High Blood Pressure

Blood pressure is the measurement of systolic pressure (maximum pressure during one heartbeat) over diastolic pressure (minimum pressure between heartbeats). After the landmark SPRINT trial, published in 2015, found that lower blood pressure significantly reduced the risk of cardiovascular outcomes and death, the threshold for high blood pressure (hypertension) was lowered from 140/90 mm Hg to 130/80 mm Hg.

Natural interventions such as quercetin, coenzyme Q10, magnesium, and bioactive whey peptides, along with dietary and lifestyle changes, can help lower blood pressure.

What is Healthy Blood Pressure?

Healthy blood pressure is less than 120/80 mm Hg, and Life Extension recommends an optimal target of 115/75 mm Hg. Observational evidence suggests the risk of cardiovascular disease doubles for each increment of 20 mm Hg systolic and 10 mm Hg diastolic above 115/75 mm Hg.

Adding one or more blood pressure-lowering medications may be appropriate if dietary and lifestyle changes alone are insufficient to bring blood pressure into the healthy range.

People with diabetes, pre-existing cardiovascular or kidney disease, or who are over age 80 should be particularly careful with blood pressure-lowering medication. Always consult a doctor before implementing any changes to your daily regimen.

Note: High blood pressure is not the only risk factor for cardiovascular events. People interested in reducing their cardiovascular risks should follow these blood pressure-lowering strategies, and also read the Life Extension Magazine article titled “How to Circumvent 17 Independent Heart Attack Risk Factors.”

Dietary and Lifestyle Changes–The First Step in Controlling Blood Pressure

For otherwise healthy people with blood pressure above 120/80 mm Hg, dietary and lifestyle changes are often sufficient to bring blood pressure into a healthy range.

• Follow a healthy diet (eg, Dietary Approaches to Stop Hypertension [DASH] and Mediterranean diets)
• Reduce caloric intake
• Reduce sodium intake and consume sufficient dietary potassium
• Weight loss
• Regular exercise
• Limit alcohol consumption
• Limit use of non-steroidal anti-inflammatory drugs (NSAIDs)
• Get tested for sleep apnea, as it can increase the risk of high blood pressure
• Manage stress

Note: Using an at-home blood pressure monitor to regularly monitor blood pressure throughout the day is an effective way to track effectiveness of dietary and lifestyle changes and other interventions for blood pressure.

Medications to Help Lower Blood Pressure

If diet and lifestyle changes alone do not sufficiently lower blood pressure, blood pressure medication may be appropriate. Consult a qualified healthcare provider before beginning medical treatment for high blood pressure.

• First-line recommendation
• Angiotensin II receptor blockers (particularly telmisartan)
• Angiotensin-converting enzyme inhibitors
• Second-line recommendation
• Thiazide diuretics
• Third-line recommendation
• Calcium channel blockers

Simultaneous use of more than one blood pressure medication, called combination therapy, may be appropriate for people in whom a single drug fails to control blood pressure.

Note: Beta-blockers are generally not recommended as first-line therapy for blood pressure reduction except in those with an indication for beta-blocker therapy such as recent heart attack or heart failure.

What Natural Interventions May Help Lower Blood Pressure?

• Quercetin. Quercetin, a plant flavonoid shown to effectively lower blood pressure, is linked to lower cardiovascular risk. It is believed to act as an angiotensin receptor blocker.
• Myricetin. Myricetin is a flavonoid like quercetin, which also appears to act as an angiotensin receptor blocker. Myricetin may lower blood pressure in diabetics with hypertension.
• Stevioside. Stevioside, an extract from the Stevia plant commonly used as a sweetener in the United States, can also act as a calcium channel blocker to reduce blood pressure.
• Melatonin. Melatonin helps relax blood vessels and inhibit the sympathetic nervous system, both of which can reduce blood pressure. A meta-analysis indicated melatonin supplementation was effective at lowering nocturnal blood pressure.
• Fish oil. Fish oils and omega-3 fatty acids are associated with lower cardiovascular risk. Fish oil supplements have been shown to lower blood pressure in numerous clinical studies.
• Coenzyme Q10. Coenzyme Q10 has strong antihypertensive and cardioprotective effects, which may be due to its protection of various vasodilators.
• Magnesium. Magnesium supplementation can lower blood pressure in people with hypertension. It can improve endothelial function and act as a calcium channel blocker and vasodilator.
• Other natural interventions include whey protein peptides, grape polyphenols, pomegranate, olive leaf extract, celery seed extract, and hesperidin.

Life Extension has long warned that blood pressure exceeding 115/75 mm Hg can be deadly.^1-4 A large study published in 2015 helped corroborate our contention, but also pointed out some important caveats that aging individuals should be aware of before embarking on an aggressive blood-pressure-lowering regimen.

The SPRINT trial results were published November 9th, 2015 in the New England Journal of Medicine.⁵

This randomized controlled trial that enrolled over 9,300 subjects showed that non-diabetics at increased cardiovascular risk can substantially reduce their risk of cardiovascular events and death by lowering their blood pressure to levels below what were clinical standards at that time.

One group of SPRINT trial participants was intensively treated with blood-pressure-lowering medications to a target systolic blood pressure of less than 120 mm Hg. The other group received medications with a treatment goal of achieving systolic blood pressure of less than 140 mm Hg. The intensively treated subjects took, on average, one additional blood pressure medication compared with the standard treatment group.

The trial was scheduled to last for 5 years, but was stopped after a median of only 3.3 years of follow up because subjects who underwent more intensive blood pressure lowering had a dramatic 25% risk reduction for a composite of cardiovascular outcomes and a 27% lower risk of death from any cause compared with the standard-treatment group.

But while the intensive treatment led to better cardiovascular and overall outcomes, it did increase the risk of kidney problems. As readers of Life Extension publications are aware, aggressive blood-pressure-lowering treatment has the potential to cause side effects, such as impaired kidney function.^6,7 We have long recommended regular blood testing to assess kidney function, as well as overall health; this strategy is particularly important for people who undergo aggressive blood-pressure-lowering treatment. By periodically testing one’s glomerular filtration rate, creatinine, and cystatin-C, declining kidney function can be identified in time to initiate preventive measures.

