What is high blood pressure?
Blood pressure consists of two components: systolic pressure and diastolic pressure. Systolic pressure is the pressure when the ventricles of the heart contract and pump blood through the body. Diastolic pressure is the pressure between heartbeats, when the heart is filling with blood.[1] High blood pressure (commonly referred to as “hypertension”) is when the force of your blood pushing against the walls of the arteries is consistently too high.
What are the main signs and symptoms of high blood pressure?
There are generally no signs or symptoms of high blood pressure until it has caused serious health problems (e.g., stroke, heart attack, kidney failure), which is why it is colloquially known as the “silent killer”.
How is high blood pressure diagnosed?
High blood pressure is diagnosed by measuring a person’s blood pressure. There are multiple methods for measuring blood pressure, including using hand-powered cuffs and a stethoscope, semiautomatic monitors (either at the doctor’s office or at home), or ambulatory blood pressure monitors (which collect blood pressure readings several times per hour across a 24-hour period).
Broadly speaking, a systolic and diastolic blood pressure of <120 and <80 mmHg is considered optimal.[2] Hypertension is diagnosed at the doctor’s office if they measure a systolic and/or diastolic blood pressure of ≥ 130 and ≥ 80 mmHg over multiple measurements.
What are some of the main medical treatments for high blood pressure?
There are five major classes of blood pressure-lowering drugs: angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), beta-blockers, calcium channel blockers (CCB), and thiazide or thiazide-like diuretics. Broadly, these drugs have their effects by reducing blood volume and/or relaxing the smooth muscles that control the diameter of blood vessels.
A combination of an ACEi or ARB with a CCB or diuretic is the preferred initial therapy for most people with high blood pressure.[2] If blood pressure remains uncontrolled, a combination of an ACEi or ARB with a CCB and a diuretic is recommended.[2]
How could diet affect high blood pressure?
Diet directly affects blood pressure. In most people, sodium reduction reduces blood pressure,[9] and so does increasing potassium intake,[10] whereas alcohol seems to increase blood pressure.[11] A sodium intake of <1,500 mg/day is ideal for people with high blood pressure, but reducing sodium intake by 1,000 mg/day is a good starting point.
The most effective diet for reducing blood pressure is the Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in fruits, vegetables, whole grains, nuts, legumes, and low-fat dairy products and is greatly reduced in added sugar and saturated fat.[12]
Are there any other treatments for high blood pressure?
Exercise has a powerful effect on blood pressure, and evidence suggests that it’s as effective as some medications.[13] Exercise seems to reduce blood pressure independent of changes in body weight,[14] but the magnitude of blood pressure reduction will increase if weight loss also occurs.[15]
People with high blood pressure should perform at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise per week and two resistance exercise sessions.
A growing body of evidence suggests that stress-reduction interventions, such as yoga, meditation, and guided breathing can also decrease blood pressure.[16]
What causes high blood pressure?
In the vast majority of cases (>80%), high blood pressure is caused by lifestyle habits such as unhealthy eating patterns, insufficient physical activity, and excessive intake of alcohol.[12] Consequently, there is a direct relationship between increases in body mass index or waist-to-hip ratio and increases in blood pressure.[11] Genetic variants also influence blood pressure, but they only contribute to about 3.5% of the variability in blood pressure between people.[12]
In about 10-20% of cases, high blood pressure is caused by a separate medical condition (e.g., primary aldosteronism, renal artery stenosis, obstructive sleep apnea). Primary aldosteronism is increasingly recognized as an underdiagnosed cause of high blood pressure and may be responsible in up to 10% of cases.[17]
Examine Database: High Blood Pressure
Research FeedRead all studies
Can cruciferous vegetables reduce blood pressure?
Going beyond salt restriction to reduce blood pressure
Beetroot juice to reduce blood pressure?
Does dietary advice on sodium restriction actually lead to a meaningful decrease in blood pressure?
Frequently asked questions
What is high blood pressure?
Blood pressure consists of two components: systolic pressure and diastolic pressure. Systolic pressure is the pressure when the ventricles of the heart contract and pump blood through the body. Diastolic pressure is the pressure between heartbeats, when the heart is filling with blood.[1] High blood pressure (commonly referred to as “hypertension”) is when the force of your blood pushing against the walls of the arteries is consistently too high.
What are the main signs and symptoms of high blood pressure?
There are generally no signs or symptoms of high blood pressure until it has caused serious health problems (e.g., stroke, heart attack, kidney failure), which is why it is colloquially known as the “silent killer”.
How is high blood pressure diagnosed?
