Image Credit: Dustin Kirkpatrick.

How Not to Die from High Blood Pressure

High blood pressure is the number-one risk factor for death in the world. In the United States, it affects nearly 78 million people, one in three adults. As we age, our blood pressures get higher and higher, such that by age 60, high blood pressure strikes more than half of us.

Given that it affects most of us when we get older, could high blood pressure be less a disease and more just an inevitable consequence of aging? No. We’ve known since the 1920s that high blood pressure need not occur, which I discuss in my video How Not to Die from High Blood Pressure.

Researchers measured the blood pressures of a thousand people in rural Kenya, where their traditional diet included more whole grains, beans, vegetables, fruit, and dark leafy greens. Though our pressures go up as we age, their pressures actually go down.

With blood pressure, the lower, the better. The 140/90 cut-off you may have heard here or there is arbitrary. Even people who start out with blood pressures under 120/80 appear to benefit from blood pressure reduction. Your doctor would likely give you a gold star if you had a blood pressure of 120/80, but research indicates the ideal blood pressure—blood pressure that wouldn’t get benefit from being any lower—may actually be 110/70.

Is it even possible to get blood pressures as low as 110/70? It’s not just possible—it’s normal for those living healthy enough lives.

Over two years, 1,800 patients were admitted to a rural Kenyan hospital. How many cases of high blood pressure were found? Zero. Wow they must have had low rates of heart disease. No, in fact, they had no rates of heart disease. Not a single case of our number-one killer, arteriosclerosis, was found. Rural China, too. There, people are about 110/70 their entire lives—70-year-olds with the same average blood pressure as 16-year-olds.

Those in Asia and Africa traditionally eat vastly different diets, but they do share a commonality: Both were plant-based day-to-day, with meat eaten only on special occasions. Why do we think 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 people getting their blood pressures down that low were those eating strictly plant-based diets, coming in around 110/65.

The largest study to date of people eating plant-based diets studied 89,000 Californians. Non-vegetarians were compared to semi-vegetarians (also called flexitarians, those who eat meat more on a weekly rather than daily basis), pesco-vegetarians (those who eat no meat except fish), lacto-ovo-vegetarians (those who eat no meat at all), and vegans (who eat no meat, eggs, or dairy).

The subjects were Seventh-day Adventists, who all tended to eat lots of fruits and vegetables, exercise, and not smoke, and even the nonvegetarians didn’t eat a lot of meat. So, even compared to a group of relatively healthy meat-eaters, there appeared to be a step-wise drop in hypertension rates as people ate more and more plant-based diets, with vegans having lower rates than lacto-ovo-vegetarians, who had lower rates than pesco-vegetarians, and so on—and the researchers found the same for diabetes and obesity.

So, yes: We can wipe out most of our risk by eating a strictly plant-based diet, but it’s not all-or-nothing. It isn’t black-or-white. Any movement we can make along the spectrum towards healthier eating can accrue significant health benefits.

This can be shown experimentally: Give vegetarians some meat (and pay them enough to eat it), and their blood pressures go up. In another study, meat was removed from people’s diets, and their blood pressures went down—and did so in only seven days. What’s more, this was after the vast majority had reduced or even stopped their blood pressure medications completely. Indeed, the subjects had to stop their medications because once you treat the cause, you can’t be on multiple blood pressure pills with normal blood pressure. Your pressures could fall too low and you could get dizzy, fall, and hurt yourself, so your doctor has to take you off the pills. Lower blood pressures on fewer drugs—that’s the power of plants.

So, does the American Heart Association recommend a no-meat diet? No, it recommends a low-meat diet, known as Dietary Approaches to Stop Hypertension, or the DASH diet. Why wouldn’t the AHA recommend a completely plant-based diet? When the DASH diet was being created, were they just not aware of this landmark research, done by Harvard’s Frank Sacks showing those who eat strictly plant-based average 110/65? No, they were aware. The Chair of the Design Committee that came up with the DASH diet was Frank Sacks.

As he described, the DASH diet was designed explicitly with the number-one goal of capturing “the blood pressure-lowering benefits of a vegetarian diet, yet contain enough animal products to make them palatable” to the general population. They didn’t think the public could handle the truth.

In their defense, just as drugs don’t work unless you actually take them, diets don’t work unless you actually eat them. So, maybe they thought few would eat strictly plant-based, so by soft-peddling the message, by coming up with a kind of compromise diet perhaps on a population scale they felt it would do more good. Fine, but tell that to the thousand American families who lose a loved one every day to high blood pressure.

Maybe it’s time to start telling the American public the truth.