Subsequent to publication of the SPRINT trial results, major shifts have occurred in the conventional interpretation of blood pressure levels. In late 2017, a consortium of prominent medical organizations focused on heart and vascular health released updated guidelines overhauling the definition of high blood pressure.⁸ The most significant change was that the threshold for overt Stage 1 hypertension dropped from 140/90 mm Hg to 130/80 mm Hg. This change caused millions of additional Americans to suddenly be classified as having high blood pressure.

While we at Life Extension applaud the new guidelines for increasing awareness of the dangers of blood pressure levels previously described only as “prehypertension,” it is disconcerting that it took these major medical organizations this long to lower blood pressure thresholds. Life Extension has advocated a target blood pressure for most people of 120/80 mm Hg for many years, with an optimal level of 115/75 mm Hg for many people.

This protocol outlines a systematic approach to blood pressure control that combines natural interventions—such as quercetin, myricetin and myricitrin, stevioside, and melatonin—and lifestyle strategies with prescription antihypertensive drugs. When coupled with consistent at-home blood pressure monitoring and periodic blood testing to assess kidney function, this approach can help achieve a target blood pressure of 115/75 mm Hg while minimizing risk.

The table below shows the blood pressure categorization thresholds based on the 2017 consortium guidelines.⁸

We at Life Extension agree that “normal” blood pressure levels are below 120/80—with an optimal target being 115/75 for most adults up to age 80. Concerningly, up to half of adults worldwide have blood pressure levels ranging from 120/80 to 139/89 mm Hg.⁹

A recent meta-analysis of observational studies showed that blood pressure in this range correlates with a nearly 20% increased risk of declining kidney function; the association was especially strong in older individuals.¹⁰

In 2006, an analysis of 8,960 middle-aged adults in the Atherosclerosis Risk in Communities (ARIC) study demonstrated that individuals with blood pressure levels ranging from 120/80 to 139/89 mm Hg had about double the risk of cardiovascular disease compared with people whose blood pressure was below 120/80 mm Hg.¹

A meta-analysis of 61 prospective trials evaluated the relationship between blood pressure and cardiovascular-related mortality rates for one million individuals with no known history of cardiovascular disease. Researchers noted that at least down to 115/75 mm Hg, there is no threshold where lower blood pressure is not directly associated with lower mortality rates due to cardiovascular events. In addition, among people 40 to 69 years old, each 20 mm Hg difference in systolic blood pressure was associated with at least a twofold difference in overall mortality due to stroke, ischemic heart disease, or other cardiovascular events.²

With the publication of the SPRINT trial results, the evidence base supporting more aggressive blood pressure treatment targets in select populations continues to broaden. In late 2016, Life Extension Magazine published a comprehensive analysis of the SPRINT trial and an overview of the shortcomings of conventional views regarding blood pressure in an article titled “Lower Blood Pressure Empowers Longer Life.”

The table below shows the blood pressure categorization thresholds based on the 2017 consortium guidelines.⁸

We at Life Extension agree that “normal” blood pressure levels are below 120/80—with an optimal target being 115/75 for most adults up to age 80. This becomes concerning when considering the staggering prevalence of higher-than-normal blood pressure: up to half of adults worldwide have blood pressure levels ranging from 120/80 to 139/89 mm Hg.⁹

A recent meta-analysis of observational studies showed that blood pressure in this range correlates with a nearly 20% increased risk of declining kidney function; the association was especially strong in older individuals.¹⁰

In 2006, an analysis of 8,960 middle-aged adults in the Atherosclerosis Risk in Communities (ARIC) study demonstrated that individuals with blood pressure levels ranging from 120/80 to 139/89 mm Hg had about double the risk of cardiovascular disease compared with people whose blood pressure was below 120/80 mm Hg.¹

A meta-analysis of 61 prospective trials evaluated the relationship between blood pressure and cardiovascular-related mortality rates for one million individuals with no known history of cardiovascular disease. Researchers noted that at least down to 115/75 mm Hg, there is no threshold where lower blood pressure is not directly associated with lower mortality rates due to cardiovascular events. In addition, among people 40 to 69 years old, each 20 mm Hg difference in systolic blood pressure was associated with at least a twofold difference in overall mortality due to stroke, ischemic heart disease, or other cardiovascular events.²

With the publication of the SPRINT trial results, the evidence base supporting more aggressive blood pressure treatment targets in select populations continues to broaden. In late 2016, Life Extension Magazine published a comprehensive analysis of the SPRINT trial and an overview of the shortcomings of conventional views regarding blood pressure in an article titled “Lower Blood Pressure Empowers Longer Life.”

For decades, Life Extension has suggested that most otherwise healthy adults up to age 80 should target a blood pressure of 115/75 mm Hg. However, some adults with pre-existing cardiovascular disease, diabetes, or significant kidney disease may not tolerate aggressive blood pressure control. Caution must be used when lowering blood pressure in all older adults, paying careful attention to heart function^202-205 as well as renal and cognitive function. Baseline blood pressure and health status must be taken into account during the implementation of this protocol:

