How to normalize your blood pressure naturally

Elevated blood pressure (hypertension) is a common health issue.

High blood pressure isn’t necessarily something you can feel, but it remains one of the most important commonly identified risk factors for serious conditions such as strokes and heart attacks.1

Therefore, it is helpful to know your numbers, understand what they mean, and know what you can do about it.2

The good news

While medications are commonly needed to treat hypertension, the good news is that you can often lower your blood pressure by way of simple lifestyle changes.

Even better, these lifestyle changes can also help you lose weight and improve your overall health.

This guide will review the evidence and give you resources explaining 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


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

1. When should hypertension be medicated?


Hypertension is classified according to the AHA hypertension guidelines.3

A systolic pressure between 120-129 or a diastolic above 80 is considered “elevated blood pressure.”4

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

Almost half of U.S. adults are classified as having high blood pressure based on current guidelines.5 But does this mean everyone with a diagnosis of hypertension needs medication? 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.6

This implies that you should keep your blood pressure within the normal range. But what’s the best way to do that? We suggest that if you can normalize blood pressure with lifestyle modifications, that will likely be better than normalizing it with medications.7

The SPRINT trial

A large 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 120.8

Although the benefit of intensive treatment was significant, there was also an increased risk of side effects including kidney injury, fainting, and electrolyte abnormalities.9

We should also note that the SPRINT trial studied people at high risk of heart disease, making it difficult to extrapolate the benefits of intensive treatment to people at lower risk.10

This means that for lower risk individuals, it’s unclear if the risks of intensive treatment outweigh the benefits.

Lifestyle first

To their credit, the guidelines recommend lifestyle therapy as a fundamental treatment for all stages of hypertension.11 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.12

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 we do have studies showing the relative ineffectiveness of standard weight loss advice.13

Medications aren’t always better

Randomized controlled trial evidence suggests that medication either does not improve or barely improves the outcomes of otherwise healthy people with Stage 2 hypertension.14

Observational studies of low-risk patients with mild hypertension, like one extensive chart review of over 38,000 patients, have found no reduction in the risk of heart disease events or risk of death with medication use.15

We believe that it is inappropriate to generalize the findings from data examining high-risk individuals to those at lower risk. Not only is the benefit of treatment questionable, but the risk of significant side effects is clearly elevated.

Therefore, if your blood pressure is mildly elevated and you are otherwise healthy, we suggest discussing with your doctor if it is appropriate for you to try lifestyle interventions before medications.

Patients with diabetes

People with type 2 diabetes have an increased risk of heart disease, so the findings from trials looking at low-risk subjects with mild hypertension cannot necessarily be applied to them.

Current American Heart Association/American College of Cardiology guidelines recommend a blood pressure goal of less than 130/80. The American Diabetes Association recommends treating most people with diabetes to less than 140/90, reserving the lower goal of 130/80 for higher-risk people in whom the potential benefits outweigh the risks.16

Although the evidence is clear that risk is reduced by lowering blood pressure to less than 140/90, it is less clear that targeting blood pressure to even lower levels further reduces risk in people with diabetes. One major trial (ACCORD) attempted to answer this question and found that lowering systolic blood pressure to less than 120 did not reduce total atherosclerotic cardiovascular events, but it did significantly increase the risk of serious side effects.17


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

  • Otherwise healthy individuals: Guidelines suggest starting medication AND lifestyle therapy if blood pressure is above 140/90.19 However, we suggest discussing with your doctor if lifestyle therapy alone is a reasonable first step.
  • People living with diabetes: Over 140/90
  • Over age 50 with other cardiovascular risk factors who have not improved their BP with lifestyle interventions: Over 140/90

2. What causes 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 that requires specific treatment. These so-called “secondary” causes of high blood pressure comprise about 5-10% of all cases (such as kidney or endocrine disorders, sleep apnea, vascular abnormalities, certain medications or supplements, etc.).20

The most common type of elevated blood pressure, however, is called primary or essential hypertension. Essential hypertension typically does not have a single, discernible cause.

