How to normalize your blood pressure naturally

The good news

The good news is that you can improve your blood pressure by way of simple lifestyle changes.

Medications are often prescribed to treat high blood pressure. In some cases this is often reasonable. But what if you could achieve improved, if not perfect, blood pressure with fewer pills or no pills at all? What if you could also experience improved weight, improved overall health, and no side effects?

We at DietDoctor are here to help! This guide will review the evidence and give you resources on how to normalize your blood pressure naturally.

For more background information on blood pressure, see our evidence based guides What is normal blood pressure and High blood pressure- What you need to know

Contents

1. Who needs blood pressure medication?
2. Causes of blood pressure
3. Five ways to lower your blood pressure

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1. When should hypertension be medicated?

The most recent update to the AHA hypertension guidelines refined how we classify hypertension.³ A systolic pressure between 120-129 and a diastolic above 80 is now classified as “elevated blood pressure.”⁴

A systolic pressure between 130-139 and diastolic 80-89 is now stage 1 hypertension, and a systolic greater than 140 or diastolic greater than 90 is now stage 2 hypertension.

Almost half of U.S. adults are now classified as having high blood pressure based on the updated definitions.⁵ But does this mean everyone with a diagnosis of hypertension needs medications? That depends on a detailed analysis of the risks, benefits, and alternatives to drug therapy.

Observational studies suggest that health risks begin to increase as we enter into the “elevated blood pressure” category, and conversely, having lower blood pressure correlates with less heart disease and longer life.⁶

This, however, is different than saying drug therapy to achieve lower blood pressure is universally beneficial. Instead, it shows that having naturally low blood pressure is beneficial.

What if we lowered blood pressure to normal levels with medications – wouldn’t that be just as beneficial?

The SPRINT trial

A 2015 study showed that people over age 50 with hypertension and additional cardiovascular risk factors lived longer and reduced the risk of heart disease if they used multiple medications to lower their systolic blood pressure all the way to 120.⁷

Unfortunately, this benefit comes with a significantly increased risk of side effects including the risk of falls, kidney disease, and loss of consciousness.⁸

Furthermore, the SPRINT trial studied people at high risk of heart disease such that only 1 in 6 people with hypertension would be included in the study.⁹ This means that for the vast majority of people, there is no evidence to support the practice of pushing blood pressure to 120 with medication.

While naturally low blood pressures are associated with longer life, reducing blood pressure to these levels with medications comes with risk.

Lifestyle first

To their credit, the guidelines recommend lifestyle therapy as a fundamental treatment for all stages of hypertension.¹⁰ For stage 1 hypertension, they recommend three months of lifestyle efforts before initiating medications.

For stage 2 hypertension without other serious risk factors for heart disease (as long as the blood pressure is less than 160/100 in a doctor’s office), the guidelines recommend confirmation with home blood pressure monitoring before initiating therapy.¹¹

But how often do clinicians start with drug therapy rather than providing detailed lifestyle guidance? And if they do provide lifestyle guidance, how often is it the standard “low-fat, eat less, move more” advice? Aside from anecdotal reports, we don’t have good data on how often that occurs, but data exists showing the relative ineffectiveness of standard weight loss advice.¹²

Medications aren’t always better

The ineffectiveness of standard lifestyle interventions is problematic, especially when there is a lack of convincing evidence that medication improves the outcomes of otherwise healthy people with Stage 2 hypertension.¹³

Another study was an extensive chart review of over 38,000 patients at low risk for heart disease with stage two hypertension treated with blood pressure medications. Over an average follow-up of almost six years, they found no reduction in the risk of heart disease events or risk of death with medication use. They did, however, find an increased risk for low blood pressure, fainting, and acute kidney injury among those treated with medications.¹⁴ The authors suggested that physicians exercise generalizing findings from data on high-risk individuals to those at lower risk.

The data are not as conclusive as guidelines may suggest. That is why we suggest working with your doctor to try lifestyle interventions before medications if it is safe.