• Those whose baseline blood pressure exceeds 120/80 mm Hg and are otherwise healthy should begin by implementing phase 1 of this protocol, which consists of dietary and lifestyle changes as well as targeted dietary supplementation, for a 3-month trial period. If this 3-month trial does not produce consistent blood pressure readings of approximately 115/75 mm Hg, the patient should discuss with his or her physician whether it is appropriate to add one or more blood-pressure-lowering medications to their regimen, as described in phase 2 of this protocol.
• Diabetics whose baseline blood pressure exceeds 120/80 mm Hg should implement phase 1 of this protocol (diet and lifestyle changes along with targeted natural interventions), but should carefully weigh the risks and benefits of blood-pressure-lowering drug treatment. A large clinical trial conducted by the ACCORD Study Group showed that, in diabetics, intensive antihypertensive drug treatment targeting a systolic blood pressure of less than 120 mm Hg did not reduce a composite measure of fatal and nonfatal cardiovascular events, nor of most specific cardiovascular outcomes, compared with less-intensive treatment targeting a systolic blood pressure of less than 140 mm Hg. There was, however, a reduced risk of stroke in the group receiving more intensive therapy.¹² A 2016 analysis of data on more than 73,000 subjects from 49 clinical trials investigated the link between blood pressure levels and treatment outcomes in diabetics. The research team found that antihypertensive treatment in diabetics whose systolic blood pressure was under 140 mm Hg at baseline led to worse outcomes. Specifically, diabetics whose systolic blood pressure was under 140 at baseline experienced a 15% increased risk of cardiovascular death as a result of further blood-pressure-lowering treatment, with no observed benefit.¹⁴ The American Diabetes Association recommends treatment targets of <140/90 for most diabetic patients, and <130/80 for diabetics at high cardiovascular risk as long as more intensive treatment does not create an undue burden on the patient.²²⁴
• People who have significant pre-existing cardiovascular or kidney disease (including previous kidney transplant) and individuals over age 80 may not tolerate aggressive blood-pressure-lowering drug therapy, and may need a slow, steady, individualized approach.
• Blood pressure targets for those over age 80 may need to be individualized based on the overall health and functional status of the patient. There is a lack of consensus in recent guideline statements as to the ideal treatment target for older patients generally. Over-aggressive blood-pressure-lowering treatment in the elderly can increase risk of adverse events.²²⁵
• Anyone already on a physician-supervised plan to lower their blood pressure should consult their physician before adjusting their program or plan.

Phase 1: Diet and Lifestyle Changes and Targeted Natural Interventions

The initial phase of Life Extension’s systematic strategy for blood pressure control involves diet and lifestyle changes combined with targeted natural interventions. Blood pressure readings should be taken twice daily for at least three days prior to embarking on this regimen, and the average blood pressure should be recorded. After initiating the phase 1 regimen, blood pressure should be monitored and recorded twice daily. The recommendations described here should be continued indefinitely, even if medications are required to maintain blood pressure in the target range of 115/75 to 120/80 mm Hg.

For people whose blood pressure exceeds 120/80 mm Hg, these dietary and lifestyle changes and natural interventions may be tried for three months before medications are considered.

Accurate and Consistent Blood Pressure Monitoring is Important

Many people may not realize that blood pressure treatment targets depend on the method by which blood pressure is measured. It is thus important that blood pressure is measured regularly, using a consistent technique. Regular at-home self-monitoring of blood pressure is crucial for anyone concerned with cardiovascular health.¹⁹ At-home blood pressure monitoring helps confirm that any intervention you are undertaking is keeping your readings near your target goal.

In a randomized controlled trial, 136 participants with uncontrolled high blood pressure were assigned to at-home blood pressure monitoring or usual care; their medication regimen was not modified. Those who regularly monitored their blood pressure at home saw significant reductions in systolic and diastolic blood pressure compared with those who did not self-monitor. At the end of the two-month trial, 32% of the self-monitoring group had blood pressure of less than 130/80 mm Hg, while only half as many participants (16%) who did not self-monitor saw their blood pressure fall below this level.²⁰ Several other studies have found similar benefits associated with at-home blood pressure monitoring.^21-24

In routine clinical practice, the mere presence of a physician or healthcare professional can lead to a phenomenon known as “white coat syndrome,” an acute rise in blood pressure when it is measured in a healthcare setting.²²⁷ In fact, blood pressure measurements in routine clinical practice are slightly higher than measurements made by using the recommended strategy of the American Heart Association (AHA), also utilized in the SPRINT trial.^228,229 The AHA recommendation is to measure blood pressure three to five minutes after quiet rest using an automated oscillometric device, have proper positioning (ie, seated with feet flat and back supported), utilize appropriate cuff size and cuff positioning, and take the mean of two or more blood pressure readings taken on two or more separate occasions.

A recent analysis of SPRINT data revealed that the mean systolic blood pressure was 7.3 mm Hg lower with the AHA recommended strategy compared with measurements taken in the traditional clinical setting. The finding that blood pressure readings taken by the method utilized in the SPRINT trial are lower than those taken in traditional clinical settings have important implications for the management of blood pressure. The SPRINT trial suggested that more aggressive blood pressure control may improve outcomes. However, the more aggressive treatment targets may not be appropriate if blood pressure measurements are being taken by traditional in-office methods. This is another example of why regular at-home blood pressure monitoring is so important. The restful environment at home may produce readings more similar to those obtained by the SPRINT investigators because they took steps to ensure participants were relaxed before taking their blood pressure by automated device.²²⁹

Dietary and Lifestyle Changes

Healthy Diet (DASH- or Mediterranean-Type Dietary Pattern). The Dietary Approaches to Stop Hypertension (DASH) diet is high in fruits, vegetables, nuts, and low-fat dairy products, and emphasizes fish and chicken over red meat. DASH is low in saturated fat, cholesterol, sugar, and refined carbohydrates,^25-27 and is especially high in fiber (31 g/day) and potassium (4.7 g/day), factors that likely contribute to its efficacy for treating hypertension.²⁸ A sodium-restricted DASH diet may be particularly effective.²⁹ Research has shown that the DASH diet, when combined with a weekly cognitive-behavioral weight loss intervention and supervised exercise sessions 3 times per week, helped reduce systolic blood pressure by 16.1 mm Hg and reduce weight by 19.2 lbs in overweight men and women with above-normal blood pressure.³⁰

The Mediterranean dietary pattern emphasizes similar foods, and may include moderate amounts of wine with dinner. This dietary pattern has a robust research record associating greater adherence with reduced risk of cardiovascular disease, diabetes, neurodegenerative disease, cancer, and death from all causes, as well as with lower blood pressure.^31-35

A group of a bioactive plant compounds called flavan-3-ols, which are particularly high in wine, tea, chocolate, nuts, and certain fruits, have been shown in interventional studies to provide cardiovascular benefits.^230,231 A diet that contains higher flavan-3-ol has been associated with blood pressure reductions similar to those achieved with the Mediterranean diet. In a cross-sectional study of over 25,000 European participants, there was a significant association between participants with higher biomarker estimated flavan-3-ol intake and significantly lower blood pressure in both men and women.²³²

