How can I reduce high blood pressure naturally at home?

The 2017 American College of Cardiology (ACC) and American Heart Association (AHA) guidelines for the treatment of hypertension recommend several evidence-based nonpharmacological interventions that can lower blood pressure (BP).¹ Interventions that had the strongest evidence included weight loss, a heart healthy diet, such as the DASH diet, sodium reduction, potassium supplementation, increased physical activity, and alcohol restriction.²

Other dietary interventions to lower BP have been studied, but the evidence to date is not yet strong enough to recommend them.¹ These include garlic,^3,4 green tea,⁵ probiotics,⁶ dietary protein,⁷ fiber,⁸ flaxseed,⁹ fish oil,¹⁰ dark chocolate,^11,12 calcium,¹³ and magnesium.¹⁴ 

Some behavioral therapies also show promise for short-term benefits, but lack rigorous studies evaluating a longer-term BP-lowering effect.^1,15 These include stress reduction,^16,17 yoga,¹⁸ and transcendental meditation.^19–21

Recommended Interventions

Diet and Nutrition

Weight loss in people who are overweight and have hypertension has been shown to be effective in lowering BP.²² Neter et al. conducted a meta-analysis of 25 (total n=4,874) randomized controlled trials to estimate the impact of weight reduction on BP and found that, on average, weight loss of 5.1 kg (11.2 pounds) by diet or exercise reduced systolic BP by 4.44 mm Hg (95% confidence interval [CI] [2.95 – 5.93]) and diastolic BP by 3.57 (95% CI [2.25 – 4.88]).²² The BP-lowering effect was even greater in people who were also taking antihypertensive medications. A 2016 Cochrane systematic review concluded that while weight loss reduces BP, it is difficult to estimate the magnitude of the impact on BP and all cause morbidity and mortality because of the small number of randomized controlled studies of adequate duration that have studied these effects.²³

Eating foods that are high in sodium and low in potassium increases the risk for high BP.²⁴ Both reductions in sodium and increases in dietary potassium appear to improve BP levels, especially among people who are overweight or obese.^25–28 Depending on the degree of salt reduction, systolic BP may drop as much as 3 – 4 mm Hg and diastolic BP by 1 – 2 mm Hg, and more in individuals with hypertension at baseline.^26,28 Increasing potassium in the diet of people with hypertension was shown to lower mean systolic BP by 3 – 4 mm Hg and diastolic by 1 – 2 mm Hg.²⁷

The DASH dietary pattern (Dietary Approaches to Stop Hypertension) has been tested in randomized clinical control studies to evaluate its effect on cardiovascular risk factors.^29,30 The DASH Sodium trial and other studies demonstrated the diet’s beneficial effect on BP and serum cholesterol, particularly among people with very high BP.^31,32 Depending on baseline levels of BP the DASH diet has been shown to lower systolic BP by 5 – 7 mm Hg and diastolic BP by 3 – 4 mmHg.^29-30,32 Even greater reduction in BP may be seen in patients with hypertension at baseline.³²

Dietary patterns, other than the DASH diet, including low carbohydrate, vegetarian, and Mediterranean diets, have also been shown to lower BP, but further study is needed before they can be recommended specifically as an antihypertensive strategy.^1,33,34

Physical Activity

Although the quality of the overall evidence is varied, the most recent meta-analyses confirm that moderate-intensity aerobic exercise can significantly lower BP within a few months of initiation. It is generally felt that at least 30 minutes per day of aerobic exercise on most days of the week is needed to achieve a BP-lowering effect.^35,36 Because there is a risk of musculoskeletal injury and cardiovascular risk in some individuals, this level of aerobic exercise is recommended when there is no medical contraindication. A meta-analysis of aerobic exercise interventions found such training could reduce systolic BP by 3 – 4 mm Hg and diastolic BP by 2- 4 mm Hg.³⁵ Even greater BP reductions were seen among people with hypertension at baseline.