Patients with diabetes

Recommendations for blood pressure control for type 2 diabetes are inconsistent. Since people living with type 2 diabetes are at increased risk of heart disease, guidelines from the AHA and ACC recommend a blood pressure goal of 130/80.¹⁵

However, the ACCORD trial as well as a meta-analysis of randomized trials suggest aggressive treatment to this level does not reduce cardiovascular events but may increase significant adverse events.¹⁶Thus, the latest recommendations from the American Diabetes Association set the target blood pressure for those with diabetes at 140/90.¹⁷

We feel the evidence supports that stage 1 hypertension and stage 2 in otherwise healthy individuals are best treated with lifestyle interventions. These lifestyle changes should target the underlying causes of high blood pressure and decrease the risk of long term complications. The use of medications should be individualized based on response to lifestyle changes, individual preference, and cardiovascular risk factors.

Summary

The following are approximate limits for the levels of blood pressure at which evidence supports that medications are appropriate:¹⁸

• Otherwise healthy individuals: Over 160/100¹⁹
• People living with diabetes or heart disease: Over 140/90
• Over age 50 with other cardiovascular risk factors who have not improved their BP with lifestyle interventions: Over 140/90

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2. Reasons for high blood pressure

Anyone with a new diagnosis of hypertension should see their healthcare provider to ensure there isn’t a reversible or dangerous cause of their elevated blood pressure. These less common causes of high blood pressure comprise about 10% of all cases (such as kidney or adrenal disorders, certain medications or supplements, etc.).²⁰

By far and away, the most common type of elevated blood pressure is called primary or essential hypertension. Essential hypertension is often part of metabolic syndrome, also known as syndrome X or insulin resistance syndrome.²¹

The above health problems are grouped together because they often appear as a cluster of symptoms in one individual. People with elevated blood pressure often carry extra weight around their belly, and they’re also likely to be at risk for high blood sugar and type 2 diabetes.

The good news is: if you can get to the root cause, you can often improve all these markers with one simple lifestyle change.²²

Read more about causes of hypertension in our guide on high blood pressure

The common cause

It is often difficult to find one solitary cause for hypertension. Age, obesity, sedentary lifestyle, smoking and others all increase the risk for hypertension.²³

However, metabolic syndrome has become a global epidemic and a major cause of not only hypertension but fatty liver, type 2 diabetes, heart attack and stroke. The major forces fuelling this epidemic are consumption of ultra-processed high-calorie, high-carbohydrate foods.²⁴ The end result is increased insulin levels with increasing insulin resistance.²⁵

High insulin and high blood pressure

Insulin is the main energy-storing hormone in the body. Too much insulin can therefore lead to becoming overweight in the long run.²⁶ Elevated insulin levels can lead to the accumulation of fluid and salt in the body which increases blood pressure.²⁷

High levels of insulin can thicken the tissue around blood vessels (the so-called smooth muscle), which also may contribute to an elevated blood pressure.²⁸ In addition, hyperinsulinemia can directly contribute to other processes that lead directly to heart disease.²⁹

Therefore, it makes sense that interventions aimed at reducing insulin levels and improving insulin resistance will greatly improve metabolic syndrome, hypertension, and cardiovascular risk.

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3. Lifestyle changes for a healthier blood pressure

There are several possible lifestyle changes you can make to lower your blood pressure, five of which we list below. The first one is likely the most important since it addresses the most common cause of high blood pressure:

1. Address metabolic syndrome with low-carb nutrition

There is growing evidence that reducing sugars and starches (carbohydrates) in the diet can improve metabolic syndrome and hypertension, especially as part of a low-carb diet.³⁰ Despite this, many guidelines for hypertension recommend eating a DASH diet that is low in fat and emphasizes increased intake of whole grains.³¹ That may be a shortsighted recommendation given the data suggesting low-carb diets are equally, if not more, effective than low-fat diets for improving high blood pressure and metabolic syndrome.

For example, one study demonstrated that a low-carb diet improved blood pressure more than a low-fat diet plus the weight loss drug Orlistat.³² A review of multiple randomized controlled trials concluded that low-carb diets were more effective than low-fat diets for weight loss and reducing blood pressure and other cardiovascular risk factors.³³

As a bonus, low-carb nutrition not only improves blood pressure, but it also improves all five markers of the metabolic syndrome.³⁴

This not only works in scientific studies but also in real life with numerous anecdotal reports of success.

A low-carb diet for beginners

2. To salt or not to salt

Eating less salt may lower your blood pressure a little.