Caloric Restriction. Caloric restriction is the long-term reduction of dietary calories while still consuming adequate amounts of essential nutrients. Caloric restriction studies have demonstrated benefit for blood pressure, diabetes, metabolic syndrome, heart disease, and possibly for the prevention of cancer. Clinical studies generally restrict calorie intake by 10–30% compared with normal energy consumption. Studies of long-term caloric restriction in many species have demonstrated that it extends life and retards age-related diseases.^36,37

Caloric restriction’s benefits are mediated through multiple physiologic pathways, including AMPK activation, reduction of inflammation, improved insulin sensitivity and nitric oxide metabolism, angiotensin-blocking effects, and reversal of age- and obesity-related changes in the nervous system.^38-43 Even modest weight loss induced by caloric restriction results in improvement in arterial stiffness superior to that achieved by resistance training exercise.⁴⁴

During a two-year clinical caloric restriction trial in which participants consumed 1750–2100 calories per day, an impressive reduction in blood pressure ensued: systolic blood pressure dropped by 25% and diastolic blood pressure dropped by 22%.⁴⁵ In a two-year randomized controlled trial of less than 25% caloric restriction, multiple cardiovascular risk parameters improved more in the caloric restriction group, including reductions in systolic and diastolic blood pressure.⁴⁶ A study of non-drug interventions compared a low-salt diet, calorie restriction, and exercise for an average of 23 months in 825 subjects with high blood pressure. Caloric restriction lowered systolic blood pressure by 6.6 mm Hg, on average. Among the caloric restriction group, there was a 17% chance of a blood pressure reduction of 10 mm Hg systolic and 5 mm Hg diastolic.⁴⁷

Reduce Sodium Intake and Maintain Sufficient Dietary Potassium. Higher salt (sodium chloride) intake is associated with higher blood pressure and greater risk of cardiovascular disease. Limiting salt intake lowers blood pressure²⁹ and cardiovascular risk, and salt reduction is part of standard dietary advice for blood pressure treatment.⁴⁸ Similarly, evidence from observational studies and clinical trials consistently indicates that high levels of dietary potassium are associated with lower blood pressure.^49,50 

Diets like the DASH diet and Mediterranean diet encourage intake of unprocessed/minimally processed vegetables, fruits, legumes, whole grains, and nuts in part to ensure a healthy balance of sodium and potassium. As part of these diets, it is also encouraged to prepare unpackaged food at home as much as possible. According to the FDA, approximately 70% of sodium in the typical American diet comes from eating packaged or preprepared foods; therefore, simply eating plant-based foods may not be sufficient to combat high blood pressure if they are highly processed.²⁷⁰

Sodium intake can be further minimized by replacing regular table salt with a potassium-enriched salt. Randomized-controlled trials have consistently shown that potassium-enriched salt is an effective option for improving potassium levels, while also reducing blood pressure, risk of cardiovascular disease, and mortality. A systematic review and meta-analyses of 21 randomized-controlled trials, totaling close to 32,000 people, evaluated the effects of potassium-enriched salts with a concentration of 25–65% potassium chloride for a duration of 1–60 months. Mean baseline systolic and diastolic blood pressure ranged from 113–177 mm Hg and 71–105 mm Hg, respectively. The results showed that the use of potassium-enriched salts reduced mean systolic blood pressure by 4.61 mm Hg and mean diastolic blood pressure by 1.61 mm Hg. Total mortality was reported in five of these trials; the results showed a statistically significant 11% reduction in total mortality risk.²⁷¹

A salt substitute that is 25% potassium chloride (75% sodium chloride) is generally recommended for those with hypertension unless they have advanced kidney disease, are using a potassium supplement, are using a potassium-sparing diuretic, or have other contraindications.²⁷²

Weight Loss. A reduction of systolic blood pressure by 5‒20 mm Hg accompanying weight loss has been observed in several studies.⁵¹ Weight loss may also allow a decrease in the required dose of blood pressure medications.⁴⁸ Weight loss has been found to be especially important in adults under the age of 65. For adults over 65, weight had less impact on systolic blood pressure.⁵² Refer to the Weight Management protocol for an overview of a comprehensive approach to attaining a healthy weight.

Exercise. Regular exercise has been associated with average reductions in blood pressure of 3.2‒3.8 mm Hg (systolic) and 2.6‒3.5 mm Hg (diastolic) in thousands of subjects across many studies.^53-55 Even something as simple as breaking up prolonged sitting with light intensity walking was associated in one study with lower blood pressure (-3 mm Hg systolic and -3 mm Hg diastolic).⁵⁶

Limit Alcohol Intake. In adults ages 20‒84 without high blood pressure, the National Health and Nutrition Examination Survey (NHANES) showed that alcohol consumption above two drinks per day in men and one drink per day in women was associated with higher systolic blood pressure in both men and women.⁵⁷ The good news is that limiting alcohol consumption to less than two drinks per day for men and less than one drink per day for women can reduce systolic blood pressure by 2‒4 mm Hg.⁵⁸

Limit Use of NSAIDs & Acetaminophen. Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen have been shown to increase blood pressure in those with and without hypertension.233-235 Low-dose aspirin does not have this effect.²³⁵ NSAIDs induce acute kidney injury and are especially problematic for individuals with existing kidney disease.^236,237 The combination of NSAIDs, diuretics, ACE inhibitors or ARBs, and advanced age is associated with an especially high risk of kidney injury.^237,238 In one study, researchers found that those with high blood pressure who had been taking NSAIDs for at least three months were 32% more likely to have chronic kidney disease than those who did not take NSAIDs, and those who used NSAIDs more than once daily were 23% more likely to have chronic kidney disease compared with nonusers.⁶⁰

The PATH-BP trial examined the effect of regular acetaminophen use in 103 patients with hypertension. The study showed that two weeks of daily acetaminophen use (1 gram four times daily) led to an increase of about 5 mm Hg in average systolic blood pressure compared with placebo.²³³ In elderly individuals, sodium-containing forms of acetaminophen have also been found to increase the risk of high blood pressure compared with non-sodium-containing forms.²³⁹

