What exactly is high blood pressure and who is at risk?

When you get a blood pressure reading, what do those numbers even mean? The first number is your systolic pressure, or the pressure that occurs as blood pumps out of the heart and into your blood vessels. The second, or diastolic pressure, is when your heart rests between beats. High blood pressure is when the force of your blood pushing against the walls of your blood vessels is consistently too high. Elevated blood pressure (prehypertensive) is 120-129/80 mm Hg, while high blood pressure is 130-139/80-89 mm Hg.⁶

Some of the common risk factors for developing hypertension include excess weight, lack of physical activity, a diet heavy in processed foods and sugar (especially fructose), excessive alcohol consumption, smoking, and low levels of nitric oxide, which naturally fall with age, but are also linked to the use of mouthwash. Research published in 2020 found that “frequent regular use of over-the-counter mouthwash was associated with increased risk of hypertension, independent of [other] major risk factors…”⁷ One study also found that using mouthwash negated the blood-pressure lowering effects of exercise.⁸ Clinical trials have shown that antibacterial mouthwash depletes the oral bacteria that help the body produce nitric oxide, decreasing overall nitric oxide availability in the body. Nitric oxide is critical for regulating blood pressure.

African Americans are also at a higher risk. According to the American Heart Association, the prevalence of high blood pressure in African Americans is among the highest in the world and develops earlier in life.⁹ One observational study found that by the age of 25, hypertension among African American men and women was nearly twice that of their white counterparts.¹⁰ And recent research from Northwestern University found that in 2017 African American men had a 43 percent higher rate of death from heart failure, while African American women had a 54 percent higher death rate from heart failure compared to other racial groups.¹¹

“This heart failure trend is another manifestation of the undertreatment of hypertension,” senior study author and cardiologist Sadiya Khan, MD said. “Know your blood pressure and make sure it’s being well managed and well-treated.”

Make managing your blood pressure a priority

Managing high blood pressure is possible—and you can do it with lifestyle interventions. Reduce your intake of processed foods and sugar, especially high-fructose corn syrup, which has been independently associated with higher blood pressure, even in adults with no previous history of hypertension.¹² Eat an abundance of potassium-rich vegetables and fruit to maintain a healthy sodium-potassium balance. Move your body regularly. This doesn’t have to mean rigorous workouts at the gym; something as simple as a daily walk goes a long way. If you are a heavy drinker, work to cut back your alcohol intake. Adopt small healthy habits and they will coalesce into big changes to your health!

In addition to healthy lifestyle habits, certain vitamins and nutrients are proven to support healthy blood pressure.

Sodium and Potassium

Sodium and potassium are partner minerals in the function of muscles, including the heart. The typical American consumes excess sodium, but often low levels of potassium, creating an imbalance in the sodium:potassium ratio, which can lead to increased blood pressure. According to one study, increasing potassium, while keeping sodium in moderation, can reduce blood pressure by 17%.¹³ Changes in sodium consumption alone only provide a moderate benefit. It’s important to note that salt (sodium) is extremely important to our health and ultra-low levels of sodium can lead to serious health issues, including a shorter life expectancy.¹⁴ Great sources of potassium include pinto beans and other legumes, mushrooms, potatoes, sweet potatoes, bananas, coconut water, and celery juice. 

Beetroot juice

Nitric oxide (NO) is a molecule that is naturally produced by the body, but diminished production is associated with hypertension and other cardiovascular dysfunction.¹⁵ NO has a number of important functions, including promoting blood vessel flexibility and vasodilation, both of which help maintain normal blood pressure. Beetroot is rich in dietary nitrate, which the body readily converts to NO. Nitrate naturally occurs in many other vegetables and fruits, in particular spinach, celery, lettuce, arugula and bok choy.¹⁶ One recent review investigated 11 studies to examine the relationship between beetroot juice and blood pressure and concluded, “This easily found and cheap dietary intervention could significantly decrease the risk of suffering cardiovascular events and, in doing so, would help to diminish the mortality rate associated to this pathology. Hence, beetroot juice supplementation should be promoted as a key component of a healthy lifestyle to control blood pressure in healthy and hypertensive individuals.” Recent research suggests that another way beetroot juice supports cardiovascular health is by reducing over-stimulation of the sympathetic nervous system (SNS); activation of the SNS increases heart rate, blood pressure, and blood vessel constriction.

