Hypertension, or high blood pressure, is the top cause of heart disease. Although medications are often prescribed, there are actually a handful of evidence-based, natural ways to lower blood pressure. Nonpharmacologic approaches can help many people to lower blood pressure into target ranges, allowing them to come off medications or reduce the dosage or number of medications they require. It can also be very effective at preventing high blood pressure in the first place! Let’s review the top 7 ways to lower blood pressure without medications.

Understanding high blood pressure

Blood pressure is the force of blood through your arteries at any given time. Hypertension, or high blood pressure, is when it’s higher than it should be - based on the new guidelines, hypertension is diagnosed when systolic blood pressure (the top number) is greater than 130 mmHg and diastolic blood pressure (the bottom number) is greater than 80 mmHg on several occasions.

It’s incredibly common, affecting almost half of all Americans and is a top risk factor for heart disease. It’s also silent until it’s not - meaning, many people won’t have any symptoms of high blood pressure, with their first symptom a heart attack or stroke.

Large-scale epidemiologic studies have definitively demonstrated that high blood pressure, at all ages and in all sexes and ethnicities, has a continuous graded association with the risk of stroke, heart disease, heart failure, and vascular disease - meaning as blood pressure goes up over 115/75 mmHg, so does risk. It’s also a top cause of kidney disease and dementia.

Head to a prior blog post here for an even bigger deep dive on blood pressure

Natural ways to lower blood pressure

1. Eat more potassium-rich plants

   The best studied diet to lower blood pressure is that of the Dietary Approaches to Stop Hypertension or DASH diet. It is a plant-predominant diet, which emphasizes vegetables, fruits, whole grains, nuts, and legumes (as well as lean protein and low-fat dairy if you consume animal products), minimizing refined sugar, saturated fats, and cholesterol. In the original trial, individuals randomized to this arm lowered their systolic blood pressure by 5.5 mmHg compared to a control diet, which was intended to mimic the standard American diet.

   While exact mechanisms are not entirely clear, it is likely in part due to the high potassium intake of fruits and vegetables. Randomized controlled trials administering potassium in the form of potassium chloride, have consistently demonstrated blood pressure reductions, likely due to the effect on the potassium/sodium index. As such a potassium-rich diet is encouraged, with a goal of 3500 to 5000 mg/day per the American College of Cardiology/American Heart Association for blood pressure lowering.

   Other potential pathways that plants may lower blood pressure include typically higher intakes of magnesium, fiber, plant protein, unsaturated fats, and fiber, all of which have been shown in some studies to lower blood pressure.

2. Cut down on sodium

   High dietary sodium intake (>2000 mg per day) has been associated with an increased risk of death from heart disease.

   A follow-up study to the above mentioned DASH diet, in which sodium consumption was restricted to less than 1500 mg/day (2/3 tsp salt), led to even further blood pressure reductions, demonstrating synergistic effects. Reducing sodium intake to below 1500 mg of sodium resulted in reductions in systolic blood pressure of 12 mmHg in those with hypertension, with smaller reductions in blood pressure seen with sodium intake below 2300 mg of sodium (1 tsp salt) and in those without high blood pressure.

   While reducing how much salt you add in your cooking is important, be mindful that the average person gets 75% of their sodium from processed and packaged foods. Be particularly mindful of canned foods (particularly canned soups), frozen entrees, chips, cookies, crackers, breads, dressings, and sauces.

   Additionally, while pink Himalayan sea salt is pretty, it still contains sodium (the same amount as regular table salt) so keep that in mind.

3. Exercise

   Regular physical activity, about 150 minutes a week, is also key to lowering blood pressure

   Aerobic exercise - the kind that gets you feeling short of breath, not casually reading People magazine on the elliptical - can decrease your systolic blood pressure by 5-8 mmHg independent of weight loss. The recommended amount is 30 to 40 minutes of true aerobic exercise at least 4 to 5 times per week. Blood pressure lowering effects have been demonstrated in all many forms of aerobic activity, including high-intensity, low-intensity, traditional continuous exercise, and interval training (alternating short bursts of intense activity with subsequent recovery periods of lighter activity), so any favorite form of exercise is a great option.

   Additionally, resistance training has been shown to also lower blood pressure independently of aerobic training by about 4-5 mmHg systolic. Isometric resistance (ie planks, wall sits) as well as dynamic resistance (ie biceps curl) have both been found to lower blood pressure. I wrote about resistance training and it’s impact on heart health here.