A wide range of other medications and drugs can raise blood pressure, including alcohol, nicotine, and stimulant drugs; migraine medications; estrogens, including in birth control pills; decongestants such as pseudoephedrine and other over-the-counter cold medications; some antidepressants; and corticosteroids.^240,241

Get Tested for Sleep Apnea. Symptoms of obstructive sleep apnea include snoring and choking, gasping, or silent breathing pauses during sleep. Sleep apnea is a major underappreciated risk factor for high blood pressure. Rates of sleep apnea have greatly increased over the past two decades and are now estimated to occur in 26% of adults between the ages of 30 and 70 years old.⁶¹ Sleep apnea causes a sudden drop in blood oxygen, which can lead to an increase in blood pressure.⁶² A meta-analysis of randomized controlled trials found that continuous positive airway pressure (CPAP), a treatment for sleep apnea, helped to decrease blood pressure in individuals with sleep apnea and resistant hypertension by nearly 5 mm Hg systolic and 3 mm Hg diastolic.⁶³

Manage Stress. Acute stress can cause short-lived blood pressure spikes, and effectively managing stress may improve blood pressure and overall health. The body’s stress response results in release of the hormones cortisol and epinephrine, which elevate heart rate and cause blood vessel constriction, raising blood pressure.⁶⁴ A meta-analysis found that individuals who had stronger responses to acute psychological stress were 21% more likely to develop hypertension.⁶⁵Many strategies for reducing stress are described in Life Extension’s Stress Management protocol.

Maintain Good Oral Hygiene. Poor oral hygiene has been associated with cardiovascular risks, and particularly with high blood pressure.^261,262 In people with existing hypertension, the presence of multiple dental caries has been shown to increase the risk of adverse outcomes like stroke and myocardial infarction.²⁶³ A meta-analysis that included over 250,000 participants found that those who brushed their teeth infrequently (approx. one or fewer times per day) had an 84% increased risk of hypertension compared with those who brushed their teeth more frequently (approx. three or more times per day), and each increment of daily tooth brushing decreased the risk of hypertension by 22%.²⁶⁴

The relationship between oral hygiene and hypertension appears to be mediated in part by the oral microbiome. Certain bacteria in the mouth reduce ingested nitrate and nitrite to produce nitric oxide, a multifunctional signaling molecule that plays an essential role in the function of the vascular endothelium. Disruption of nitrate-reducing bacteria in the oral microbiome, either through overgrowth of pathogenic bacteria as in periodontitis, or through overuse of antibacterial mouth rinses, can decrease nitric oxide levels and increase blood pressure.²⁶¹ Frequent use of antibacterial mouth rinses (≥2 times daily) has been shown to raise blood pressure and increase the risk of hypertension.^265,266

This effect appears to be strongly tied to chlorhexidine mouth rinses and changes in the oral microbiome that affect nitrite availability.²⁶⁷ There is some evidence that probiotics may help improve blood pressure, although further studies are needed to elucidate specific beneficial strains and the role of the oral microbiome in hypertension.^268,269

Targeted Natural Interventions

Quercetin. Quercetin is a type of plant pigment called a flavonoid. Many fruits and vegetables contain quercetin. Studies over the last few decades have found that quercetin intake is linked to reduced cardiovascular disease. More recently, intervention studies in animals and humans have shown that quercetin supplementation lowers blood pressure.⁶⁶ Quercetin is thought to lower blood pressure through multiple mechanisms, including functioning as an angiotensin receptor blocker (ARB). In fact, a 2015 study showed quercetin achieved a similar estimated receptor docking score for the angiotensin receptor as some pharmaceutical ARBs, including irbesartan and losartan.⁶⁷

The blood-pressure-lowering capacity of quercetin has been observed in several clinical trials. For example, a trial in 93 overweight or obese individuals showed 150 mg of supplemental quercetin daily for six weeks reduced systolic blood pressure by 2.6 mm Hg.⁶⁸ In a separate randomized controlled trial, 49 men consumed 150 mg of quercetin or a placebo each day for eight weeks. Subjects who took quercetin experienced a 5.7 mm Hg reduction in 4-hour postprandial (after-meal) blood pressure, while placebo recipients’ blood pressure did not change significantly.⁶⁹ A 2015 randomized controlled trial found that in hypertensive subjects six weeks of treatment with 162 mg of quercetin daily lowered 24-hour ambulatory blood pressure by 3.6 mm Hg compared with placebo.⁷⁰ Other trials that used different quercetin doses and treatment durations have also shown that this flavonoid effectively lowers blood pressure.^71,72

Myricetin and myricitrin. Like quercetin, myricetin is a flavonoid present in vegetables, fruits, nuts, berries, tea, and red wine.^73,74 And also as with quercetin, it appears that myricetin functions as an angiotensin receptor blocker (ARB).⁶⁷ Preclinical studies have shown that myricetin attenuates the rise in blood pressure in response to hypertensive stimuli in animals.^75,76 Myricitrin, also a naturally occurring flavonoid, is converted to myricetin by intestinal flora.⁷⁷ Both myricetin and myricitrin have anti-inflammatory properties,^78,79 and myricitrin has shown anxiolytic properties in a preclinical study.⁸⁰

In an uncontrolled 2014 pilot clinical study on diabetics with normal blood pressure, 600 mg of the myricitrin-containing herb Eugenia punicifolia daily for three months led to an 11 mm Hg reduction in systolic blood pressure, and a 6 mm Hg reduction in diastolic blood pressure.⁸¹

Stevioside. A glycoside derived from the leaves of Stevia rebaudiana, stevioside is commonly known in the United States as a sweetener. In South America and Asia, extracts of the Stevia plant have been used traditionally to control blood sugar levels.^82,83 Preclinical evidence has shown that stevioside may help control blood pressure by functioning as a calcium channel blocker. Blocking calcium channels is how some medications like verapamil lower blood pressure.^84-86