However, we know that a number of risk factors predispose individuals to developing essential hypertension. These risk factors include obesity, sedentary lifestyle, high levels of alcohol consumption, smoking, stress, family history, and genetics.21

We are particularly interested in the role that obesity plays in the development of high blood pressure, as studies suggest that roughly 70% of the risk for primary hypertension is attributable to obesity. This is especially true for weight gain around the midsection, which tends to be associated with accumulation of fat in and around abdominal organs such as the liver, and can also be associated with insulin resistance.22

There are numerous complex mechanisms — incompletely understood — by which obesity appears to raise blood pressure. Suffice it to say that weight gain causes multiple hormonal changes within the kidneys, adrenal glands, and elsewhere that contribute to high blood pressure. In addition, obesity activates the sympathetic nervous system, which also affects blood pressure. Finally, obesity leads to insulin resistance, glucose intolerance, abnormal lipid levels, and inflammation, all of which can be associated with high blood pressure.23

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 describe below. The first one is likely the most important since it addresses the most common risk factor for high blood pressure:

1. Address obesity and metabolic syndrome with low-carb nutrition

Abdominal obesity and hypertension are often found together with other cardiovascular disease risk factors – this is referred to as metabolic syndrome.24 There is growing evidence that reducing sugars and starches (carbohydrates) in the diet can improve metabolic syndrome and hypertension.25

Further, there have been many trials over the years showing that low-carb diets are either better or equivalent to low-fat diets when it comes to weight loss and improvement in cardiovascular risk markers.26

Many individuals who adopt a low-carb or ketogenic diet see a rapid reduction in blood pressure. The Virta study of cardiovascular disease markers found that diastolic blood pressure measurements dropped significantly in participants and 11.5% were able to stop high blood pressure medications.27

However, there is still uncertainty about the long term blood pressure-lowering benefits of a low-carb diet, and whether the effect is due to weight loss alone or from an added benefit of lowering carbohydrates.28

Why does low-carb nutrition work? Research is still preliminary, but a number of mechanisms are theorized: weight loss, lower levels of circulating insulin, reduced insulin resistance, improved insulin sensitivity, reduction in sodium retention by the kidney, lowered blood sugar, and others.29

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 saltsalt

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 definitive evidence that less salt in our food will reduce the risk of heart disease or death.30

In addition, it’s unclear if sodium reduction is as important as increasing potassium.31 Some studies suggest that the sodium-to-potassium ratio is better at predicting cardiovascular disease and death than the intake of either nutrient alone.32

Regardless of whether sodium or potassium is more important, we should note that much of the salt we ingest comes from fast food, ready-made meals, bread and soft drinks. Therefore, most low-carb diets automatically lower salt intake, because these foods are avoided.33 Furthermore, when starting a low-carb diet, insulin levels tend to drop, which is thought to help explain why blood pressure drops on low carb.34

Lastly, large observational trials, such as the PURE study, suggest that the risk of heart attack and death increases with sodium intakes less than 3000mg and greater than 7000mg per day. Moderate intakes between these amounts were not associated with increased risk.35

With all the conflicting evidence, it’s unclear whether you will become healthier by eating less salt. 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.36

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:37

  • Medications: a number of prescriptions and over-the-counter drugs have side effects that include increasing blood pressure. These include:
    • Oral contraceptives and hormone replacement therapy, especially with higher estrogen doses.38
    • Oral decongestants found in some cold and allergy medications.39
    • Non-steroidal anti-inflammatories (NSAIDs) for pain relief and inflammation.40
    • Stimulant drugs used to treat Attention Deficit Hyperactivity Disorder (ADHD), especially mixed amphetamine salts (Adderall).41
  • Coffee (caffeine).
  • Alcohol in large amounts.
  • Nicotine (smoking and smokeless tobacco) can give dramatic short-lived rises in blood pressure of 15-20 points.
  • Herbal supplements including St. John’s Wort, ginseng, ginkgo, blue kohosh.42
  • Recreational drugs such as methamphetamine and cocaine.
  • Licorice. A compound in licorice root called glycyrrhizin — which is found in licorice-flavored herbal teas, candies, lozenges, and herbal remedies — is a very potent blood pressure-raising agent. Its use has prompted a number of case studies and a warning from the US Food and Drug Administration.43
  • 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 modestly lower blood pressure long-term.44

    Exercise not only reduces blood pressure but is also associated with a reduced risk of death and many other chronic conditions.45 A large review of almost 400 randomized trials including ~40,000 patients showed that exercise and anti-hypertensive drugs were similarly effective in patients with hypertension.46

    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, because it can reduce insulin and improve weight loss, both of which can improve blood pressure.47 Some studies show intermittent fasting is associated with reduced systolic blood pressure.48

    However, not all studies show an effect, and varying definitions of intermittent fasting limit the generalizability of the data.49

    Read more about intermittent fasting and time restricted eating in our evidence-based 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.


    We should focus on lifestyle interventions that address some of the root causes of hypertension, reserving medications for blood pressure that is very high or isn’t responsive to these interventions.

    With good diet, exercise, and avoidance of substances that raise blood pressure, it is often possible to improve hypertension without medications.

