Nutrition and Lifestyle Strategies for Managing Blood Pressure
Mar 04, 2024
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Hypertension, aka high blood pressure, affects about 1in adults 3 worldwide, which translates across the to nearly 2 billion people (PMID: 34050340; PMID: 32024986).
High blood pressure is referred to as a silent killer because it doesn't cause many symptoms but slowly damages the heart and blood vessels eventually contributing to heart disease, kidney disease, vision loss, sexual dysfunction.
Over 8 million deaths per year can be attributed to uncontrolled hypertension. Fortunately, there are several evidence-based nutrition and lifestyle strategies for helping to lower blood pressure. In this article comprehensive guide we'll discuss the causes of hypertension and the established evidence-based strategies for helping to manage it without medications.
We are going to:
- Define high blood pressure
- Describe the reasons why our blood pressure increases
- Discuss how to test your blood pressure
- Outline the nutrition and lifestyle strategies that have been shown to improve blood pressure
What is High Blood Pressure?
Our heart is a muscle that contracts approximately 70 times per minute, this can be higher or lower depending on several factors. When it contracts it squeezes and pumps blood into a complex network of blood vessels and sends blood to all the organs and tissues throughout our body.
The pressure gradient in these blood vessels is what we measure as our blood pressure. A higher amount of pressure in the blood vessels places stress on the cells that make up the walls lining of the blood vessels, which are called the endothelial cells.
It also places stress on the heart which must work harder to pump the same amount of blood as before because it is pumping into a higher-pressure gradient. Over time this stress damages both our heart and our blood vessels and can contribute to the development of heart disease and other health conditions that are the result of damaged blood vessels.
What Causes High Blood Pressure?
This is why it is very important to be diligent about managing our blood pressure. So, let's discuss why our blood pressure increases. It can rise for two main reasons:
- Our heart is pumping more total blood into the vessels (increased cardiac output)
- There is higher vascular resistance in the blood vessels which means that the blood vessels do not dilate in the way that they should in response to increased output.
Let’s break each of these down.
Cardiac output can increase for two primary reasons.
- The first is due to an increase in heart rate. If your heart pumps faster, it will pump more blood into the blood vessels and create more pressure.
- Second, due to increased volume of blood. If you have more blood volume then the pressure in the vessels will go up. This is largely driven by sodium consumption which we will discuss later.
Vascular resistance is impacted by:
- The width of our blood vessels. Narrower blood vessels will experience higher pressure gradient moving the same amount of blood.
- Their ability to dilate and contract them in response to increased cardiac output. Blood vessels are supposed to dilate and contract to regulate blood pressure, but they don't as well when there is damage to the endothelial cells.
- The thickness or viscosity of our blood. Thicker, stickier blood is harder to pump and will contribute to elevated blood pressure.
So if your heart beats faster, your blood volume increases, your blood vessels become narrower, their ability to dilate becomes impaired, or your blood becomes thicker your blood pressure will increase. These factors work together to determine the amount of pressure that is maintained in your blood vessels.
How Do You Know If You Have High Blood Pressure?
If your blood pressure is consistently above 130/80 mmHg someone is considered to have stage 1 hypertension, or high blood pressure. This is the point when someone should start making efforts towards reducing blood pressure with nutrition and lifestyle factors. If your blood pressure is above 140/90 mmHg it might be time to consider pharmacological approaches in addition to nutrition and lifestyle to help manage it.
Testing Your Blood Pressure
The best way to keep track of your blood pressure is by purchasing a blood pressure to use at home and testing it regularly. Blood pressure cuffs can be inexpensive, you just want to make sure that the monitor that you are using has been validated which you can check if it has by doing to validatebp.org
Here is a good option that you can find on Amazon: https://amzn.to/3P6FrBz
When you test your blood pressure you want to try to do it at the same time everyday. You want to sit still for at least 5 minutes before testing, don’t smoke, drink caffeinated beverages or exercise within 30 minutes before and try to use the restroom before measuring.
Sit with your back straight and supported, feet should be flat on the floor with your arm should be supported on a flat surface, such as a table, with the upper arm at heart level. Make sure the bottom of the cuff is placed directly above the bend of the elbow. Check your monitor's instructions for an illustration or have your health care professional show you how.