Resistance (dynamic and isometric) training has been shown to lower BP.^35,37–40 Ninety to 150 minutes per week of dynamic resistance activity or three sessions per week of isometric resistance work for a minimum of eight to ten weeks is estimated to be needed to see BP effects.¹ Although meta-analyses of the effects of isometric resistance exercise are limited by small numbers, the effects of blood pressure have been shown to be large after sustained programs of 4 weeks or more. Drops in systolic BP range from 6 – 13 mm Hg and in diastolic BP from 4 – 6 mm Hg.^37-40

Alcohol Restriction

Consumption of alcohol is known to have a direct effect on BP and 2017 ACC/AHA guidelines recommend that alcohol be limited to no more than two drinks per day for adult men and one drink per day for adult women.¹ Hypertensive individuals who drink in excess of this recommendation can be expected to reduce their systolic BP on average by 4 mm Hg if they adopt the recommended level of consumption.^41–43

Other Natural Interventions

Scientists have studied other possible nonpharmacological non-dietary approaches to lowering BP including meditation, yoga, relaxation therapies, biofeedback, device-guided breathing, and acupuncture.⁴⁴ The AHA reviewed the strength of evidence for these non-pharmacological approaches to lowering blood pressure and issued a scientific statement.⁴⁴ It is the consensus in this statement that it is reasonable for all individuals with BP levels >120/80 mm Hg to consider trials of alternative approaches as adjuvant methods to help lower BP when clinically appropriate. Some individuals with stage 1 hypertension who desire avoiding medications can use alternatives to drug therapy for a trial of six to twelve months to see if BP <140/90 mm Hg can be maintained or lowered without medication. The AHA recommends that other individuals with Stage 1 or 2 hypertension use non-pharmacologic treatments as a supplement to drug therapy.

Alternative modalities that were identified with some promising but insufficient evidence to recommend as an antihypertension treatment might be considered as adjuvant methods to lower BP. These are summarized below.

Meditation and Yoga

Originally designed as a path to improve awareness by transcending thought, transcendental meditation (TM) has been incorporated into a mindfulness-based stress reduction technique.¹⁹ The practice has been studied by several high quality randomized control studies with respect to its effect on lowering BP that found modest, but statistically significant reductions in clinic systolic and diastolic BP among those practicing TM compared to controls.^17,20,21 A more recent systematic review and meta-analysis included studies that compared individuals participating in a combined yoga and mindfulness-based stress reduction program to a control group and reviewed their effect on physiological parameters, including BP.¹⁵ Average BP dropped about 5/3 mm Hg after intervention, compared to controls. Studies of yoga alone as an intervention to reduce blood pressure are generally of poorer quality, and because yoga can be associated with musculoskeletal risks, evidence is currently insufficient to recommend yoga as a BP-lowering treatment whose benefits outweigh its potential risks.⁴⁴

Device-Guided Breathing

The Food and Drug Administration has approved a device designed to achieve slow breathing for use in stress reduction and BP management.⁴⁵ The device uses a belt around the chest that feeds information about the respiratory rate to a control box that generates musical tones as feedback to the user. The device has been shown to be an effective way for people to modulate their breathing with the goal of stress reduction.  A number of studies have been conducted to evaluate its effectiveness in reducing BP. Although some clinical trials exist that demonstrate a BP-lowering effect, others do not.⁴⁶ The quality of the existing studies are variable. In one study in the office setting, device-guided breathing resulted in an average drop in BP of about 3/2 mm Hg, a significant difference compared to controls.⁴⁶ The AHA position statement felt that the preponderance of evidence suggested the device can significantly lower BP and that it was reasonable to use device-guided breathing techniques to lower BP in a clinical setting.⁴⁴

Biofeedback

Biofeedback techniques to control BP provide information feedback that can be used by an individual to lower BP.⁴⁴ Techniques that are included under this heading are cognitive behavior therapy, behavioral training, relaxation therapy, guided imagery, and psychological education. BP responses are provided to the patient during active therapy to identify thoughts or activities that could be responsible for the change in BP. Some recent trials have suggested that certain biofeedback techniques can reduce BP, but overall the results are inconsistent, and more study is needed.^47–49

^References

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