Take: 250 mL to 500 mL of beetroot juice daily.^{17 18 19 20 21}

Vitamin D

Studies have consistently shown that low blood levels of vitamin D are linked to hypertension. One study found that men and women with vitamin D levels of 15 ng/mL or less had a three to six times increased risk of developing hypertension over a four-year period compared to those with levels of 30 ng/mL or higher.²² Other research has found that increasing vitamin D levels with supplementation lowers blood pressure.²³ A study investigating the effects of vitamin D supplementation on 250 African American men and women found that for each 1 ng/mL increase in blood levels of vitamin D, there was a drop in systolic blood pressure. Doses were given at 1,000, 2,000, or 4,000 IUs daily for three months, with the most significant decreases found in those taking 4,000 IUs.²⁴ It is worth noting that African Americans are particularly at risk of developing a vitamin D deficiency because darker skin reduces natural vitamin D production.²⁵

Take: 2,000 to 5,000 IUs per day and regularly have your levels checked, aiming to maintain levels between 40-80 ng/mL.²⁶

L-citrulline

The body efficiently converts this amino acid to L-arginine, which increases nitric oxide (NO), a molecule that plays a crucial role in endothelial function—the term endothelial refers to the endothelium, a thin layer of cells that line the interior of blood vessels and come in direct contact with blood. The endothelium plays a major role in regulating the flexibility of blood vessels, and in turn, blood pressure. A lack of NO interferes with normal endothelial function and healthy blood vessel tone, contributing to hypertension and cardiovascular disease. Both arginine and citrulline have been shown to improve NO production and cardiovascular function; however, because of the different ways in which they are metabolized by the body, citrulline is more effective at increasing and maintaining plasma and tissue levels of L-arginine and enhancing NO production. Citrulline has also been shown to effectively attenuate blood pressure increases due to cold weather.^{27 28 29 30 31 32} Good food sources of citrulline are squashes, gourds, cucumbers, pumpkins and watermelon, which is an especially good source, delivering a respectable 250mg per cup.^{33 34 35}

Take: 1,000 mg of L-citrulline, three to four times daily.^{36 37}

Vitamin C

Dozens of studies have investigated whether vitamin C supplements can lower blood pressure. The body needs this vitamin to synthesize collagen and elastin, key proteins that keep blood vessel walls strong and flexible. Doctors at Johns Hopkins School of Medicine analyzed 29 of those studies that gave subjects, on average, 500 mg of vitamin C daily for eight weeks. They found that vitamin C reduced both systolic and diastolic blood pressure.^{38 39 40} Nearly all fresh fruits and veggies contain vitamin C, but some especially good sources are papaya, bell peppers, broccoli and Brussels sprouts.⁴¹

Take: at least 500-1,000 mg of vitamin C daily.

Magnesium

According to the National Institutes of Health, intakes of magnesium among Americans are consistently below the recommended daily amounts.⁴² Considerable research has shown that magnesium deficiency contributes not only to hypertension but also to arrhythmias and coronary artery disease.⁴³ Not surprisingly, studies have found that magnesium supplements can reduce blood pressure. The mineral works with both sodium and potassium to regulate blood pressure. 

