6 evidence-based strategies for reducing blood pressure

The Bottom Line

  • Managing your blood pressure is vital for good health. 
  • Community-based blood pressure screening can be effective in detecting high blood pressure, leading to a potential diagnosis and treatment.
  • Measuring and monitoring one’s own blood pressure can help reduce it in those with high blood pressure.  
  • Decreasing salt intake can reduce blood pressure in folks with high and normal blood pressure.
  • Fish-oil supplements can reduce blood pressure in people with high blood pressure, while calcium supplementation can decrease blood pressure in those with normal blood pressure.
  • Some plant-based diets can reduce one or more aspects of blood pressure in adults.
  • Other non-drug-based strategies such as stress-reducing practices, physical activity, weight loss interventions, and lifestyle modification can reduce blood pressure in people with high blood pressure or a high risk of developing it.
  • Discuss the diverse blood pressure lowering strategies available with your health care team and develop a tailored treatment or prevention plan that you can adhere to.  

It is no secret that we should all aim to keep our blood pressure in check. Look up any list of major risk factors for chronic illness and premature death, and you will be sure to find high blood pressure among the ranks. But, there is good news, whether you are trying to lower your high blood pressure or avoid developing it altogether, there are evidence-backed strategies that can help you achieve these important health-related goals. Click on the links below to learn more.


1. Community-based screening and self-monitoring

Know your numbers! Effective blood pressure management can be impacted by a lack of access to health care professionals that provide formal diagnoses and prescribe treatments, as well as inadequate adherence to the treatment plan and follow-up care (1-5). Community-based screening—which takes place at pharmacies, mobile health units, and other non-traditional healthcare settings—can help people detect their high blood pressure and act as a point of referral to other healthcare services. These referrals have the potential to result in a new diagnosis or treatment (1). Additionally, self-monitoring—which involves an individual measuring and tracking their own blood pressure—can decrease blood pressure in folks who have high blood pressure. How, you ask? This strategy can result in better medication adherence and offer data that health care providers can use to optimize treatment plans (3).


2. Less salt

Did you know that the majority of folks consume more than the recommended amount of salt? Research shows that adults who cut back on their salt intake can bring their blood pressure down. Noteworthy reductions can be seen in people with normal blood pressure but are especially pronounced in those with high blood pressure (6). Unsurprisingly, larger reductions in salt consumption hold more blood pressure benefits than smaller ones (7). Consuming a smaller amount of processed foods and adding less salt while cooking and eating are two strategies that can help you scale back on your salt intake. Low-sodium salt substitutes are one alternative to normal salt. However, keep in mind that they may not be safe for everyone (8-10).


3. Fish oil supplements  

You have likely heard the fun fact about “fatty” fish—such as salmon, sardines, tuna, and trout—being high in omega-3 fatty acids from your fish-loving pescetarian friend or relative. Omega-3 fatty acids are said to thwart the development of heart disease (11). But if the thought of eating these “fatty” fish at the recommended two to three servings a week (or even at all) does not sound appetizing, there are alternatives like fish oil supplements (12). These supplements can lower both systolic and diastolic blood pressure in folks with high blood pressure but have no effect in those with normal blood pressure (13). It is important to remember that not all supplements are safe for all people, and to not replace prescribed medications with supplements. Instead, proper nutrition and supplements, once approved by your health care team, can be used as additional strategies that work alongside other prescribed treatments.


4. Calcium supplementation

The supplementation game continues with calcium, but this time for folks with normal blood pressure looking to avoid developing high blood pressure. It appears that upping your calcium intake results in modest but meaningful reductions in systolic and diastolic blood pressure. Calcium tablets and food fortified with calcium are two strategies used to increase calcium consumption. Although current research shows that calcium tablets are effective when it comes to lowering blood pressure and food fortification is not, fortifying foods with calcium has not been studied as heavily. As such, we cannot yet comment on which strategy is better. Like fish oil supplements, calcium supplements may not be right for everyone and should only be used after a consultation with your health care team about the potential benefits and harms for you as an individual (14).


5. Plant-based diets

Plant-based diets, which limit or completely remove the consumption of animal products, are diverse and aplenty! Research shows that the Dietary Approach to Stop Hypertension (DASH), lacto-ovo vegetarian, and healthy Nordic diets can reduce systolic and diastolic blood pressure in adults. The same may be said for the Mediterranean diet and systolic blood pressure, specifically. Generally, these beneficial diets prompt folks to limit, but not eliminate, their intake of animal products and to eat more fruits, vegetables, whole grains, legumes, nuts, and seeds. Patterns of plant-based eating that do not seem to yield blood pressure lowering effects are the vegan, high fruit and vegetable, and high fiber diets (15).