The first time someone visits NutritionFacts.org can be overwhelming. With videos on more than 2,000 health topics, where do you even begin? Imagine stumbling onto the site not knowing what to expect and the new video-of-the-day is about how a particular spice can be effective in treating a particular form of arthritis. It would be easy to miss the forest for the trees, which is precisely why I created a series of overview videos that are essentially taken straight from my live, hour-long 2016 presentation How Not to Die: Preventing, Arresting, and Reversing Our Top 15 Killers.

The other videos in this overview series are:

Inspired to learn more about the role diet may play in preventing and treating high blood pressure? Check out these other popular videos on the topic:

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:

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


80 responses to “How Not to Die from High Blood Pressure

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  1. If they really told people the truth, the meat and dairy industries would collapse. And people would sue them for holding back the information and losing their loved ones because they didn’t know. Of course many would still eat meat and dairy. Just as I see young people still smoking everyday.

    1. I’m surprised doctors aren’t being sued for withholding life saving information or gross incompetence. All my family died of cardio and no doctor ever said anything about cardio being preventable and reversible by simply changing one’s diet. As Dr. Dean Ornish and others proved years ago.

    2. There is a lot more to lowering your BP than just eating a healthy diet. Meditation and yoga will do wonders for your BP and help you link a spiritual mind to a spiritual body. Most people living in rural areas outside the USA do physical work all day and go to sleep well before midnight. They are also not bombarded with 24/7 hyped-up news, every hour on the hour, telling them the world is coming to an end. Rural people also live around natural landscapes with plenty of vegetation to absorb pollutants, compared to people living in cities with the noise, traffic, and crime. Just my opinion…

      1. Agreed…and my question about the people cited in Dr. Greger’s blog (from Kenya and China)  What other cultural and environmental influences are in their world that help to contribute to lower BP than just food.  And what is the quality of the food?  Do they lead a sedentary or more active lifestyle, etc. etc.  We are comparing apples to oranges, perhaps…and ultimately, some of us are genetically wired differently and by staying with or switching to a PB lifestyle is best practice, regardless.  If we manage to stay healthy and are without other chronic disabling conditions, a higher BP may not be of concern.  I would love a part 2 to Dr. Greger’s blog to address our concerns.

        1. Good reading for you would be on blue zones in the world, but specifically Loma Linda, California. Look at what their diets and blood pressure numbers are right here in the good old U of S.

  2. As a 16 year old, my bp was 140/90. I was into macrobiotic diets at the time with rice, veggies.

    Pizza and hamburgers are cheap filling convenient foods for teenagers on up. And if they are started on it as kids (with sports and energy drinks to wash it down with) then it becomes a part of their own food culture. Very tough habit to break.

    1. So you were 140/90 with no animal products at all?

      There has to be some genetic variability.

      I was closer to 110/70 eating pizza multiple times per week.

      My brother finally had high blood pressure after his surgery this year. His pre-surgery blood pressure was 120/80, but it went up over 140/90 for a few weeks after surgery and his diet is pizza, burgers, etc. even now.

      But I wouldn’t recommend how we were eating as a way to lower blood pressure.

  3. I am really salt sensitive. Even as a vegan my blood pressure was around 140 (before as a meat eater it was 168). I have gotten it below 120 by water fasting and eating only fruit.

    1. But can you live on water and fruit alone?  I, too, have found it difficult as a vegan (I do not eat processed vegan foods and try to avoid  salted foods…though I enjoy a little salt from time to time!) and I find it very hard to lower my blood pressure to where Dr. Greger states it is best and should be accomplished through a healthy plant based diet.  I guess one size does not fit all???

      1. Nancy, exercise is important also to keep your endothelium healthy. I advise all patients to get at least 150 minutes a week, 300 better.
        (Of course with doctors ok.)
        They can start with walking, work up to 45 min a day walking briskly (like late for an appointment).
        If physically able some intermittent cardio and strength training even better.
        When you feel ‘pins and needles’ in your hands after that can be nitric oxide. It’s nitric oxide that lowers blood pressure.
        Exercise isn’t just good physically, it also lowers stress and depression.

        Posting just one of many studies demonstrating this.
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369613/

    2. I also struggle to lower my BP and the only time I’ve ever seen it drop dramatically was one summer two years ago when my diet was mostly fruit, but I wasn’t able to maintain an all or mostly fruit diet. I was never satisfied which would lead to binge-eating on unhealthy vegan snacks. I haven’t eaten meat in over 20 years.