High blood pressure is diagnosed by measuring a person’s blood pressure. There are multiple methods for measuring blood pressure, including using hand-powered cuffs and a stethoscope, semiautomatic monitors (either at the doctor’s office or at home), or ambulatory blood pressure monitors (which collect blood pressure readings several times per hour across a 24-hour period).
Broadly speaking, a systolic and diastolic blood pressure of <120 and <80 mmHg is considered optimal.[2] Hypertension is diagnosed at the doctor’s office if they measure a systolic and/or diastolic blood pressure of ≥ 130 and ≥ 80 mmHg over multiple measurements.
What are some of the main medical treatments for high blood pressure?
There are five major classes of blood pressure-lowering drugs: angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), beta-blockers, calcium channel blockers (CCB), and thiazide or thiazide-like diuretics. Broadly, these drugs have their effects by reducing blood volume and/or relaxing the smooth muscles that control the diameter of blood vessels.
A combination of an ACEi or ARB with a CCB or diuretic is the preferred initial therapy for most people with high blood pressure.[2] If blood pressure remains uncontrolled, a combination of an ACEi or ARB with a CCB and a diuretic is recommended.[2]
Have any supplements been studied for high blood pressure?
A variety of supplements may reduce blood pressure to a moderate extent including taurine,[3] garlic,[4] nitrate,[5] cocoa extract,[6] potassium,[7] and magnesium.[8]
What specific nutrients lower blood pressure?
Besides the restriction of sodium, there are some nutrients that may help lower blood pressure. For example, one meta-analysis found that supplementation of potassium lowered blood pressure by about 4–5 mmHg.[18] Beetroot juice may also lower blood pressure,[19] which may be partially driven by nitrate content,[20] but also by mechanisms independent of nitrate. Garlic also probably lowers blood pressure in people with hypertension. The form doesn't seem to matter much for lowering systolic blood pressure, but garlic powder may outperform aged garlic extract when it comes to lowering diastolic pressure.[21]
How could diet affect high blood pressure?
Diet directly affects blood pressure. In most people, sodium reduction reduces blood pressure,[9] and so does increasing potassium intake,[10] whereas alcohol seems to increase blood pressure.[11] A sodium intake of <1,500 mg/day is ideal for people with high blood pressure, but reducing sodium intake by 1,000 mg/day is a good starting point.
The most effective diet for reducing blood pressure is the Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in fruits, vegetables, whole grains, nuts, legumes, and low-fat dairy products and is greatly reduced in added sugar and saturated fat.[12]
How does baseline blood pressure modify the effects of salt reduction?
Sodium restriction may reduce both systolic and diastolic blood pressure, primarily among people starting out with higher blood pressure. Although there can be small benefits among people with lower blood pressure, these effects are typically not clinically relevant (and possibly non-existent). The effects of a reduction in salt intake of 2,300 milligrams (2.3 g) stratified by blood pressure are summarized below.
Changes in blood pressure to salt reduction, by baseline status
How does salt increase blood pressure?
Sodium is a known regulator of blood pressure. Sodium concentrations are sensed by macula densa cells in the kidneys.[22] When the blood sodium concentration increases, these cells activate the renin-angiotensin-aldosterone system, as shown below.
In short, increased salt intake causes your body to hold onto more water, which increases blood pressure. This extra pressure places a strain on your cardiovascular system which can eventually lead to worse cardiovascular disease outcomes over time.
Sodium’s role in blood pressure
How does potassium lower blood pressure?
Potassium is well known to reduce blood pressure by inducing diuresis (increased production of urine). However, precisely how potassium achieves this effect is less well-known. Potassium works to lower blood pressure primarily in a specific part of the kidney, known as the distal convoluted tubule.[23] This area of the kidney acts as a potassium sensor. When potassium is low, the kidney holds onto more potassium and water and increases blood pressure. When potassium is high, it allows more potassium and more water to pass by, reducing blood pressure. Furthermore, high sodium intake can increase potassium excretion,[24] indicating that high sodium intakes can exacerbate potassium balance issues in those who consume low potassium diets.
Are there any other treatments for high blood pressure?
Exercise has a powerful effect on blood pressure, and evidence suggests that it’s as effective as some medications.[13] Exercise seems to reduce blood pressure independent of changes in body weight,[14] but the magnitude of blood pressure reduction will increase if weight loss also occurs.[15]
People with high blood pressure should perform at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise per week and two resistance exercise sessions.
A growing body of evidence suggests that stress-reduction interventions, such as yoga, meditation, and guided breathing can also decrease blood pressure.[16]
Is there a best type of exercise to reduce blood pressure?