A 2015 meta-analysis of data from published studies found stevioside reduced blood pressure by nearly 12 mm Hg (for diastolic pressure) when used for more than one year. Overall, studies in this analysis that used predominantly stevioside as the intervention showed an average reduction of 4.5 mm Hg in systolic blood pressure. The dosage of stevioside used in the studies included in this analysis ranged from 750 to 1,500 mg daily.⁸⁷

Melatonin. Melatonin is well-known and widely used as a natural sleep aid. It is a hormone that the pineal gland releases at night to promote restful sleep and help regulate circadian (day-night) body rhythms.⁸⁸

Melatonin has some other important but underappreciated health benefits: it appears to help control blood pressure by acting within the central nervous system as well as peripheral parts of the body. Peripherally, melatonin helps relax blood vessels and promote vasodilation, which reduces blood pressure. Melatonin can also inhibit the sympathetic nervous system, overstimulation of which can contribute to high blood pressure.^89,90 Uncontrolled nocturnal hypertension is a serious problem that many people may not take into consideration. Elevated nighttime blood pressure contributes to cardiovascular disease and mortality, and is especially prevalent in people with sleep apnea.^91-93

In a 2011 meta-analysis of data from seven studies (221 subjects in total), 2‒3 mg of controlled release melatonin at bedtime reduced nocturnal systolic blood pressure by 6 mm Hg, and nocturnal diastolic pressure by 3.5 mm Hg.⁹⁴

Fish Oil. Fish oil is a source of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), polyunsaturated omega-3 fatty acids best known for their anti-inflammatory effects. Omega-3 fatty acids from fish oil are important cardioprotective nutrients, due to their ability to reduce inflammation and oxidative stress, stabilize cell membranes, improve disordered lipid levels and glucose metabolism, normalize blood vessel function, and inhibit formation of blood clots and atherosclerosis.²⁴² In addition, DHA is used in the body to make compounds called resolvins, protectins, and maresins, known collectively as specialized pro-resolving mediators (SPMs), that have a critical role in ending inflammatory processes.²⁴³

A meta-analysis published in 2022 that included data from 71 randomized controlled trials, with a total of 4,973 participants, found supplementing with a combination of EPA plus DHA reduced both systolic and diastolic blood pressures. The researchers identified 2–3 grams per day of combined EPA plus DHA as an optimal dosage. This dosage resulted in an overall 2.61 mm Hg drop in systolic blood pressure and 1.64–1.80 mm Hg drop in diastolic blood pressure. No additional blood pressure reductions were seen using dosages higher than 3 grams per day, especially in those with normal baseline blood pressures. The greatest effects were seen in older individuals, those with systolic blood pressure ≥ 140 mm Hg, and those with abnormal lipid levels, and findings suggested these populations may possibly benefit from doses slightly higher than 3 grams per day.²⁴⁴

Coenzyme Q10. An in-depth review examined randomized controlled trials that used coenzyme Q10 (CoQ10) supplementation, for a minimum of three weeks, to treat primary hypertension. Treatment with CoQ10 resulted in an average decrease in systolic blood pressure of 11 mm Hg and an average decrease in diastolic blood pressure of 7 mm Hg.¹⁰¹ CoQ10’s antihypertensive effects may be a result of nitric oxide-dependent vasodilation and protection of nitric oxide from free radical-mediated degradation; CoQ10 may also boost production and increase tissue sensitivity of prostacyclin, a potent vasodilator that prevents blood clotting.¹⁰² CoQ10 supplementation has demonstrated efficacy for decreasing risk of major cardiovascular events and death from cardiovascular and all causes; improving endothelial function, an important concern in high blood pressure, including in statin-treated diabetics; and increasing activity of the free radical modulating enzyme superoxide dismutase.^103-106 In a five-year randomized trial of 443 elderly individuals, CoQ10 combined with selenium reduced cardiovascular mortality by half compared with placebo.¹⁰⁷

Magnesium. Magnesium supplementation dose-dependently lowers blood pressure in hypertensives.¹⁰⁸ Based on data from epidemiologic and observational studies, individuals with high blood pressure have lower intakes of magnesium than those with normal blood pressure, and low magnesium intake is associated with greater risk of having and dying from heart disease. Magnesium intake of 500–1000 mg per day is associated with lower systolic and diastolic blood pressure. Magnesium also appears to increase the effectiveness of all classes of anti-hypertensive medications. Magnesium’s effectiveness is attributable to its ability to improve endothelial function, act as a natural calcium channel blocker and vasodilator, and possible anti-inflammatory activity.^109-113

In a meta-analysis of seven studies that enrolled patients with systolic blood pressure over 155 mm Hg who had taken antihypertensive medication for at least six months, magnesium supplementation was shown to significantly lower systolic and diastolic blood pressure, by an average of 18.7 mm Hg and 10.9 mm Hg, respectively.¹¹⁴ Low serum magnesium is associated with a decline in kidney function and an increased risk of chronic kidney disease.¹¹⁵ Magnesium status can be assessed using the red blood cell magnesium test.¹¹⁶

Whey Protein. Whey is a liquid byproduct of cheesemaking. For centuries whey was treated as waste, but is now recognized as a valuable source of high-quality protein, peptides, and amino acids.^245,246 Whey protein powder is an extract from the liquid whey.²⁴⁷ Numerous controlled clinical trials have demonstrated whey protein’s ability to lower blood pressure and improve vascular function. These studies have also shown that whey protein improves other metabolic risk factors, including insulin sensitivity and glucose and lipid levels.^120,248 Two separate meta-analyses concluded that whey protein consumption results in lower systolic and diastolic blood pressure, as well as other metabolic improvements such as improved lipid levels, lower fasting glucose, and improved body composition.^249,250