      1. I think there is great genetic variability. I have always had low blood pressure- 90/50 to 105/70 at the highest. This was when I ate meat, when I was vegetarian, when I was processed-food vegan and now at WFPB diet. It’s higher now on WFPB, about 104/62 at my most recent appointment. It has gotten so low before that it caused dizzy spells and times where I couldn’t see. Doctors recommend a higher salt diet and lots of water. So despite being WFPB I do find that I still somehow need more salt than most people just to stand upright.

        Meanwhile my husband has always had high blood pressure. He finally got it down to its lowest, around 125/90, on a WFPB diet. It just wont go lower though. It leads me to believe that there isn’t necessarily a one-size-fits-all blood pressure, genetically mine will always be incredibly low even with massive salt intake, and his will always be on the higher side even with no salt, sugar or oil.

      2. Both Cyrus Khambatta, PhD and Robby Barbaro at Mastering Diabetes eat a Fruitarian Diet.

        Its difficult eating only fruit, which is why I’m experimenting with beans, fruit, magnesium supplements, and potassium chloride.

        1. Define “fruitarian diet”. It does not generally mean eating only fruit.
          If one is not very careful, a long term fruitarian diet could be a formula for serious nutritional deficiencies.

          https://health.clevelandclinic.org/fruitarian-diet-is-it-safe-or-really-healthy-for-you/

          I think eating such a restrictive diet is a bad idea, no matter what the Mastering Diabetes guys do. I doubt many people would know how to keep themselves heathy on one, and I doubt it could be optimal for most people. If you have type 1 diabetes, you might try it, but that’s a special case.

  4. “Maybe it’s time to start telling the American public the truth.”

    Well, even if you do, they don’t want to hear it. I’ve encountered this time and time again. I’m sure that everybody who visits this website has had the same experience. Even when it’s a matter of life or limb, they don’t want to hear it. Or, they don’t care.

    Charitably, perhaps they don’t believe it. Since the food industry is working to confuse them. So I’d settle for home cooking, from whole foods, with lots of plant food. But, they don’t want to do that either. I think the general attitude is: as long as there’s a pill, or a treatment, I can continue to eat and do whatever I want.

    In fact, I actually saw that message in action: an ad for Zantac. It showed a young couple at a backyard barbecue, who felt lousy after eating whatever was served. She took Zantac, he took a no name antacid, and she was soon up and having a great time while he continued to languish in pain. The voice-over actually said something like “Eat whatever you like” or “Keep eating your favorite foods” because you can take Zantac!! To counteract the ill effects of the food you just ate, I guess. My reaction: WOW!!

    1. Dr. J, agree, what I experience. I can explain studies, encourage people to change their lifestyle, diets, exercise patterns, sleep, but most just don’t. Habits are hard to break. Men are more resistant to change than women, kids are the easiest.
      Probably because most parents are willing to put in the time and effort to help them.
      Those who improve their lifestyle in small ways, and feel better, usually go on to bigger changes. So I don’t try to “build Rome in a day”. Encourage one step at a time, and show them that it’s helping them to reach their health goals.

  5. I have eaten a plant based lifestyle for at least 4 years now, I have been vegetarian and vegan on and off for most of my life and still struggle with blood pressure. It averages in the 120s-130s/80s-90s. I can occasionally get it in the 110s/70s-80s but that is not my norm. What I see as the greatest impact for me to lower my BP is exercise (long distance walking mostly) I am 68 years old and for now, I choose to not take medication to lower my BP for all the possible negative side effects as my average BP seems to be closest to 125/85 with no other known co morbidity.

    I am interested in any thoughts/comments on this.

      1. Yes…but it hasn’t been consistent. I monitor my blood pressure at home. After a rowing class, no change. After a 10 hour day of walking 28 miles at an average 3 mph…my BP was in the 110s/70s (took it 2 times after I returned home). Not sure if there were other factors involved? Ex…it was a warm day causing perspiration, possibly causing a change in electrolytes with no additional salt added but maintaining hydration with water and eating small snacks throughout the walk (sun butter, rice crackers, apples, dried fruit, bananas, sprouted wheat bread, can’t remember the rest, to add carbs, sodium, potassium and sugar). My doctor believes it’s genetics but something about that walk lowered my blood pressure and tells me it’s possible. ???

        1. Nancy, I walk too and find any relaxation will lower bp. Sugar raises it, but fruit lowers it. (lots of fruit) Fitness walking does not lower it for me. Just normal walking for longer times.

          As a meat eater my bp was 110/70 at the doctor’s office and rately differed. Now, It sometimes is 104/64, but can just as easily be 128 or much much higher. I agree with the comments to get bp taken at least three times automatically while sitting alone quietly in the office… it’s how my doctor does it.