Increasing physical activity can reduce your systolic blood pressure by 4–9 mmHg. However, it’s not as clear if there’s a dose-response effect of exercise or what types of exercise might impact blood pressure the most. Luckily, a network meta-analysis aimed to answer these questions.[13]
Exercise becomes more effective for lowering blood pressure the higher the starting systolic pressure is — in other words, people with higher starting blood pressures tend to benefit more from exercise. You can also see from the figure below that a combination of resistance and endurance training looks to be more effective, although there’s no clear winner between isometric, endurance, and resistance training taken on their own.
Effects of exercise on systolic blood pressure
Reference: Naci et al. Br J Sports Med. 2019.[13]
However, the authors of the paper caution that more research is needed to explore whether one type of exercise is indeed better than another due to the relative lack of research into this topic.
There are also some other key takeaways from this research that aren’t apparent from the figure.
- Due to reporting issues and lack of relevant data, the authors were not able to explore whether some frequencies or durations of exercise improved blood pressure more than others.
- The authors didn’t see a clear relationship between exercise intensity and blood pressure reduction, mainly due to not having enough data. There is much more room for future research to explore the relationship between exercise intensity and blood pressure reduction.
- There’s some concern about the generalizability of the exercise results to people with high blood pressure, since most of the exercise trials involved people with normal or mildly elevated blood pressure. Future research focused on exercise’s effect on people with high blood pressure would be useful. In short: all types of exercise seem to reduce systolic blood pressure, especially in people with high blood pressure. However, how much exercise is best, whether intensity matters, and exactly what kinds of exercise have the biggest impact are still unclear.
What causes high blood pressure?
In the vast majority of cases (>80%), high blood pressure is caused by lifestyle habits such as unhealthy eating patterns, insufficient physical activity, and excessive intake of alcohol.[12] Consequently, there is a direct relationship between increases in body mass index or waist-to-hip ratio and increases in blood pressure.[11] Genetic variants also influence blood pressure, but they only contribute to about 3.5% of the variability in blood pressure between people.[12]
In about 10-20% of cases, high blood pressure is caused by a separate medical condition (e.g., primary aldosteronism, renal artery stenosis, obstructive sleep apnea). Primary aldosteronism is increasingly recognized as an underdiagnosed cause of high blood pressure and may be responsible in up to 10% of cases.[17]
References
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- ^Xi Zhang, Yufeng Li, Liana C Del Gobbo, Andrea Rosanoff, Jiawei Wang, Wen Zhang, Yiqing SongEffects of Magnesium Supplementation on Blood Pressure: A Meta-Analysis of Randomized Double-Blind Placebo-Controlled TrialsHypertension.(2016 Aug)
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- ^Naci H, Salcher-Konrad M, Dias S, Blum MR, Sahoo SA, Nunan D, Ioannidis JPAHow does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressureBr J Sports Med.(2019 Jul)
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- ^Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, Ganzaroli C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Mattarello MJ, Moretti A, Palumbo G, Parenti G, Porteri E, Semplicini A, Rizzoni D, Rossi E, Boscaro M, Pessina AC, Mantero F,A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients.J Am Coll Cardiol.(2006-Dec-05)
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Examine Database References
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- Blood Pressure - Machowiec P, Ręka G, Maksymowicz M, Piecewicz-Szczęsna H, Smoleń AEffect of Supplementation on Systolic and Diastolic Blood Pressure: Systematic Review and Meta-Analysis of Randomized Controlled Trials.Nutrients.(2021-Aug-31)
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- Interleukin 2 - Sara Mohiti, Meysam Zarezadeh, Fatemeh Naeini, Helda Tutunchi, Alireza Ostadrahimi, Zohreh Ghoreishi, Mehrangiz Ebrahimi MamaghaniSpirulina supplementation and oxidative stress and pro-inflammatory biomarkers: A systematic review and meta-analysis of controlled clinical trialsClin Exp Pharmacol Physiol.(2021 Aug)
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- Chronic Venous Insufficiency Signs - Cesarone MR, Belcaro G, De Sanctis MT, Incandela L, Cacchio M, Bavera P, Ippolito E, Bucci M, Griffin M, Geroulakos G, Dugall M, Buccella S, Kleyweght S, Cacchio MEffects of the total triterpenic fraction of Centella asiatica in venous hypertensive microangiopathy: a prospective, placebo-controlled, randomized trialAngiology.(2001 Oct)
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- Pre-Eclampsia Risk - Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L, Torloni MRCalcium supplementation during pregnancy for preventing hypertensive disorders and related problemsCochrane Database Syst Rev.(2014 Jun 24)