In a dietary challenge trial comparing the eight-hour response to 28 grams of whey protein, casein, or maltodextrin, whey resulted in a significantly greater drop in systolic blood pressure that lasted up to five hours. Arterial stiffness also improved.²⁵¹ A similar rapid effect of whey protein on blood pressure was revealed in a study in normal-weight men with an average age of 75 years. A nutrient drink supplemented with 70 grams whey protein alone, or mixed with carbohydrate and fat, lowered systolic blood pressure by 22–24 mmHg in the two to three hours after the drink was consumed. The combination drink lowered diastolic blood pressure as well.²⁵² An eight-week trial in 38 adults with pre-hypertension and mild hypertension showed that two daily doses of 28 grams of whey protein daily for eight weeks lowered systolic and diastolic blood pressure, and improved endothelial function as measured by flow-mediated dilation.²⁵³ Another randomized controlled trial in 54 adults found that in obese and overweight individuals who received 30 grams of whey protein for 12 weeks, systolic blood pressure was significantly lower, as were body fat, fat percentage, and waist circumference, compared with the control group. Endothelial function also improved. The authors of this paper concluded that body fat loss was the mechanism for the blood pressure benefit.²⁵⁴

Fat loss and improvements in arterial stiffness and endothelial function all likely contribute to the blood pressure benefits of whey protein, but they do not completely explain the rapid lowering effect that occurs within hours. It has been suggested, however, that whey protein’s effects may also be mediated by inhibition of the angiotensin converting enzyme (ACE) and by interaction with opioid neurotransmitter receptors.²⁴⁶

Trials showing these benefits generally have used roughly one to three ounces (28–84 grams) of whey protein powder per day.^249,250

Grape Polyphenols. A meta-analysis of randomized controlled trials found that, compared with controls, grape polyphenol treatment lowered systolic blood pressure. The effective dosages used in these clinical trials ranged from 200 to 733 mg/day, over a period of 2–12 weeks. The blood pressure-lowering effect was most pronounced in study participants with metabolic syndrome.¹²⁸ This effect is probably mediated in large part by grape polyphenols’ antioxidant properties and ability to substantially improve endothelial function in both healthy subjects and those at cardiovascular risk.^127,255 The endothelial benefit of grape polyphenols may be explained by a modulation of nitric oxide metabolism.¹²⁹

Evidence has continued to accumulate from preclinical studies,^256,257 randomized controlled trials,^255,258 and meta-analyses^259,260 that grape polyphenols and grape seed extract are potent modifiers of vascular endothelial function, yielding improvements in blood pressure.

Pomegranate Extract. Pomegranate juice and its polyphenolic extract have established cardioprotective benefits that include reduction in systolic and diastolic blood pressure.^131-133 Pomegranate juice naturally inhibits the angiotensin-converting enzyme, mimicking the mechanism of antihypertensive ACE inhibitor drugs.^134,135 Animal studies indicate that pomegranate juice extract also interferes with the hypertensive effect of angiotensin II, a property similar to angiotensin II receptor blocker (ARB) medications, and has a beneficial influence on endothelial nitric oxide.^136,137

Olive Leaf Extract. A 12-week randomized clinical study compared the blood-pressure-lowering effects of olive leaf extract to the ACE-inhibitor medication captopril in patients with stage I hypertension. Both the olive leaf and the captopril group experienced reductions in systolic and diastolic pressure, with no important difference in the effects of the two compounds. In the olive leaf extract group, systolic and diastolic blood pressure decreased on average by 11.5 mm Hg and 4.8 mm Hg, respectively.¹³⁸ This study confirmed results of earlier trials that found olive leaf extract effective for hypertension.^139,140 Olive leaf extract has been shown to increase insulin sensitivity in men at risk of developing metabolic syndrome, a condition often accompanied by high blood pressure.¹⁴¹ Olive leaf’s antihypertensive effect may be attributable to several of the same mechanisms as prescription blood pressure drugs, including calcium-channel blocking, ACE inhibition, and angiotensin II antagonism.^142-145

Celery Seed Extract. A trial of standardized celery seed extract in 30 patients with mild-to-moderate hypertension found that six weeks of supplementation reduced systolic and diastolic blood pressure by 8.2 and 8.5 mm Hg, respectively.¹⁴⁶ Long-term administration of celery seed extract to hypertensive rats resulted in a substantial reduction in blood pressure.¹⁴⁷ Laboratory studies with celery extract have demonstrated vasodilatory and vasorelaxant activity, which may be mediated by calcium-channel-blocking activity.^148,149

Hesperidin. The inner peels of sweet orange (Citrus sinensis) are a rich source of flavonoids, including hesperidin.²⁰⁶ Hesperidin and other citrus flavonoids enhance vascular health by improving endothelial function and reducing inflammation.^207,208 In addition, hesperidin’s anticoagulant and lipid-regulating properties add to its potential utility in preventing and treating hypertension and other cardiovascular diseases.²⁰⁹

In a randomized controlled trial, 64 subjects with type 2 diabetes received either 500 mg of hesperidin per day or placebo for six weeks. Those taking hesperidin had greater reductions in systolic and diastolic blood pressure and inflammatory marker levels compared with placebo.²¹⁰ A randomized controlled trial in subjects with metabolic syndrome found that 500 mg of hesperidin for three weeks improved endothelial function and levels of inflammatory markers.²⁰⁸

Citrus fruits and their juices have high concentrations of hesperidin.²¹¹ In a controlled clinical trial in healthy individuals, drinking orange juice and taking 500 mg of hesperidin daily for four weeks each resulted in changes in gene expression toward a less inflammatory and less atherosclerosis-promoting profile.²¹² In a similar four-week trial, orange juice and supplemental hesperidin were found to have similar positive effects, compared with placebo, on diastolic blood pressure and endothelial function of small blood vessels. This study, in moderately overweight men aged 50‒65, suggests hesperidin may be the active compound responsible for oranges’ cardioprotective effects.²¹³ In animal research, hesperidin has been shown to reduce high blood pressure²¹⁴ and reverse age-related arterial stiffness.²¹⁵

Hesperidin and its breakdown product, hesperetin, have been found to increase the production of nitric oxide in cells from the inner lining of human blood vessels.^216,217 Nitric oxide from these cells plays a key role in relaxing blood vessel walls and reducing high blood pressure.²¹⁸ In the same study, after treatment with hesperidin, human blood vessel cells also produced less endothelin-1, a compound that constricts blood vessels and increases blood pressure, and fewer oxygen free radicals.²¹⁶ Hesperidin’s ability to raise levels of vessel-dilating nitric oxide has also been demonstrated in animal studies.^219,220 Animal and preclinical research indicates hesperidin may also relax blood vessel walls by altering the function of potassium channels that help regulate muscle contraction in blood vessel walls.^221,222