    1. Nancy, just found this post of yours. Note my reply to an earlier post of yours. Would encourage you if your doctor agrees, to work in cardio and strength training.
      I know patients in their 80’s still doing this on no meds.
      Also some veggies work better than others, arugula, and beets for example. Can make a salad including thinly sliced beets if you don’t mind crunchy. I like them with red onion, and a smooth good quality balsamic vinegar. Avoid those vinegars with caramel coloring which is a probable carcinogen.

      1. Thank you!  I’d like to say I haven’t tried your suggestions…but I have and still do.  What’s lacking for me is the cardio part…Time is a factor with my work schedule.  Just can’t get much in when I arrive home at 9-10 PM :-(  However, I’m still very active, love to ride my bike long distances when I can and recently joined a rowing class.  Luckily I have no other illnesses and my doctors are great in that they support my no medication rule…Besides they tell me that they have nothing to offer because I am doing everything they would offer.  But I appreciate everyone’s comments and suggestions.  Lots of good things to think about.  It seems many of us are struggling with similar issues around blood pressure even when we follow the basic rules :-)And…I love beets and eat them at least once a week.  Thank for the salad recommendation  Sounds simple!

    2. Handgrip exercises have also been shown in multiple studies to significantly lower BP ….. eg

      ‘Our study showed that there is decrease in resting blood pressure with IHG exercise training for a period of 10 weeks in normal healthy volunteers. Systolic blood pressure reduced from 122.67±2.31 mm Hg in the rest week to 112.8±1.86 mmHg after 10 wk (p<0.001), statistically highly significant. Diastolic blood pressure reduced from 81.73 ± 2.66 mmHg in the rest wk to 76.47 ±3.00 mmHg after 10 wk (p<0.001), statistically highly significant.'
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225874/

      Meditation may also be worth considering:

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303565/

  6. Blood pressure results can vary pretty widely depending on how/when it’s taken.
    The Dr.’s office would take my bp pretty much as soon as I sat in the chair. One reading, and that’s your blood pressure.

    We live near Pennsylvania State University, and have participated in several medical research trials as healthy controls. Most involved monitoring blood pressure and heart rate. When going in for any visit, they’d have me sit quietly in a dimly lit room for 5 minutes before taking my blood pressure, and sometimes take readings throughout the visit. Other times I wore a blood pressure/heart rate monitor for 24 hours. That gives the most accurate information.

    A doctors office should, ideally, have people sit quietly for 5 minutes before taking the blood pressure and heart rate, and do it three times and get an average from the results; but I don’t see that happening anytime soon, since they’re always pressed for time. Many people have “white coat syndrome “, where blood pressure is elevated due to being in the doctors office!

    1. Dharma,

      I’ve read guidelines for taking blood pressure; they include what you wrote, to sit quietly for 5 minutes beforehand, but also to sit with both feet on the floor, have the arm about chest height and supported, and not to talk. None of these are followed at the doctor’s office. So I consider any blood pressure reading at a doctor’s office to be a “high” reading.

      Once my PCP took my blood pressure, following most of these guidelines, later in the visit, and my BP was considerably lower than when measured at the start of the office visit, following none of these guidelines. I forget the exact numbers, but I was impressed with the difference between them.

      Though I’ve never measured my blood pressure at home.

    2. Right. In my experience, BP is frequently taken incorrectly in doctors’ offices. No time to relax, feet not on the ground and back supported, arm about heart height. I get “white coat” mild hypertension, and when my doctor recommended medication when the number. was about 135/80, I laughed. They also take the measurement at the start of the visit when I am the most tense. I took some home measurements. and also brought in some better numbers from places like a blood donation center (where I was tense) that took the measurement correctly. Then she said, “well, looks like you don’t need medication”. Ironically I like my doctor, in part because she does not press me when I disagree with her, but the BP measurement was a joke, and I don’t understand how they can be so unconcerned about accuracy. Don’t rely on a few measurements at a doctor’s office!

      1. Gengo, you are right. Have rarely seen BP taken correctly by techs in doctor’s offices. People who are advised to take meds should get a monitor and check themselves at home.

    3. I actually have that syndrome even at home taking my BP because I am always anticipating getting a high reading so I do! It takes sitting still for at least 5 minutes and doing 3 or 4 readings before it will come down and even then it is not acceptably low and I am on BP meds. Telling someone to relax is not effective in my case.

  7. Because my family members always had pretty low blood pressure, this issue never really seemed significant to me, but when Dr. Williams said that Medicare could go bankrupt just from blood pressure meds, we have so many people affected by having to take all of these expensive medications.

    Lowering our blood pressure can affect the whole country and the future generation. That is the truth.

    1. Yes, Deb, isn’t it amazing to think how different our country and health care would be if everyone knew about and followed Greger’s, McDougall’s, Esselstyn’s, Campbell’s, etc., suggestions?!

