Ask an Expert: Lowering blood pressure without pills

"I was recently diagnosed with high blood pressure. I'd like to lower it without medications, if I can. What are the best non-drug ways to reduce blood pressure? Is it possible to do this without popping pills?"

Answer from Craig Walsh, M.D., M.P.H., cardiologist with Providence St. Vincent Heart Clinic and the Providence Heart and Vascular Institute, and Miles Hassell, M.D., director of Providence Integrative Medicine: 

Making healthful changes in your eating and exercise habits is an excellent first step to dealing with your high blood pressure. Your efforts will show results in just a few weeks. Even if your levels don't go down as far as needed, your drug therapy may involve fewer drugs and at lower doses.

If you haven't already done this, it's also a good idea to talk with your doctor about all of the prescription and over-the-counter medicines you take. Some, including common pain relievers and decongestants, can elevate blood pressure.

Research studies have shown that the following strategies can lead to modest but lasting decreases in blood pressure. The payoff is big: Healthy blood pressure reduces your risk of stroke, heart failure and kidney disease.

1. Exercise regularly. Exercise is powerful medicine. Walking briskly for 30 minutes to 45 minutes, five or six days a week, can lower your blood pressure up to 10 points. We recommend combining an aerobic activity that you enjoy – such as walking, swimming, running or biking – with some type of resistance exercise, such as lifting light weights.

During aerobic exercise, work hard enough to break into a sweat, but not so hard that you become out of breath or unable to converse. If you are just getting in shape, start with 20 minutes of aerobic activity, three times a week. Gradually build to 60 minutes daily. Talk with your physician for advice specific to your needs.

For strength training, use light weights and do multiple repetitions. Your muscles should tire after 10 to 15 reps.

Physical activity yields a two-fer benefit for your blood pressure: Exercise is great for arterial health, and it builds muscle and burns stored fat to keep you at an ideal weight.

2. If you are overweight, lose weight. Excess weight raises blood pressure. You can lose pounds, if you need to, by cutting calories, increasing physical activity and eating proper foods.

3. Eat a healthy diet. Food is another powerful medicine. Whether you need to lose weight or not, eating well can improve your blood pressure. That means eating fruits and vegetables, whole grains, healthy oils (such as olive and canola), foods rich in omega-3 fatty acids (salmon, tuna, walnuts and flaxseed, for example) and two or three servings daily of low-fat or nonfat dairy products. It also means avoiding saturated and trans fats.

Researchers studying the effects of diet on high blood pressure created the Dietary Approaches to Stop Hypertension, or DASH diet.  This also is a good diet to help with losing weight. Providence’s medical library offers several tips for following the DASH diet.

4. Limit your salt usage. A sudden jump in blood pressure may be a sign of salt-sensitive hypertension. Overall, about half of Americans with high blood pressure are sodium sensitive; it's particularly common in African-Americans and those over age 65. Cutting the salt in your diet can result in anything from a small to a dramatic improvement in high blood pressure, depending on your level of salt sensitivity.

Keep sodium intake under 2,000 to 2,500 mg daily (one teaspoon of salt is about 2,300 mg). That's far below the 3,300 mg per day that’s typical in the American diet. Count the salt you shake as well as the salt in restaurant meals and processed foods. You'll want to quiz the server, read package labels and emphasize natural, whole foods.

5. Drink alcohol moderately, if at all. Although moderate alcohol consumption does not reduce the risk of high blood pressure, it is associated with a reduced risk of cardiovascular disease. The National Institute on Alcohol Abuse and Alcoholism defines “moderate” consumption as an average of no more than two drinks per day for men and one drink per day for women. Drinking more than a moderate amount increases the risk of high blood pressure.

Some other good moves
Some studies suggest that calcium and potassium supplements lower blood pressure. Because the scientific data are mixed, we can't recommend a dosage or confidently say that calcium and potassium will reduce blood pressure.

For some people, 500 mg of vitamin C and 400 to 800 mg of magnesium oxide are helpful.

Chocolate lovers can celebrate this finding: About an ounce a day of seriously dark chocolate – that’s chocolate with a cocoa content of at least 70 percent – tends to improve blood pressure.

Breathing techniques, such as yoga and meditation, can relax the blood vessel walls and reduce blood pressure. A device called Resperate uses timed breathing three times weekly to effectively help many people reduce blood pressure, as well.

After you've worked on these lifestyle modifications for three or four weeks, ask your health care provider to recheck your blood pressure. Most people can expect to see clear, sustainable improvement.

An aside: We don't much like taking medications, either. But if you end up needing blood pressure medicine to achieve a healthy blood pressure, don't be discouraged. The medicines are effective and safe, and they present only mild side effects, if any. Studies comparing older and newer blood pressure medicines found that one of the oldest and cheapest classes of drugs (the thiazide diuretics, such as hydrochlorothiazide and chlorthalidone) was as good as, or better than, the newer, more expensive ones.

The numbers
It's great that your high blood pressure was diagnosed and that you want to act on it. About a third of Americans with high blood pressure do not even know they have it, and even among those who have been diagnosed, hypertension often remains uncontrolled. Yet it is a serious and very treatable illness.

A few years ago, the federal government revised its high blood pressure guidelines after research showed that even slightly elevated blood pressure starts damaging the arteries and increasing the risk of a heart attack, stroke and kidney failure. The new guidelines specify the blood pressure numbers that indicate when a person is considered “hypertensive,” as well as a new category for “prehypertensive” people who are at risk for developing high blood pressure. The new category is a red flag to spur Americans to make the kinds of lifestyle changes that you are interested in. The idea is to prevent the upward creep of blood pressure that tends to happen with age.

Here are the hypertension categories:

  • Normal: Systolic (top number) 120 or lower, Diastolic (bottom number) 80 or lower
  • Prehypertensive: Systolic (top number) 120-139, Diastolic (bottom number) 80-89
  • High (hypertensive): Systolic (top number) 140 or higher, Diastolic (bottom number) 90 or higher

When you make the lifestyle changes that help reduce your blood pressure, you will be benefiting your health in other ways, too. The recommended diet, weight and exercise guidelines will also lower your risk of developing diabetes, some cancers, dementia and high cholesterol. Good luck!