Hesperidin, like other plant polyphenols, impacts the health and diversity of the microbial community of the gut. Because the gut microbiome plays a key role in regulating metabolism and inflammation, it is now thought that flavonoids like hesperidin may exert their positive effects on health and disease in part through interactions with gut microbes. The possible links between hesperidin, the gut microbiome, and improved metabolic and cardiovascular health is an exciting and emerging topic in nutrition research.^211,223

Garlic. Garlic has been examined in many studies for its benefits primarily on blood lipid profiles, such as reducing high cholesterol and serum triglycerides. Evidence from multiple studies also suggest garlic can reduce systolic and diastolic blood pressure.²⁷³ A meta-analysis of 12 trials including 553 hypertensive participants found that garlic supplements lowered systolic and diastolic blood pressure by an average of 8.3 mm Hg and 5.5 mm Hg, respectively.²⁷⁴

A branded aged garlic extract, Kyolic, was found to effectively reduce blood pressure in multiple clinical studies. In one randomized controlled study conducted over 12 weeks, a total of 79 participants with uncontrolled systolic hypertension (≥ 140 mm Hg) were randomized to placebo or 240, 480, or 960 mg of aged garlic extract. In the 480 mg group, systolic blood pressure was significantly reduced by 11.8 mm Hg compared with placebo.²⁷⁵ In a separate controlled trial, participants taking 1.2 grams of Kyolic aged garlic extract daily for 12 weeks were found to have significant reductions in systolic (10 mm Hg) and diastolic (5.4 mm Hg) blood pressure.²⁷⁶

Black garlic is produced from the aging of raw garlic under high temperature and humidity conditions. The aging process changes the garlic to a dark color and increases the content of various compounds, including S-allyl cysteine (SAC). SAC is a major bioactive component in aged and black garlic that contributes to many of its health benefits.²⁷⁷ In one randomized controlled trial conducted over 12 weeks, 56 healthy individuals aged 25-65 years with borderline cardiovascular disease risk factors received placebo or 500 mg of aged black garlic, providing 2.5 mg SAC. After 12 weeks, those given aged black garlic had statistically significant and clinically meaningful reductions in systolic and diastolic blood pressure compared with placebo. Aged black garlic also showed significant improvements in total cholesterol, LDL cholesterol, serum triglycerides, and fasting blood glucose.²⁷⁸ A separate randomized trial including 67 participants with hypercholesterolemia found that 250 mg aged black garlic (providing 1.25 mg SAC) modestly reduced diastolic blood pressure compared with placebo.²⁷⁹

Those who take prescription antihypertensive medications must remain aware of the potential for these drugs to cause kidney dysfunction and electrolyte abnormalities in some people. Also, blood pressure that is too low can cause dizziness, especially upon standing, which may result in fainting and injurious falls. At-home blood pressure monitoring is critical, and should be performed twice daily, once in the morning and once in the evening.

In order to mitigate the chances of medication-related complications, particularly those related to kidney function, blood tests should be performed regularly to monitor treatment and health status. Changes in medications and medication dosage levels, and changes in overall health status (including urinary and fluid balance symptoms) are indications to repeat testing, bearing in mind that some alterations will manifest rapidly while others may appear gradually. It is important to remember that this applies to all medications, including over-the-counter drugs, not simply to blood pressure medications. For those in stable health, with no change in medication or dosage, testing should be performed every six months at minimum. All changes that could potentially impact kidney function should be closely followed using the indicated laboratory tests.

Important tests for people undertaking strategies to lower blood pressure include:

• Chemistry panel and complete blood count (CBC)
• Cystatin-C
• Orthostatic hypotension evaluation (clinical test)

Life Extension has identified at least 17 independent risk factors that increase your likelihood of succumbing to a deadly cardiovascular event. All of these risk factors must be addressed if one’s goal is optimal risk reduction.

Although high blood pressure is recognized worldwide as one of the strongest cardiovascular risk factors, focusing only on blood pressure and neglecting the other 16 independent risk factors could be a devastating oversight. These risk factors include:

• Excess LDL
• Excess total cholesterol
• Low HDL
• Excess blood glucose
• Excess homocysteine
• Excess C-reactive protein (CRP)
• Insufficient vitamin D
• Insufficient vitamin K
• Elevated triglycerides
• Low blood EPA and DHA
• Low testosterone (in men)
• Excess estrogen (in men)
• Excess insulin
• Nitric oxide deficit
• Excess fibrinogen
• Elevated levels of oxidized LDL

People interested in maximizing their cardiovascular risk reduction should follow the strategy outlined in this article to control their blood pressure, and also read the Life Extension Magazine article titled “How to Circumvent 17 Independent Heart Attack Risk Factors.”

Life Extension has long suggested that the lower blood pressure achieved by calorie restriction adherents is a critical component of the health and longevity benefits they enjoy. A growing body of evidence supports the benefit of blood pressure lower than 120/80 mm Hg for certain populations.^1-3 The results from the SPRINT trial,⁵ published in 2015, lend additional support to a target systolic blood pressure of less than 120 mm Hg as opposed to a more conservative target of less than 140 mm Hg. For decades, Life Extension has advocated a blood pressure goal of 115/75 mm Hg.

The foundation for Life Extension’s approach is the evidence-based diet, lifestyle, and integrative intervention program outlined in this protocol; this aspect of the program should be continued indefinitely for those who want to maximize their health and longevity through optimal blood pressure control. For those who aren’t able to reach a target blood pressure of less than 120/80 mm Hg using these natural measures alone, Life Extension has presented a drug treatment protocol that represents an integration of the most current scientific knowledge, maximizing therapeutic benefit and minimizing the risk of adverse effects.

By working closely with your clinician, regularly monitoring your blood pressure and health status, and taking advantage of the cutting edge information presented here, you can marshal the longevity benefits of optimal blood pressure.