  8. Well, after waiting over 40 minutes to be seen by the doctor, I do not know how one can relax for an accurate BP reading. I just want to get the check-up over with and leave. One-hour wait time is not unusual when your doctor makes multiple appointments at the same time because insurances do not pay them enough. Better get your BP reading at home.

    Addind to the Zantac TV commercial Dr. J mentioned, I also find odd that painkillers are advertised for muscle pain after a workout, Honestly, why would anyone exert themselves so badly during their workout that they need a painkiller? It seems less harmful to stop exercising when you feel pain.

    1. Carolina, There’s a difference between pain from injury and soreness from intense/vigorous workouts, often called “delayed muscle soreness (DOMS)” as it does not typically occur right away, and might not until the next day.
      There is nothing unusual about DOMS for those who exercise vigorously, e.g.
      doing high intensity interval training or weight lifting. This common post-exercise soreness is not harmful at all. Just uncomfortable.

      However, taking NSAIDs for DOMS is counterproductive as it interferes with the process that repairs the damaged tissue and makes one stronger.

  9. Anxiety can skyrocket the blood pressure! Once I had 178/90 after talking about my doctor’s husband who was nearly killed. I felt very anguished, she is a good and nice MD. I feel so anxious about my BP that it is way up even when quiet. I have to take it numerous times so as to be bored enough to bother worrying. A new fact I observed about blood pressure, when it is higher, the veins on the top of my left hand is wider than on the top of the right hand.
    I now have 140/85 often, but when relax, it would be sometimes 115/75.
    Before my next MD appointment I should try 2 weeks of no dairy, no meat.

    1. So interesting…blood pressure IS affected by so many variables. I also observe that anxiety raises my blood pressure. So yo be honest…I really don’t know what the actual numbers are. And what we really need to do when we have high readings and then low readings.

      1. Nancy,

        There is variability, genetic, related to lifestyle and dietary, but blood pressure is still important.

        It is important to eat as close to Whole Food Plant-Based as possible and not use salt. Exercise and breathing techniques would be the next line of defense, along with meditation, prayer, relaxation techniques of all sorts.

        The thing is, my family would be an outlier who kept low blood pressure without eating properly at all, but I look at the blog post and obviously diet is still the biggest factor. Stress and being sedentary might be neck and neck for the next spots, but I say that without seeing if there is a PubMed study agreeing with that concept.

        Anyway, what do you do with the information? Take it seriously, is what I would say.

        Eat cleaner, exercise more regularly, work on breathing techniques, decrease the stress in your life, etc.

  10. I already about 5 years in PB diet, but still have very high BP. I do not even guess what else I can take out from my diet to lower BP. In my meals I am adding very small amount of salt almost none.

    1. Marina,

      Do you eat flaxseeds? Flaxseeds were something that has a study.

      Dr. Greger also mentioned watermelon, but he said the study had people eat a lot of it.

      Double-check all of your foods because unless you are doing pretty much all Whole Food Plant-Based without any processed foods, there can be hidden salts and sugars.

      I will tell you that I sometimes had used things like non-dairy ravioli, non-dairy bean burritos, and tofu dumplings, and all of them had things like oil, sea salt, and the tofu dumplings turned out to have whole milk in it.

      Dairy increases the risk of high blood pressure by 36%

      Boullion, soups, broths tend to have a lot and we often don’t think about that. I do use low sodium broths in cooking, but low sodium is not the same as no sodium.

      Aromatherapy with essential oils is another thing that can lower blood pressure.

  11. I have low blood pressure…. 90 over 48 some of the time, my cardiologist says he could prescribe something for it but if I can tolerate it,he’d rather not. My primary care physician keeps congratulating me which is irritating. So the cardiologist is recommending I double my salt intake… Salt everything on the plate is what I’ve heard. How does that play with this information?

        1. I will also ask if you are symptomatic?

          Are you fainting or getting dizzy?

          Do you have anemia? Is your B12 high enough?

          Are you sedentary?

          I am asking the list because if it is that you need B12 and hydration, and don’t move enough to keep your circulation flowing freely, adding salt may not be the right thing.

          Not trying to disagree with your doctors. Just saying that I would be starting with trying to figure out what is causing it.

          If you were a smoker and have poor circulation, something, like getting off of cigarettes and using a PEMF or a Nasal light or an Infrared panel, could increase the circulation.

