How to lower blood pressure
What's normal blood pressure?
"Blood pressure" is the amount of force that is applied to the blood vessels from the blood flowing through them. When blood pressure is high, the risk of an adverse event such as heart attack or stroke increases. Normal blood pressure is defined by the American Heart Association as a value of less than 120/80 mm Hg. When someone is diagnosed with having high blood pressure, the typical goal is to keep their blood pressure below 130/80 mm Hg.1 Others may be told by their doctor that they have a different blood pressure goal based on individual factors such as age or health conditions.
Diet
One of the best ways to lower blood pressure is by making heart-healthy eating choices:
Foods to avoid
Avoid foods high in sodium, being mindful to keep your total daily sodium intake to less than 1,500 mg per day. This is less than one teaspoon of salt. Extra sodium in the body tends to increase blood pressure because it increases the amount of fluid in the vessels. Foods that tend to have higher amounts of sodium include potato chips, pretzels, salted nuts, some canned foods, lunch meat, dried or cured meats, cheese, and much more.2 Use of non-sodium sources, such as spices and herbs, can also help to enhance the flavors of foods without affecting blood pressure.
Individuals concerned with high blood pressure should also limit their consumption of saturated and trans fats.3,4 Common sources of saturated fats are desserts, hot dogs, breakfast sausages, bacon, cheeses, and creams. Examples of foods high in trans fats include fried foods, pie crust, frosting, animal fat, dairy, and microwavable popcorn. Overall, it is important to look at the nutrition facts on food labels to be aware of sodium and fat intake.
When it comes to alcohol, women should drink no more than one beverage per day, while men should drink no more than two. Caffeinated beverages can also increase blood pressure, such as coffee, sodas, and energy drinks.
Foods that lower blood pressure
The National Heart, Lung, and Blood Institute (NHLBI) recommends a regimen called the DASH (Dietary Approaches to Stop Hypertension) diet, promoting heart-healthy foods and eating habits.2 This diet encourages individuals to eat lots of fresh fruits, vegetables, and whole grains which can all help with lowering blood pressure. Other foods that are beneficial for keeping blood pressure under control include low-fat or fat-free products, lean cuts of white meat, fish, nuts, seeds, legumes, and non-tropical oils. This dietary plan also estimates the number of calories needed per day based on age and level of activity.
How to lower blood pressure naturally
There are several ways to naturally lower blood pressure without the use of medications:
Exercise
Other than eating a healthy diet as described above, exercise is an excellent way to help keep blood pressure under control. Experts recommend getting 90 to 150 minutes per week of aerobic exercise and/or resistance training.1,3 Keep your exercises fun by alternating between activities such as jogging, biking, swimming, hiking, and more. Ask your doctor what exercises are safe for you before trying anything new.
Weight loss
Individuals that are overweight or obese should strive to lose weight until they reach a healthy goal. When someone is overweight, the heart has to work harder than normal in order to maintain good oxygen and blood flow throughout the body, which causes high blood pressure. According to the Centers for Disease Control and Prevention, a weight loss goal of 5 to 10% can be highly beneficial for blood cholesterol and blood sugars in addition to blood pressure.3 This can be achieved through diet and exercise, being mindful not to rush the process and avoiding losing a dangerous amount of weight in a short period of time. A loss of 1 to 2 pounds per week is considered safe and healthy.
Quit smoking
Smoking tobacco products keeps the body in a constant state of inflammation, which keeps blood pressure high.1 There are various over-the-counter and prescriptions products that are available to help individuals give up smoking. Ask your pharmacist what products may be helpful for you.
Medicines for high blood pressure
Sometimes lifestyle changes in diet and exercise alone may be enough to treat high blood pressure before even starting any medications. Depending on certain factors and your blood pressure readings, however, your healthcare provider may decide that it is best to start you on a medication in addition to the lifestyle changes.