In an analysis of seven studies, researchers confirmed that magnesium supplements reduced both systolic and diastolic blood pressure.⁴⁴ Other researchers investigated magnesium levels in people with and without prehypertension, which reflects a slight but consistent abnormality in blood pressure. People with prehypertension had low levels of magnesium, but no other apparent differences with healthy subjects.⁴⁵ An added bonus: Spanish researchers recently reported that people with high intake of magnesium were one-third less likely to die from any cause, including heart disease and cancer. They also found that people who ate low-fat diets had low levels of the mineral.⁴⁶ To get more magnesium in your diet, add more nuts and seeds, dark leafy greens, green beans, cocoa powder and salmon.47

Take: 200-400 mg of elemental magnesium daily.

Coenzyme Q10 (CoQ10)

Several studies have found that CoQ10 supplements can improve endothelial function and reduce blood pressure.] In an analysis of 12 published studies, Australian researchers reported that supplemental CoQ10 lowered systolic blood pressure by 11 mm Hg and diastolic blood pressure by 8 mm Hg.⁵⁰ One study found a CoQ10 deficiency in 39 percent of patients with hypertension; providing the patients with 60 mg of CoQ10 daily for eight weeks resulted in a 10 percent or greater decrease in blood pressure.[51] Other studies have found similar results.^{52 53} CoQ10 is widely distributed in foods, but only in trivial amounts making supplementation essential.

Take: 60-200 mg daily.

Omega-3s

The omega-3s, found in both fish oils and algae-source supplements, have impressive cardiovascular benefits. They are potent natural anti-inflammatories and promote vasodilation, which decreases blood pressure. Recent studies have also found that they can improve endothelial function and arterial stiffness.^{54 55} Good food sources include wild salmon, sardines, anchovies, mackerel and scallops.

Take: 2,000 to 4,000 mg daily (in divided doses).

Polyphenols

Over 8,000 different naturally occurring plant compounds have been classified as polyphenols because of their chemical structure. And many of these are valued for their cardioprotective effects and specifically for their effects on blood pressure. These polyphenols act as antioxidants to protect the lining of the blood vessels from free radical damage, they regulate enzymes involved in endothelial function and they activate and enhance the production of NO.⁵⁶ Studies have found a blood pressure normalizing effect from the polyphenols found in green tea, olive oil, nuts, darkly colored fruits (such as grapes, chokeberries, cherries, bilberries and pomegranates), cacao, grape seed extract and pycnogenol^®.^{57 58 59 60 61 62 63}  To reap the benefits of polyphenols include a variety of these food sources in your diet regularly and consider supplementing with a concentrated source.

Take: 150mg of grape seed extract or 100mg of Pycnogenol^® daily.^{64 65}

Curcumin

The connection between inflammation and high blood pressure is well established, but whether inflammation causes elevated blood pressure or elevated blood pressure causes inflammation is still not fully understood.^{66 67} Either way, inflammation is a major underlying factor in most cardiovascular dysfunction and treatments aimed at reducing inflammation are important, This is where curcumin, the potent polyphenol compound found in turmeric (Curcuma longa), comes in. Curcumin is well recognized for its potent anti-oxidant and anti-inflammatory actions.⁶⁸ It helps to protect the blood vessels and cholesterol from being oxidized by free radicals and simultaneously decreases inflammation by altering the expression of inflammatory compounds.

Take: 500 mg daily.⁶⁹

Celery seed extract

Celery seeds contain a unique compound known as “L-3-n-butylphthalide” or 3nB, that has a relaxing effect on blood vessels, effectively lowering blood pressure (it is also what gives celery its unique taste and smell). Celery seed extract appears to work in the same way as calcium channel blockers, which are often prescribed as antihypertensive drugs, by blocking the flow of calcium into cells that line the blood vessel walls, helping them to relax.⁷⁰ One trial of 30 mild to moderate hypertensive patients found that a standardized extract of celery seed extract at 75 mg twice daily lowered both systolic and diastolic blood pressure at three and six weeks of follow up. And while calcium channel blockers can reduce blood flow to the brain, in animal studies, celery seed extract has been shown to improve blood flow, prevent stroke, and enhance energy production in the brain.^{71 72} A recent study found that supplementation with celery seed not only lowered blood pressure, but also improved liver and kidney function, fasting blood sugar, and lipid levels.⁷³

Take: 75 mg standardized celery seed extract twice a day.