    1. Yes, symptomatic. Postural hypo-tension, yes, dizziness, and fainted a couple of months ago. I am not anemic. My B12 hasn’t been tested. I *have* had vertigo which confounds itself with that. But yes, I’m sure that hydration is one key. And my blood sodium has been normal. However, it is a fact that I have had no impulse to salt anything. If I were on the other end of the spectrum, there wouldn’t be any straight for ward way to *reduce* my salt intake. I have started salting some foods. I can remember to do that with *some*. I salt sliced tomatoes, for example, and homemade soups. I had atrial fibrulation and an ablation procedure almost 2 years ago. And I was found to have an enlarged atrium and enlarged ascending aorta, which were said to account for that. I *have* been attempting to deal with both my hydration and not moving enough questions. I’ve started walk-jogging. I think I’m doing somewhat better. And no, I have not doubled my salt intake as suggested. But I strongly doubt that any salt reduction advice is good for me. My understanding is that electrolytes are necessary for water to achieve its’ hydration effects. So, I try to take electrolytes with my water some of the time.

    2. Dr. Greger has spoken about this and it seems that “low” blood pressure is only an issue if you are symptomatic. Have you ever stood up fast and fainted? Do you get dizzy often? These are the questions that need to be answered. If not, then you’re likely fine with a blood pressure at that level. Of course, you should always speak with your doctors about this. The issue with added salt is that salt can increase the risk of other diseases as well, so it’s best to limit if possible.

      I hope this helps,
      Dr. Matt, Health Support

  12. I have been vegan and on a no/ low salt diet for 5 years. I have had my blood pressure sit at around 140/ 80. I am now investigating sleep apnea and sinus congestion as a cause. Apparently this is a widely overlooked yet proven connection for high blood pressure. Doctors haven’t been proactive with me on any front, so I continue to be my own advocate.

  13. It is not uncommon to get conflicting points of view on various blogs but giving every point of view the benefit of the doubt I would want to know whether a) the subjects chosen in rural Africa and China were of similar weight to the average American or westener b) whether the daily water intake of the subjects were similar c) whether the lifestyle is similar ie stress etc
    Obviously the above factors especially the weight and serum sodium concentrations as affected by water ingestion have been known to have a drastic effect on BP. Plant diets by themselves contain a lot of water albeit less nutrients in their raw form.

  14. if only it was that easy. i have given up all meat and dairy. i eat a variety of whole grains and pulses, plenty of different veg, inc cruciferous every day, porridge and berries for breakfast, plant milks in hot drinks. I also take blood pressure medication, just took my readings, 143/97. this is a usual reading. obviously other factors are at play, family history, stress I can do nothing about.

    1. It would be useful to consider more factors. To assess the rigidity of the arteries, there is a simple test. Measuring the BP at the ankle and at the wrist and compare the two. A good nurse should be able to do this properly.
      If arteries are stiff, vitamin K2 may help. Also it is a good idea to have the carotides checked with ultrasounds. It is non invasive and will show if the arteries are blocked.

  15. I very much appreciated the article, and shared questions about other variables, including genetics. I am aligned with Jack in feeling it is essential to embody your beliefs through some spiritual practice. Yoga and/or any breath work, tai chi, religion, chanting, walking, running moderately, etc I have had a varied diet, flexitarian leaning, and have maintained 120/65 my whole life (73 y/o) I appreciated how thoughtful all your reassert comments were. I too would love a follow up.

  16. Hello Stephanie and thank you for your comment. I’m a family doctor with a private practice in lifestyle medicine and also a volunteer for Dr. Greger on this website.

    I’ve just read through all the comments under this video. If you haven’t already done so, it would be a good idea, because there is lots of good information. Hypertension is one of the 3 or 4 most common problems I’ve seen in my ~34 years of practicing medicine. I myself also have mild hypertension, which improved slightly on a vegan, whole foods diet for the last 4 years (and I’ve been on a very low salt diet for the past 30 years or more). I will share the main points of what I’ve learned, both from treating patients and from my own history.

    Factors influencing blood pressure:
    1) Diet — see Dr. Greger’s many excellent videos on the benefits of a low-salt, plant-based diet. Salt is especially harmful, unless you are in the minority of people who are not salt-sensitive.
    2) Exercise — this helps your arteries relax. If you do vigorous aerobic exercise for at least 10-15 minutes, and then take your blood pressure about 10-20 minutes after you’ve been relaxing, you will consistently get some of your lowest BP readings of the day — which demonstrates this phenomenon.
    3) Sleep apnea — this is far more common than most patients or doctors realize, and very clearly contributes to hypertension. I won’t try to explain the pathophysiology of that here. The good thing is that you can be tested for this with an overnight sleep study, and treated. The most common treatment is using a mask at night that provides continuous positive airway pressure (CPAP) to keep your airways open. If the sleep apnea is not severe, many cases improve with using a “mandibular advancement device” which keeps your lower jaw from relaxing back so that it blocks your airway. You can ask your dentist or look on-line.
    4) Genetics — unfortunately this does play a role. However, as Dr. G. has documented in several of his videos, your genes predisposing you to a medical problem cannot harm you unless they are expressed (which means your body actually makes the substance which causes the problem), and gene expression is greatly influenced by your diet.
    5) Stress — as several people have noted, above, this does indeed play a role. You say that you can’t do anything about stress. It’s true that you can’t avoid stressors in your life, but you very much CAN learn to change your response to stress, so that it doesn’t lead to a rise in blood pressure. This can be as simple as taking 5 slow deep breaths when you feel “stressed”. Exercise also clearly helps people deal with stress, as does meditation.

