prevention 
and treatment of essential hypertension and cardiovascular diseases with 
emphasis on mechanisms of action and clinical integration with drug therapy with 
hypertension guidelines. It is the purpose of this paper to review only the 
hypertension clinical trials that have evaluated the clinical use and efficacy 
of nutrition, weight loss, exercise and selected nutritional supplements, 
vitamins, minerals and antioxidants. Numerous clinical trials have evaluated the 
use of nutritional supplements such as beta carotene, selenium, vitamin C and 
vitamin E in the prevention of coronary heart disease and stroke yielding 
conflicting results (positive, neutral and negative). In many of these clinical 
trials there are enormous clinical design problems, methodologic flaws, varied 
patient population, variable dose and type of vitamin use, improper selection of 
vitamin used and many other issues that make the studies difficult to interpret. 
It is beyond the scope of this paper to review these trials. The reader is 
referred to the vast literature on this subject.