6. Other non-drug-based strategies 

Although anti-hypertensive medications are often the first treatment prescribed for elevated blood pressure, they do not work for everyone, are costly, and can be accompanied by negative side effects. Luckily, a wide array of complementary and alternative strategies, such as those mentioned above, are available to assist. A few additional strategies that can help people with established high blood pressure or who are at risk of developing high blood pressure include stress-reducing practices (such as breathing control and yoga); physical activity (such as aerobic and isometric exercises); weight loss interventions (such as low-calorie diet and low-calorie diet plus exercise); and comprehensive lifestyle modification. These strategies may lower systolic and/or diastolic blood pressure (16).


Treating or avoiding high blood pressure should be a priority in your health and wellness journey. With so many options to choose from, you—along with guidance and expertise from your health care team—can tailor your prevention or treatment plan. Consider strategies that are accessible, meet the specific needs of your health, and that you are most likely to adhere to.


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References

  1. Fleming S, Atherton H, McCartney D, et al. Self-screening and non-physician screening for hypertension in communities: A systematic review. Am J Hypertens. 2015; 28(11):1316-1324. doi: 10.1093/ajh/hpv029.
  2. Musini VM, Tejani AM, Bassett K, et al. Pharmacotherapy for hypertension in adults 60 years or older. Cochrane Database Syst Rev. 2019; 6:CD000028. doi: 10.1002/14651858.CD000028.pub3.
  3. Fletcher BR, Hartmann-Boyce J, Hinton L, et al. The effect of self-monitoring of blood pressure on medication adherence and lifestyle factors: A systematic review and meta-analysis. Am J Hypertens. 2015; 28(10):1209-1221. doi: 10.1093/ajh/hpv008.
  4. Fischer M, Stedman M, Lii J, et al. Primary medication non-adherence: Analysis of 195,930 electronic prescriptions. J Gen Intern Med. 2010; 25:284-290. doi: 10.1007/s11606-010-1253-1259.
  5. Gwadry-Sridhar FH, Manias E, Lal L, et al. Impact of interventions on medication adherence and blood pressure control in patients with essential hypertension: A systematic review by the ISPOR medication adherence and persistence special interest group. Value Health. 2013; 16:863-871. doi: 10.1016/j.jval.2013.03.1631.
  6. He F, Jiafu L, MacGregor G. Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomized trials. BMJ. 2013; 346:1325. doi: 10.1136/bmj.f1325.
  7. National Institute for Health and Clinical Excellence. Guidance on the prevention of cardiovascular disease at the population level. [Internet] 2010. [cited August 2022]. Available from http://guidance.nice.org.uk/PH25
  8. Hernandez AV, Emonds EE, Chen BA, et al. Effect of low-sodium salt substitutes on blood pressure, detected hypertension, stroke and mortality. Heart. 2019; 105(12):953-960. doi: 10.1136/heartjnl-2018-314036. 
  9. Mount DB, Sterns RH, Forman JP. Causes and evaluation of hyperkalemia in adults. [Internet] 2019. [cited August 2022]. Available from https://www.uptodate.com/contents/causes-and-evaluation-of-hyperkalemia-in-adults
  10. Olendzki, RD. Patient education: Low-sodium diet (Beyond the basics). [Internet] 2019. [cited August 2022]. Available from https://www.uptodate.com/contents/low-sodium-diet-beyond-the-basics
  11. Marik PE, Varon J. Omega-3 dietary supplements and the risk of cardiovascular events: A systematic review. Clin Cardio. 2009; 32:365-372. doi: 10.1002/clc.20604.
  12. Kris-Etherton PM, Harris WS, Appel LJ. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation. 2002; 106:2747-2757. doi: 10.1161/01.atv.0000038493.65177.94. 
  13. Campbell F, Dickinson HO, Critchley JA, et al. A systematic review of fish-oil supplements for the prevention and treatment of hypertension. Eur J Prev Cardiol. 2013; 20:107-120. doi: 10.1177/2047487312437056.
  14. Cormick G, Ciapponi A, Cafferata ML, et al. Calcium supplementation for prevention of primary hypertension. Cochrane Database Syst Rev. 2022; 8:CD010037. doi: 10.1002/14651858.CD010037.pub4.
  15. Gibbs J, Gaskin E, Ji C, et al. The effect of plant-based dietary patterns on blood pressure: A systematic review and meta-analysis of controlled intervention trials. J Hypertens. 2021; 39(1):23-37. doi: 10.1097/HJH.0000000000002604.
  16. Fu J, Liu Y, Zhang L, et al. Nonpharmacologic interventions for reducing blood pressure in adults with prehypertension to established hypertension. J Am Heart Assoc. 2020; 9(19):e016804. doi: 10.1161/JAHA.120.016804. 

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