    So, my advice is to definitely continue with a very low-sodium diet (less than 500 mg per day is ideal) of whole plant foods, to get daily aerobic exercise for at least 30 minutes (preferably 60), to get checked for sleep apnea — especially if you have any of the signs, such as snoring, daytime fatigue, etc., and to have a regular practice for de-stressing, such as taking 5 slow deep breaths as soon as you realize that you’re feeling stressed.

    If none of that gets your pressure consistently below about 130/80, then I definitely recommend seeing your doctor to get started on medication (as I have done, even though I got my pressure down to usually about 135/85), because like Dr. G says, any BP above 110/70 increases your risk of getting a heart attack or stroke. There are lots of excellent medications for hypertension now, several of which have no discernible side effects.

    I hope this helps.
    Dr. Jon
    PhysicianAssistedWellness.com
    Health Support Volunteer for NutritionFacts.org

    1. Dr. Jon, Thank you for reading through the replies and addressing many of our concerns (mine included).   Your comments are very much appreciated  and I think, for me, what I’m lacking is the aerobic activity beyond many miles of walking each day.  I am currently undergoing physical therapy for some age related! challenges (so as not to injure myself as I exercise).  Once I’m given the green light again I will see if that makes a difference.  And I will pay attention to my sodium intake (though even when low it hasn’t affected my blood pressure).  As I have no other co morbidity and otherwise healthy… sometimes my  BP can be 117/78 (ex) and then later at night its 135/88 (ex)! Perhaps related to a meal that had salt a few hours prior to measuring my BP???  It’s a work in progress…thank you again.

      1. You’re welcome, Nancy. You should be able to do SOME type of aerobic exercise even if you’ve had some injuries. Your physical therapist will be able to help you with that. As I mentioned, exercise will help both with lowering your blood pressure directly, and will definitely help with stress. Having a “labile” blood pressure — where your pressure fluctuates fairly widely throughout one day — is probably more common than people realize. Having some type of relaxation ritual (e.g. taking deep breaths) can help a lot. Also some people have BP very responsive to caffeine, so consider cutting that back. Dr. Jon.

    2. Dr. Jon, I am wondering if less than 500mg/d sodium is sufficient to avoid hyponatremia, assuming one drinks 8-12 glasses per day of water, tea, coffee.

      1. Hyponatremia (low sodium level in your blood) is unlikely, because sodium levels are so tightly regulated by your body. If you were doing heavy exercise, you might need more than 500 mg. And yes, it is possible to drink so much water that you can develop hyponatremia. But in early human evolution, we probably almost all ate less than 500 mg per day. Dr. Jon

        1. Thx for the reply.

          I asked because I recently had hyponatremia (131), resulting from drinking too much water before a fasting blood test. I was probably getting about 800 mg-1000 mg/ d on my 100% WFP diet. I know now not to guzzle water before blood tests (I have since read that kidneys can generally filter only 26-33 fl oz. (0.8- 1.0 liters) of H2O per hour.

    3. Dr. Jon

      Could you please list those excellent medications so that I may discuss them with my doctor?
      It would be very useful to me and much appreciated.

      1. Hello Lola,
        There are several categories of blood pressure medications which have very few side effects.
        1) ACE inhibitors (stands for Angiotensin Converting Enzyme): these include lisinopril, benazepril, fosinopril, and a bunch of others whose generic names all end in “pril”. The only problem with these is that they cause a side effect of a dry cough in ~5-30% of people. But otherwise they are very well tolerated. (I take one of these, with no problems).
        2) ARB’s (stands for angiotensin receptor blockers): these are newer than the ACE inhibitors, and do NOT cause a cough; some of these are still on patent so there isn’t a generic form, so can be expensive. Some that ARE generic and relatively cheap are: losartan, irbesartan (Avapro), and valsartan (Diovan). These all have very few common side effects.
        3) Calcium channel blockers of the dihydropyridine class: e.g. amlodipine. These tend to have few side effects, except in elderly patients they can cause some swelling in the feet.