After starting one of the medications below, it may take several weeks for individuals to see the full blood pressure lowering effects. Because these medications help lower blood pressure, some generally common side effects may include dizziness and feeling tired. These side effects should go away with time as your body adjusts to your new blood pressure levels. Keep in mind that your healthcare provider may need to adjust your medications and doses over the course of several months to find the best blood pressure lowering regimen for you with minimal medication side effects.
There are four main classes of medications commonly prescribed for blood pressure lowering:
Angiotensin-Converting Enzyme (ACE) Inhibitors
ACE-inhibitors include medications such as lisinopril, benazepril, quinapril, enalapril, and ramipril. These drugs work by preventing the creation of a chemical called angiotensin II. Decreasing angiotensin II causes blood vessels to expand and prevents water from being reabsorbed into the kidneys, which helps lower blood pressure.2,4 ACE-inhibitors may increase your potassium levels or may cause a dry cough. Let your prescriber know if you develop a bothersome dry cough.
Angiotensin II Receptor Blockers (ARBs)
ARBs include medications such as losartan, candesartan, irbesartan, olmesartan, telmisartan, and valsartan. ARBs block angiotensin II from binding to its receptors,and stop angiotensin II from exerting any actions. This once again allows the blood vessels to expand and prevents reabsorption of water into the kidneys.2,4 These drugs can also cause high potassium levels, but do not typically cause dry cough.
Calcium Channel Blockers (CCBs)
Amlodipine, nifedipine, diltiazem, and verapamil are common CCBs that are prescribed. These medications block calcium channels in the blood vessels which relaxes the smooth muscle of the blood vessels, allowing them to expand and let blood flow more easily. CCBs also help strengthen the heartbeat and movement of blood through the arteries. Because this class of medication works to expand blood vessels throughout the body, the most common side effect that may be seen is swelling in the lower legs and feet.
Thiazide and Loop Diuretics
Diuretics increase urination because of how they work in the body. There are a couple of different classes of diuretics. Thiazide diuretics include medications such as hydrochlorothiazide and chlorthalidone, and loop diuretics include furosemide and bumetanide. These medications generally prevent sodium and other substances from being reabsorbed into the kidneys, which causes an increase in the amount of water and fluid that exits the body through urination.2,4 These medications should be taken earlier rather than later in the day to prevent nighttime awakenings to go use the bathroom.
Natural remedies
There are some natural over-the-counter products and supplements that may help with lowering blood pressure. It is important to remember that these products are not regulated by the Food and Drug Administration (FDA) and, therefore, may have varying potency from one bottle to another. It is also very important to remember that these products still need to be checked with your other medications for drug interactions and still have the potential to cause side effects or even toxicity if too much is taken. These products should not be used as your sole source of blood pressure lowering unless you are instructed to do so by your prescriber. Some remedies that have shown possible ACE-inhibition includes fermented milk, maritime pine, hibiscus, and pomegranate. Black seed and cardamom have shown that they may potentially act like a CCB. Fatty acids such as fish oils may have cardiovascular benefits relating to blood pressure as they are also sometimes used for certain high cholesterol.4
Published on April 30, 2020
Sources:
1. American Heart Association. High Blood Pressure. https://www.heart.org/en/health-topics/high-blood-pressure.
2. National Heart, Lung, and Blood Institute. High Blood Pressure. https://www.nhlbi.nih.gov/health-topics/high-blood-pressure.
3. Centers for Disease Control and Prevention. High Blood Pressure. https://www.cdc.gov/bloodpressure/index.htm.
4. MacLaughlin EJ, Saseen JJ. Hypertension. In: DiPiro JT, Yee GC, Posey L, Haines ST, Nolin TD, Ellingrod V. eds. Pharmacotherapy: A Pathophysiologic Approach, 11e New York, NY: McGraw-Hill; http://accesspharmacy.mhmedical.com.ezproxy.ttuhsc.edu/content.aspx?bookid=2577§ionid=220356112. Accessed: February 10, 2020.