Each time you measure, take two readings one minute apart and record the results so that you can track trends over time. Some monitors will do this automatically. Measure your blood pressure on a few different occasions to get an accurate reading. If you find that you have a blood pressure that is consistently >130/80 mm/Hg it is time to act.
Risk Factors for Hypertension
The primary risk factors for elevated blood pressure including age, genetics, smoking, excessive alcohol consumption, physical inactivity, obesity, poor dietary habits, stress, and lack of sleep (PMID: 28607131; PMID: 25139781).
These can raise blood pressure in the ways that we have previously discussed. For example, smoking can increase oxidative stress in the blood vessels, which can interfere with vasodilation of the blood vessels causing them to be more narrow.
Poor dietary habits (excess energy consumption, excessive sodium consumption, consumption of fried oils, excessive sugar, etc) can have a similar effect and also increase blood pressure by increasing blood volume as well. On the other hand, consumption of a diet that can reduce oxidative stress and support antioxidant defense systems can support healthy blood vessel function and improve blood pressure.
So let's discuss the dietary habits that have been shown to lower blood pressure.
Nutritional Strategies for Managing Hypertension
The DASH Diet/Sodium Restriction
Most people in Western countries are consuming more sodium than their body needs, and this causes water retention and contributes to increased fluid volume and elevated blood pressure (PMID: 35581323).
Sodium restricted diets have shown to be the most effective method for managing blood pressure and reducing the risk of cardiovascular disease associated with high blood pressure (PMID: 32057379).
One of the most well-studied diets for lowering blood pressure is the DASH diet which stands for Dietary Approaches to Stop Hypertension (PMID: 29718689). This diet emphasizes whole grains, fruits, vegetables, low-fat dairy, lean meats, nuts, and seeds, and limiting sodium consumption to under 2,300 mg per day by choosing lower sodium food choices.
This diet has been consistently shown to reduce BP in both normal and hypertensive individuals with grater results shown in people who have higher salt consumption and higher blood pressure at baseline. (PMID: 32330233).
To reduce sodium consumption in your diet, reduce the amount of salt that you add to meals and read labels on and choose lower sodium/salt free options as much as possible. Be careful with ultra-processed foods and when eating out as many of these foods are high in sodium. The majority of sodium in the diet for most people will come from processed food sources.
Make sure you read labels, though, because there are some unsuspecting hidden sources of sodium like cottage cheese and protein powder that can contribute to excessive intake for many people. Electrolyte drinks, which have become popular recently and promoted by many health influencers can also be a source of A LOT of sodium.
Another thing that is important to mention here is that some people experience more significant rises in blood pressure than others when consuming more salt, so the effect of salt restriction will vary based on how much you are eating currently and your sensitivity. In some cases restricting sodium may not be very helpful, but in most cases it will be.
Nordic and Mediterranean Diets
In addition to the DASH diet, the Mediterranean and Nordic dietary patterns have also been shown to improve blood pressure to a similar degree despite not directly targeting sodium reduction. (PMID: 26773016).
These diets are rich in fruit, vegetables, whole grains, legumes, seeds, nuts, fish, and dairy and low in meat, sweets, and alcohol which can lower blood pressure via a variety of mechanisms including increasing potassium intake, increasing the consumption of antioxidant micronutrients, and by promoting weight loss, which we will discuss coming up.
Increasing Potassium
Increasing potassium consumption acts via mechanisms opposite to sodium as it is a diuretic causes us to lose water and reduce blood volume lowering blood pressure. Potassium supplementation has also been shown to help improve blood pressure (PMID: 26039623). This meta-analysis found that potassium supplementation at an average of about 2,400 mg per day reduced systolic blood pressure by about 5 mmHg in normotensive individuals and by about 7 mmHg in people with hypertension.
Potassium rich foods include apricots, lentils, potatoes, bananas, spinach, kidney beans, soybeans and milk (here is a list of potassium rich foods). Those with kidney disease may need to be careful because they can have a reduced ability to excrete potassium and accumulation of potassium can be deadly.
