How to Treat High Blood Pressure with Diet

High blood pressure ranks as the number-one risk factor for death and disability in the world. In the video below, I showed how a plant-based diet may prevent high blood pressure. But what do we do if we already have it?

The American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention recommend lifestyle modification as the first-line treatment. If that doesn’t work, patients may be prescribed a thiazide diuretic (commonly known as a water pill) before getting even more meds until their blood pressure is forced down. Commonly, people will end up on three drugs, though researchers are experimenting with four at a time. Some patients even end up on five different meds.

What’s wrong with skipping the lifestyle modification step and jumping straight to the drugs? Because drugs don’t treat the underlying cause of high blood pressure yet can cause side effects. Less than half of patients stick with even the first-line drugs, perhaps due to such adverse effects as erectile dysfunction, fatigue and muscle cramps.

What are the recommended lifestyle changes? The AHA, ACC and CDC recommend controlling one’s weight, salt and alcohol intake, engaging in regular exercise and adopting a DASH eating plan.

The DASH diet has been described as a lactovegetarian diet, but it’s not. It emphasizes fruits, vegetables and low-fat dairy, but only a reduction in meat consumption. Why not vegetarian? We’ve known for decades that animal products are highly significantly associated with blood pressure. In fact, if we take vegetarians and give them meat (and pay them enough to eat it!), we can watch their blood pressures go right up.

I’ve talked about the benefits to getting blood pressure down as low as 110 over 70. But who can get that low? Populations centering their diets around whole plant foods. Rural Chinese have been recorded with blood pressures averaging around 110 over 70 their whole lives. In rural Africa, the elderly have perfect blood pressure as opposed to hypertension. What both diets share in common is that they’re plant-based day-to-day, with meat only eaten on special occasion.

How do we know it’s the plant-based nature of their diets that was so protective? Because in the Western world, as the American Heart Association has pointed out, the only folks getting down that low were those eating strictly plant-based diets, coming out about 110 over 65.

So were the creators of the DASH diet just not aware of this landmark research done by Harvard’s Frank Sacks? No, they were aware. The Chair of the Design Committee that came up with the DASH diet was Dr. Sacks himself. In fact, the DASH diet was explicitly designed with the number-one goal of capturing the blood pressure-lowering benefits of a vegetarian diet, yet including enough animal products to make it “palatable” to the general public.

You can see what they were thinking. Just like drugs never work—unless you actually take them. Diet never work—unless you actually eat them. So what’s the point of telling people to eat strictly plant-based if few people will do it? So by soft-peddling the truth and coming up with a compromise diet you can imagine how they were thinking that on a population scale they might be doing more good. Ok, but tell that to the thousand U.S. families a day that lose a loved one to high blood pressure. Maybe it’s time to start telling the American public the truth.

Sacks himself found that the more dairy the lactovegetarians ate, the higher their blood pressures. But they had to make the diet acceptable. Research has since shown that it’s the added plant foods—not the changes in oil, sweets or dairy—that appears to the critical component of the DASH diet. So why not eat a diet composed entirely of plant foods?

A recent meta-analysis showed vegetarian diets are good, but strictly plant-based diets may be better. In general, vegetarian diets provide protection against cardiovascular diseases, some cancers and even death. But completely plant-based diets seem to offer additional protection against obesity, hypertension, type-2 diabetes and heart disease mortality. Based on a study of more than 89,000 people, those eating meat-free diets appear to cut their risk of high blood pressure in half. But those eating meat-free, egg-free and dairy-free may have 75 percent lower risk.

What if we’re already eating a whole food, plant-based diet, no processed foods, no table salt, yet still not hitting 110 over 70?

Here are some foods recently found to offer additional protection: Just a few tablespoons of ground flaxseeds a day was 2 to 3 times more potent than instituting an aerobic endurance exercise program and induced one of the most powerful, antihypertensive effects ever achieved by a diet-related intervention. Watermelon also appears to be extraordinary, but you’d have to eat around 2 pounds a day. Sounds like my kind of medicine, but it’s hard to get year-round (at least in my neck of the woods). Red wine may help, but only if the alcohol has been taken out. Raw vegetables or cooked? The answer is both, though raw may work better. Beans, split peas, chickpeas and lentils may also help a bit.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations—2013: Uprooting the Leading Causes of DeathMore Than an Apple a Day, 2014: From Table to Able: Combating Disabling Diseases with Food, 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

How to Prevent High Blood Pressure with Diet
Why Was Heart Disease Rare in the Mediterranean?
Cholesterol Crystals May Tear Though Our Artery Lining


Peggy B
Peggy Babout a year ago


Sarah Hill
Sarah Hill2 years ago


Marie W.
Marie W2 years ago


Nathan D.
Nathan D2 years ago

My grandma drank tea from Chinatown when she had a problem. It's called Prince of Peace Blood Pressure. A Chinese lady told her about it. It's herbal and worked in just one week.

Chad Anderson
Chad Anderson2 years ago

Some points to consider when you are doing well and some questions to ask your doctor when you are not.

Carol M.
Carol M2 years ago

There are a whole lot of mays and nights in this article. There is no mention of the role genetics plays. My BP was 110/70 until I turned 30. I did the usual changes in diet, no salt, etc, and I was lean and otherwise healthy. To bring it under control requires two meds plus plenty of exercise. Both of my parents had hypertension. My dad had a quadruple bi-pass by my age, and my mother died of heart issues.

Teresa Antela
Teresa Antela2 years ago


Linda W.
Linda Wallace2 years ago

Thank you. The problem is that many people don't want to change their diets preferring to take drugs.

Mark muc
Mark p.muc2 years ago


Quanta Kiran
Quanta Kiran2 years ago