    How to normalize your blood pressure - the evidence

    This guide is written by Dr. Andreas Eenfeldt, MD and was last updated on July 13, 2022. It was medically reviewed by Dr. Michael Tamber, MD and Dr. Bret Scher, MD on July 13, 2022.

    The guide contains scientific references. You can find these in the notes throughout the text, and click the links to read the peer-reviewed scientific papers. When appropriate we include a grading of the strength of the evidence, with a link to our policy on this. Our evidence-based guides are updated at least once per year to reflect and reference the latest science on the topic.

    All our evidence-based health guides are written or reviewed by medical doctors who are experts on the topic. To stay unbiased we show no ads, sell no physical products, and take no money from the industry. We're fully funded by the people, via an optional membership. Most information at Diet Doctor is free forever.

    Read more about our policies and work with evidence-based guides, nutritional controversies, our editorial team, and our medical review board.

    Should you find any inaccuracy in this guide, please email

    1. American Journal of Hypertension 1994: Established risk factors and coronary artery disease: the Framingham Study [overview article; ungraded]

    2. NEJM 1999: Hypertension. Silent killer [overview article; ungraded]

    3. Hypertension 2018: 2017 ACC AHA AAPA ABC ACPM AGS APhA ASH ASPC NMA PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [overview article; ungraded]

    4. Systolic refers to the upper number and ist the pressure when then heart contracts to pump out blood. Diastolic refers to the bottom number which is the pressure that remains when the heart relaxes. Blood pressure of 120-129/80 was previously in the pre-hypertension range, a category the AHA has now eliminated.

    5. These data come from 2019 CDC statistics as posted on the government website.

    6. Hypertension 2005: Blood Pressure in Adulthood and Life Expectancy With Cardiovascular Disease in Men and Women [observational study; very weak evidence]

    7. We are not aware of any studies that explicitly compare normal BP achieved naturally versus with medications. However, it makes sense that you would want to avoid potential medication side effects. In addition, lifestyles that improve BP also frequently help with weight loss and improve blood sugar, thereby providing extra benefits.

    8. The subjects in this study were over age 50 and at high risk for cardiovascular disease. The “intensive-treatment” group achieved an average systolic of 121.4, while the “standard-treatment” group was treated to 136.2.

      NEJM 2015: A randomized trial of intensive versus standard blood-pressure control [moderate evidence]

    9. The risk of falls was equivalent between the two groups; we don’t know if untreated subjects would have had a lower risk of falling, because there was no untreated group.

      Major New Study: Getting Blood Pressure Below 120 Saves Lives – and Increases Risks

    10. This study shows that only 1 in 6 U.S. adults with treated hypertension have similar characteristics to the study subjects in SPRINT.

      Journal of the American College of Cardiology 2016: Generalizability of SPRINT Results to the U.S. Adult Population [observational study, very weak evidence]

    11. Hypertension 2018: 2017 ACC AHA AAPA ABC ACPM AGS APhA ASH ASPC NMA PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [overview article; ungraded]

    12. Many people will have high blood pressure in the office and normal blood pressure at home – so called “white coat hypertension.”

      Clinical and Experimental Pharmacology and Physiology 2014: White-coat hypertension [overview; ungraded]

    13. Journal of the American Medical Association 2019: Trends in self-perceived weight status, weight loss attempts, and weight loss strategies among adults in the United States, 1999-2016 [observational study; very weak evidence]

      The following systematic review of RCTs and case series found high attrition rates and high rates of weight regain in the programs that showed initial success.

      Annals of Internal Medicine 2005: Systematic review: an evaluation of major commercial weight loss programs in the United States
      [systematic review of randomized trials and case series; moderate evidence]

    14. Stage 2 hypertension is a systolic blood pressure of 140-159 and/or diastolic of 90-99.

      This systematic review showed no difference in heart attack, stroke, or death between treated and untreated groups with mild hypertension.

      Cochrane Reviews 2012: Benefits of antihypertensive drugs for mild hypertension are unclear [systematic review of randomized trials; strong evidence]

      This systematic review, unlike the one above, included trials with large numbers of subjects with diabetes. It showed statistically significant improvements for some cardiovascular endpoints, but the magnitude of benefit was very small. For example, the cohort without diabetes showed an absolute risk reduction for cardiovascular events of 0.3 percent over 5 years.

      Annals of Internal Medicine 2015: Effects of blood pressure reduction in mild hypertension: a systematic review and meta-analysis [strong evidence]

    15. The following study looked at subjects over an average six year period. It found no benefit to treatment but did find that medications increased the risk of low blood pressure, fainting, electrolyte abnormalities, and acute kidney injury.