Hibiscus tea

Drinking three cups of hibiscus tea (Hibiscus sabdariffa) every day can be an enjoyable and easy way to reduce blood pressure. A study including 65 pre- and mild hypertensive adults had the participants drink three eight-ounce servings of hibiscus tea or a placebo daily for six weeks. At the end of the study, there was an improvement in both systolic and diastolic pressure in those drinking the tea, compared to the placebo group. The most improvement was seen in systolic pressure and in those participants who had higher blood pressure to begin with.⁷⁴  A recent analysis of five studies investigating the effect of hibiscus tea on blood pressure confirmed that the tea had a significant effect on lowering systolic and diastolic blood pressure.⁷⁵ Supplements appear to work just as well according to one study. Researchers gave 250 mg of hibiscus extract to patients with high blood pressure. After four weeks, people taking hibiscus had a significant 12 percent reduction in both systolic and diastolic blood pressure, similar results to drinking hibiscus tea.⁷⁶

Additional Helpful Information

Millennials, listen up! Hypertension can affect you too

A recent study took blood pressure readings from more than 14,000 men and women between the ages of 24 and 32 and found that 19 percent of them had high blood pressure—and the majority (75%) was unaware they had the condition. The researchers concluded that the prevalence of hypertension “suggests an unexpectedly high risk of cardiovascular disease among U.S. young adults.”^{77 78} Enjoy drinking tea? Switch to hibiscus tea, which has been shown to lower blood pressure.^{79 80}

Seasonal shifts in blood pressure

Blood pressure is generally higher in the winter months, which may partly explain the higher number of cardiovascular deaths this time of year. Colder temperatures cause the blood vessels to constrict, which increases blood pressure, adding stress to the heart, especially in those who already have hypertension. And it should come as no surprise that vitamin D levels are markedly lower in the winter, especially for those living in the upper third of the U.S. If you’ve been diagnosed with high or borderline high blood pressure during the winter months, it is important to take into account this seasonal shift and get your levels tested throughout the year to get a more accurate picture, and more importantly, ensure that you maintain vitamin D levels of at least 40 ng/mL.^{81 82}

Another reason to ditch sugar…

When you are diagnosed with hypertension, your doctor will likely recommend that you reduce sodium intake. While cutting back on added sodium found in processed foods is certainly beneficial for health, sugar, particularly fructose, is likely more cause for concern. Two recent analyses of 26 published studies found that regularly consuming sugar-sweetened beverages significantly increases the risk of developing hypertension and cardiovascular disease.^{83 84} Other research has come to the same conclusion, finding that increased fructose intake in the form of added sugars is “significantly and independently associated with higher blood pressure levels in the US adult population with no previous history of hypertension.”^{85 86 87} Artificially-sweetened beverages are no better—they have been found to have virtually the same negative effect on blood pressure as sugar-sweetened beverages.⁸⁸

Lifestyle Tips for Healthy Blood Pressure

In addition to regular exercise, numerous studies have found that meditation is an effective way to lower blood pressure anywhere from 3 to 10 mmHg.^{89 90} If meditation sounds a little too complicated, try guided visualization. Sit comfortably in a chair with your feet on the floor and your hands resting on your legs. Close your eyes and visualize a place that made you feel relaxed. Maybe it was sitting on the beach or stopping on a hiking trail to look at the trees. Simply try to relive that experience. Make time to meditate for 20-30 minutes several times a week. To further counter the effects of our stressful lives you might also consider keeping a gratitude journal. According to Robert A. Emmons, professor of psychology at UC Davis and a leading expert on the science of gratitude, practicing gratitude can have dramatic effects on a person’s health, including reducing levels of stress hormones and lowering blood pressure.⁹¹ Keeping a gratitude journal can be as simple as jotting down three to five things you are grateful for each day.

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