However, despite various trials showing a slight reduction of blood pressure with lower sodium diets, we lack contemporary evidence that less salt in our food will affect the risk of heart disease or death. This was shown in a recent meta-study of all RCTs on the subject.³⁵

In addition, it’s unclear if sodium reduction is as important as increasing potassium.³⁶ Since potassium comes from whole foods, such and veggies and avocados, it’s possible that a diet with higher sodium minimally-processed-foods would still have a beneficial effect on blood pressure.

Since much of the salt we ingest comes from fast food, ready-made meals, bread and soft drinks, low-carb diets automatically lower salt intake as these foods are avoided. Furthermore, the hormonal effects of LCHF make it easier for the body to dispose of excess salt through urine; this can explain the slight lowering of blood pressure.³⁷

Lastly, large observational trials such as the PURE study, suggest the healthiest populations eat a moderate amount of sodium, with higher risk seen at extremely high and low levels of sodium intake.³⁸

With all the conflicting evidence, it’s unclear whether you will become healthier by eating less salt or not. However, if you stick to a low carb diet, you should be able to enjoy salt in moderation (4-7 grams of sodium per day or about 2 to 3 teaspoons of salt) without excess risk.³⁹

More about salt and health

3. Eliminate other things which increase blood pressure

Blood pressure can sometimes be lowered simply by avoiding the things that drive it up. Here are a few common causes of elevated blood pressure:⁴⁰

• Common painkillers (so-called non-steroidal anti-inflammatory drugs, NSAID), can increase your blood pressure by inhibiting the production of salt in your kidneys. This includes over-the-counter pills such as Ipren, Ibumetin, Ibuprofen, Diklofenak and Naproxen as well as the prescription drug Celebra. Painkillers with the active substance paracetamol are better for your blood pressure.
• Cortisone pills, such as Prednisolon(prednisone), dexamethasone, or hydrocortisone
• Birth control pills (for some people this may be an issue, you may want to discuss other options with your health care provider)
• Coffee (caffeine)
• Alcohol in large amounts
• Nicotine (smoking, other forms of tobacco) can give dramatic short-lived rises in blood pressure of 15-20 units
• Drugs such as amphetamine and cocaine
• Black licorice in large amounts

This doesn’t mean it’s imperative to abstain from coffee or alcohol completely; however, if you are a big “user” it may be wise to decrease your intake. On the other hand, it’s always a good idea to completely stop smoking: kicking a smoking habit is excellent for your health in general, not just your blood pressure.

4. Exercise

Regular exercise can play an important role in blood pressure management. Although exercise can increase blood pressure acutely, it tends to lower blood pressure long-term.⁴¹

Exercise not only reduces blood pressure but is also associated with a reduced risk of death and many other chronic conditions.⁴² A large review of almost 400 randomized trials among ~40,000 patients showed that exercise and anti-hypertensive drugs were similarly effective in patients with hypertension.⁴³

Learn more about the beneficial effects of exercise in our evidence-based guide on exercise and health.

5. Intermittent fasting

Intermittent fasting makes sense from a mechanistic perspective as intermittent fasting can reduce insulin and improve weight loss, both of which can improve blood pressure.⁴⁴ Some studies show intermittent fasting is associated with reduced systolic blood pressure.⁴⁵

However, not all studies agree, and varying definitions of intermittent fasting limit the generalization of the data.⁴⁶

Read more about intermittent fasting and time restricted eating in our medically reviewed guides.

Follow up your blood pressure

When making lifestyle changes, it is helpful to follow your blood pressure regularly. This can be done at your doctor’s office, or even better on your own. Just make sure you bring your home blood pressure monitor in to your doctor’s office on occasion to make sure it matches with their readings.

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Conclusion:

The definitions of elevated blood pressure have changed recently, which acknowledges the importance of being aware of blood pressure and the importance of lifestyle interventions to naturally improve it.

Too often medications are resorted to when lifestyle interventions may be a better option.

We should focus on the lifestyle interventions that reverse the root cause of hypertension by addressing the underlying metabolic diseases.

Medications still have a place for severely elevated pressure or pressure that does not improve with lifestyle interventions. However, if we can reverse the underlying cause, that is a much more powerful intervention than suppressing the symptom.

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