      JAMA Internal Medicine 2018: Benefits and harms of antihypertensive treatment in low-risk patients with mild hypertension [observational study, weak evidence]

    16. Randomized clinical trials of people with diabetes have consistently shown that lowering blood pressure to less than 140/90 reduces the risk of heart attack, stroke, and death.

      Hypertension 2018: 2017 ACC AHA AAPA ABC ACPM AGS APhA ASH ASPC NMA PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. [overview article; ungraded]

      Diabetes Care 2021: Cardiovascular disease and risk management: standards of medical care in diabetes — 2021
      [overview article; ungraded]

    17. ACCORD did show that more intensive blood pressure control reduced the risk of stroke, but at the expense of an increase in adverse events.

      NEJM 2010: Effects of intensive blood-pressure control in type 2 diabetes mellitus.[randomized trial; moderate evidence]

      Similarly, this meta-analysis of RCTs showed that the risk of stroke continued to decline with more intensive blood pressure control, but there was no reduction of risk for the blood vessels of the heart, kidneys, or eyes. There was, however, a dramatic increase in adverse events related to intensive treatment.

      Circulation 2011: Blood pressure targets in subjects with type 2 diabetes mellitus/impaired fasting glucose: observations from traditional and bayesian random-effects meta-analyses of randomized trials. [systematic review of randomized trials; strong evidence]

    18. Always check with your personal healthcare provider to see if medication is appropriate for you.

    19. Hypertension 2018: 2017 ACC AHA AAPA ABC ACPM AGS APhA ASH ASPC NMA PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. [overview article; ungraded]

    20. StatPearls 2021: Secondary hypertension [overview article; ungraded]

    21. Hypertension 2017: Trends in prehypertension and hypertension risk factors in US adults: 1999-2012. [overview article; ungraded]

    22. Circulation Research 2015: Obesity-induced hypertension: interaction of neurohumoral and renal mechanisms[overview article; ungraded]

      Nutrients 2013: Body fat distribution and insulin resistance[overview article; ungraded]

    23. Circulation Research 2015: Obesity-induced hypertension: interaction of neurohumoral and renal mechanisms[overview article; ungraded]

    24. One definition of metabolic syndrome is having three or more of the following markers:

      • Fasting blood glucose above 100mg/dL (5.5 mmol/L)
      • Elevated triglycerides above 150mg/dL
      • High density lipoproteins (HDL) below 40mg/dL in men and 50 in women
      • Elevated blood pressure above 130/85
      • Increased abdominal obesity with a waist circumference over 40 inches in men and 35 inches in women.

      Arteriosclerosis Thrombosis and Vascular Biology 2004: Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition [overview article; ungraded]

    25. PLoS One 2020: The effects of low-carbohydrate diets on cardiovascular risk factors: A meta-analysis [strong evidence]

      This trial showed greater improvement in metabolic syndrome markers with carbohydrate restriction, even without any weight loss.

      JCI Insight 2019: Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss. [randomized trial; moderate evidence]

    26. This 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.

      Obesity reviews 2009: Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its co-morbidities. [strong evidence]

      This review showed that low-carb diets are effective for improving cardiovascular risk factors.

      Obesity Reviews 2012: Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. [systematic review of randomized trials; strong evidence]

    27. Cardiovascular Diabetology 2018: Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open label, non-randomized, controlled study [weak evidence]

    28. BMJ 2020: Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials [systematic review of randomized trials; strong evidence]

    29. International Journal of Environmental Research and Public Health 2019: Substantial and sustained improvements in blood pressure, weight and lipid profiles from a carbohydrate restricted diet: an observational study of insulin resistant patients in primary care [cohort study; very weak evidence]

    30. Although the original paper found a mild benefit of salt restriction in certain subgroups, the authors published a correction to their paper with an updated statistical analysis that they believe more accurately reflects the conclusions that can be drawn from the available evidence. Their corrected analysis shows no benefit of salt restriction on mortality in normotensive or hypertensive people.

      Annals of Internal Medicine 2019: Effects of nutritional supplements and dietary interventions on cardiovascular outcomes: An umbrella review and evidence map [systematic review of RCTs; strong evidence]

      This meta-analysis of RCTs failed to show that reducing salt decreased cardiovascular outcomes or mortality.

      Cochrane reviews 2011: Reduced dietary salt for the prevention of cardiovascular disease [systematic review of randomized trials; strong evidence]

      In addition, in contrast to the WHO and AHA, the Institute of Medicine (IOM) concluded that there was no convincing evidence that lowering sodium intake to less than 2300mg per day improves health outcomes or death.