Plant-Based Dietary Patterns
Overall plant-based dietary patterns have shown to have favorable effects on blood pressure and this may be due to the higher amounts of potassium, but also the inclusion of several foods that have been shown to have blood pressure lowering effects (PMID: 26039623)
For example, Nitrite rich foods such as beets and leafy green vegetables provide precursors to nitric oxide production and have been shown to lower blood pressure in clinical trials (PMID: 24566947;PMID: 35369064).
In addition flax seeds (PMID: 26071633), tomatoes (PMID 33676812), polyphenol rich foods like berries, cherries, and grapes (PMID: 35807881), and legumes (PMID: 24014659) have all been shown to have a positive impact on blood pressure in clinical trials
These foods contain many antioxidant nutrients that can protect the blood vessels from oxidative stress which can impair the ability of the blood vessels to dilate properly (PMID: 32389339). These foods are all also high in fiber which has been shown to reduce blood pressure as well (PMID: 29153856).
Lifestyle Strategies for Managing Blood Pressure
Benefits of Weight Loss
Nutrition can also improve blood pressure by promoting weight loss. Carrying excess body fat can contribute to increase levels of circulating inflammatory cytokines which can impair the function of the endothelial cells (the cells the line the walls of the blood vessels) and impair their ability to dilate. Accumulation of excess body fat can contribute to vascular insulin resistance which reduces NO production and also impairs blood vessel dilation (PMID: 23306778). Losing fat, particularly visceral abdominal fat can improve blood vessels dilation and lower blood pressure in those carrying excess body fat. (PMID: 31330870)
Alcohol Reduction
Reducing your consumption of alcohol can also have a positive impact on blood pressure, particularly for those who drink two or more drinks per day (PMID: 29253389). If you are consuming alcohol regularly, you may want to consider cutting back for a variety of reasons and one of them is that it can help lower your blood pressure.
Exercise and Physical Activity
Exercise is also a very effective method for lowering blood pressure. Standard exercise recommendations to aim for at least 150 minutes of aerobic exercise per week (~22 minutes/day) and 2 days per week of muscle strengthening exercise targeting all major muscle groups is recommended to improve blood pressure (PMID: 34074137).
However, just a single bout of exercise can improve blood pressure for a full day and even just taking several short 3–5-minute walks per day can have a significant positive impact on blood pressure. (PMID: 18996856; PMID: 34262474)
This is largely because exercise improves the ability of the blood vessels to dilate and contract reducing vascular resistance during rest. So nearly ANY movement is going to be helpful for blood pressure. Find ways to get active and move more to help lower blood pressure.
Stress Management
Stress management and sleep are the last two lifestyle habits that I want to mention. Stress can increase the activity of the sympathetic nervous system which increases heart rate and causes a constriction of the blood vessels which leads to increased blood pressure (PMID: 27418756).
We all experience stressors, there is not really a way to change them in many cases. However, how we perceive those stressors is what impacts our physiological response to them. You can take two people sitting in traffic and one can be extremely stressed out while the other is completely relaxed in the situation.
Not all stress is bad, but if we make it a habit to perceive the world around us as stressful that can negative impact blood pressure and health in a variety of ways.
Sleep
Sleep deprivation can also contribute to higher blood pressure by also contributing to increase activity of the central nervous system but also via hormonal and circadian dysregulation (PMID: 33611935). Sometimes sleep deprivation is circumstantial (e.g. night shift work, new child, etc.) and there isn't much that you can do about it. However, other times it is due to poor sleep habits, poor sleep environmement, etc. and sleep can be improved by quite a bit and this can have a positive impact on blood pressure and well-being in general as well.
Review
So, let’s recap!
If you want to reduce blood pressure with nutrition and lifestyle, it is best to monitor and reduce your sodium intake, eat lots of plant foods, particularly those rich in potassium and antioxidant micronutrients, lose some body fat, manage stress, and focus on getting high quality sleep.
When making nutrition and lifestyle changes make sure you monitor your blood pressure regularly to determine if those changes are having a positive impact over time and make adjustments as needed. It is also important to work with your healthcare provider to determine if medications may be helpful for you.
Additional Guidance
If you would like some help with putting this information into action you can schedule a 60-Minute Consultation with me. This service includes a review of your health history along with current nutrition and lifestyle habits and we come up with a plan for changes that you can make to improve your health.
You can find out more and schedule (if currently available) at this link here: 60 Minute Consultation
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