   Believe it or not, how physical activity lowers blood pressure is entirely clear, but is believed to be the result of dampening the sympathetic (“fight or flight”) nervous system, improving the functionality of the endothelium (inner lining of blood vessel wall), and decreasing peripheral vascular resistance.
   

4. Lose weight if above ideal body weight

   Research has found that increasing body mass index (BMI) has a nearly direct relationship with increased risk of high blood pressure. Risk may be additionally heightened in those who tend to have increased waist size, which in an indication of visceral adiposity.

   Weight loss, if indicated based on your body mass index or waist circumference, is one of the most effective lifestyle changes for controlling blood pressure. Losing even a small amount of weight if you're above ideal body weight can help reduce blood pressure. We typically see that for every kilogram lost (~2.2 lbs), systolic blood pressure drops by 1 mmHg.

   Mechanisms likely involve chronic inflammation, activation of the sympathetic nervous system, increased absorption of sodium by the kidneys, insulin resistance, and hormonal abnormalities.

5. Stress reduction

   Studies have found that chronically elevated levels of stress are associated with increased risk of heart disease, high blood pressure, and other chronic diseases. Chronic stress does this in both direct biologic ways - such as activation of the sympathetic nervous system, increased cortisol secretion, and vascular dysfunction - and indirect ways - it’s much more difficult to engage in healthful behaviors when we are feeling stressed out.

   Meditation has been found in several trials to lower blood pressure modestly - in one meta-analysis by about 4 mmHg systolic. Transcendental meditation and mindfulness meditation are the two specific types of meditation that have been best studied, but consistency and fit is probably more important than the exact type.

   If meditation isn’t your thing, you can try other stress relieving techniques. A recent meta-analysis on mindfulness-based interventions - which included mindfulness-based stress reduction techniques, mindfulness meditation, and mindfulness-based cognitive behavioral therapy - in patients with heart disease, found improvements in psychological health and reductions in systolic blood pressure. You can also a try getting more time in nature, gratitude journaling, or any other activity you find that relaxes you.

6. Reduce toxins

   If you smoke, time to consider quitting. Acutely, smoking raises blood pressure by causing vasoconstriction, and in the long term, significantly increases risk of cardiovascular disease.

   Do you drink alcohol more than moderately? Women who have more than 1 alcoholic drink per night and men who have more than 2, have significantly higher blood pressure than those who drink less, so time to cut down. Observational studies have shown a very consistent relationship between alcohol intake and blood pressure, particularly in those who consume more than 3 alcoholic drinks a day. Switch it up with carbonated water, tea, or lightly flavored water.

7. Get checked for obstructive sleep apnea

   Obstructive sleep apnea is a very common sleep disorder that may be responsible for up to 10% of all cases of hypertension. In individuals with obstructive sleep apnea, the upper airway intermittently collapses throughout the night, leading to decreased oxygen (hypoxia) and disruption of sleep. In addition to increasing risk of hypertension, obstructive sleep apnea also increases risk for heart disease, atrial fibrillation, heart failure, and stroke.

   Common symptoms include snoring, morning headaches, daytimes sleepiness, and gasping or choking at night. It can be diagnosed with an overnight sleep test, which can either be conducted in a sleep center or in your own home.

   Treatment is typically with continuous positive airway pressure (CPAP) or a dental appliance. CPAP may also reduce blood pressure by 2-3 mmHg, but results depend on consistent use of the device and severity of the apnea.

High blood pressure treatment - and prevention

Lifestyle changes for the treatment of high blood pressure, while effective, require time and dedication. However, if practiced consistently and incorporated into daily life, they can be amazingly effective at controlling hypertension, particularly in those with Stage 1 hypertension (mild high blood pressure). Many patients find they can work with their doctor to reduce their medication burden or stop medications altogether.

Importantly, even if you do not have hypertension, these are great strategies to incorporate now to prevent it, particularly in those with risk factors or with elevated blood pressure not yet diagnosed with hypertension.

And lastly, although nonpharmacologic measures are powerful and effective, they are not a magic cure all for everyone. The causes of hypertension are complex, with many genetic, epigenetic, environmental, and socioeconomic factors at play - despite maximal adherence to the above, not everyone is able to reduce their blood pressure sufficiently to come off of medications. In this case, medications and lifestyle can work together as a treatment to reduce blood pressure, and ultimately cardiovascular consequences.