      Advances in Nutrition 2014: Institute of Medicine. 2013. “Sodium intake in populations: assessment of evidence.” Washington, DC: The National Academies Press, 2013 [overview article; ungraded]

    31. Potassium seems to have the same effect on the kidney as a blood pressure medication called a thiazide diuretic.

      Transactions of the American Clinical and Climatological Association 2015: Why Your Mother Was Right: How Potassium Intake Reduces Blood Pressure[randomized trial; moderate evidence]

      America Journal of Epidemiology 1994: Urinary electrolyte excretion in 24 hours and blood pressure in the INTERSALT Study. II. Estimates of electrolyte-blood pressure associations corrected for regression dilution bias. The INTERSALT Cooperative Research Group. [observational study, weak evidence]

    32. American Journal of Physiology: Endocrinology and Metabolism 2017: Cardiovascular benefits associated with higher dietary K + vs. lower dietary Na +: evidence from population and mechanistic studies[overview article; ungraded]

    33. Most low-carb diets are also higher in potassium than a standard American diet, as they contain more potassium-rich whole foods and vegetables.

    34. Since insulin stimulates the kidneys to retain sodium, lowering insulin levels with a low-carb diet results in excretion of sodium by the kidneys, leading to lower blood pressure.

      Diabetologia 1981: The effect of insulin on renal sodium metabolism. A review with clinical implications. [overview article; ungraded]

    35. The Lancet 2018: Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: a community-level prospective epidemiological cohort study [observational study with HR less than 2; very weak evidence]

    36. This is based on clinical experience of low-carb practitioners and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here [weak evidence].

      Occasionally, increased salt may be needed to replenish sodium losses during the first few weeks of a low-carb or ketogenic diet, during hot weather, or with strenuous physical activity. Just keep in mind that if you have salt-sensitive hypertension, you will need to be more cautious than most.

      If you have medical conditions such as high blood pressure, swelling, liver disease, heart failure, or are on blood pressure medications it is important to work with your health care provider.

    37. Journal of Clinical Hypertension 2008: Secondary hypertension: interfering substances. [overview article; ungraded]

    38. Uptodate 2018: Effect of hormonal contraceptives and postmenopausal hormone therapy on blood pressure [review, ungraded]

    39. Archives of Internal Medicine 2005: Effect of oral pseudoephedrine on blood pressure and heart rate [meta-analysis of RCTs; strong evidence]

    40. Journal of Clinical Hypertension 2007: Drug interactions and drugs that affect blood pressure [review; ungraded]

    41. Expert Review of Neurotherapeutics 2016: Alternative pharmacological strategies for adult ADHD treatment: a systematic review [expert review; ungraded]

    42. Plastic Reconstructive Surgery 2013: Herbal products that may contribute to hypertension [review article; ungraded]

      American Journal of Hypertension 2001: Herbs and supplements in the hypertension clinic [overview; ungraded]

    43. British Medical Journal Case Reports 2015: Hypertension induced by liquorice tea [case report and review of the literature; weak evidence]

    44. Journal of the American Heart Association 2020: Exercise reduces ambulatory blood pressure in patients with hypertension: a systematic review and meta-analysis of randomized controlled trials [strong evidence]

    45. These conditions include cardiovascular disease, diabetes, lipid disorders, breast and colon cancer, weight gain, frailty, and bone disease.

      International Journal of Behavior, Nutrition, and Physicial Activity 2020 A systematic review of the evidence for Canada’s Physical Activity Guidelines for Adults [review of randomized and nonrandomized studies, weak evidence]

    46. British Journal of Sports Medicine 2019: How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure [systematic review of randomized trials; strong evidence]

    47. Nutrition Review 2014: Time-restricted feeding and risk of metabolic disease: a review of human and animal studies [overview article; ungraded]

    48. Nutrition Journal 2012: Effects of Ramadan fasting on cardiovascular risk factors: a prospective observational study. [observational study, weak evidence]

      Journal of Diabetes and Metabolic Discordes 2013: The effects of modified alternate-day fasting diet on weight loss and CAD risk factors in overweight and obese women [nonrandomized study, weak evidence]

      Journal of the American Society of Hypertension 2018: The effect of intermittent fasting on blood pressure variability in patients with newly diagnosed hypertension or prehypertension [nonrandomized study, weak evidence]

    49. Blood Pressure Monitoring 2017: Trend of blood pressure in hypertensive and normotensive volunteers during Ramadan fasting [nonrandomized study, weak evidence]