        Of course, any medication can cause side effects. But compared with early blood pressure pills such as beta-blockers, many of which caused fatigue and sexual dysfuntion, and diuretics — which also can cause sexual dysfunction as well as electrolyte imbalances such as low potassium, these are relatively “clean” medications.

        Like I said before, hopefully most people won’t need to take any medication, if they follow my suggestions (above), which Dr. Greger has explained in many videos. Dr. Jon.

    4. Thanks for helping on this forum!
      I have a weird question. In the past 8 years or so because of anxiety, my BP was high 150/80 often. So I took BP several times in the day because as the manometer would start working, I got anxious about the reading. Then after several reading, I got tired of being anxious. The lowest reading being 117/67. Question: When my BP is high, the vein on the top of my right hand is constricted, but not the left hand. When normal, both hands are the same. Both hand have the same temperature, not one warmer than the other. Why?

      1. We would expect that if your BP is high your vein would seem to “pop out” due to the constriction of the blood vessel and that is what seems to be happening. Why this is only happening on the right hand may be a function of slight variation in the vein system in one hand compared to another You might also consider if you’re right or left handed, (esp if your right hand is more muscular.), on which side cuff was placed because these factors might be affecting blood flow ?), Just some thoughts.which may or may not be the cause of the difference in appearance of your hands.
        The important thing to consider is that vasoconstriction of the blood vessels is a natural part of your body balancing systems.and unless you have other symptoms in your hands and the vein returns to normal post BP check this mystery is not one to stress over. .

  17. In 2001I was diagnosed with cardiac artery obstruction. I was already on blood pressure and cholesterol lowering drugs. A friend of me told me about using diet to reverse my heart disease so I cancelled the surgery and changed my diet. At first I was doing really well, losing weight, angina resolving, feeling so much better and then I started feeling weak and fuzzy headed. I wound up in the ER and after a bunch of tests (they thought I was having a heart attack) was told that i better not take my BP pills anymore. The change in diet + the BP pills had lowered my blood pressure that much. So I’m off all my meds and doing great eight years later.

    1. Penelope,
      How I would love to follow in your footsteps. Can you reveal more specifically the diet that you followed To get such amazing results and how long it took for those issues to resolve.

      1. I am Whole Food Plant Based no SOS Whole Foods – I eat apples not apple not apple fritters, whole corn not corn flakes -so food as close to it’s original state as possible. Not “food” that has gone through a factory and had most of its nutrients remove.
        Plant Based – no animal products – no meat, no milk, no eggs – and nothing made with milk or eggs or other animal parts. Lots of fruit, vegetables and whole grains, starches (like potatoes, rice, quinoa).
        No SOS – no (or as little as possible) sugar, oil, salt. “Instructions”. Dr Gregor “How Not To Die”. Dr John McDougall (website, books, seminars etc), Dr Esselstyne (Books, website), Engine 2 (website, books, etc), Happy Herbivore (food plan, cookbooks). Dr Dean Ornish. No Meat Athlete.
        There’s more but this will get you started. they all differ a little bit but the WFPB no SOS is the core.
        It’s can be difficult at first as you build new habits but it is way better than suffering from the effects of high blood pressure. After a while its easy.

        1. Penelope,
          Thanks so much for your reply. It is so admirable that you began and followed such a strict, ascetic plan that resulted in a reversal of your health problems. I don’t know if I have the fortitude to follow and whether in all cases it would bring about such dramatic results. You didn’t indicate how long it actually took before you saw significant changes in your BP and cardiac issues. I am slowly acquiring the WFPB way of eating and hopeful that I can see some results. Again, thank you for your very informative reply.

          1. Hi. I don’t find that this diet is ascetic at all. There’s so many different vegetables, fruits and starches to eat! And I feel so much better these days and am very, very happy that I am no longer likely to have a heart attack. If you go to the WFPB websites and facebook pages you will see post from plenty of people who have done what I did and have experienced dramatic results. It all depends on how motivated you are to feel and be healthy. You can do amazing things if you set your mind to it. I don’t know what health issues you have or how you will be affected by changing your diet (you should talk to a doctor or nutritionist who is well educated in WFPB for help and more information), but a friend told me about WFPB. He is a lawyer and had a cardiac artery obstruction which he reversed by WFPB. Another friend of mine was diabetic and, after WFPB, is not. There are lots of us out there and so it can be done.

  18. It would be nice if all you needed to do is eat a vegan diet to drop blood pressure. Sadly, that doesn’t automatically happen. The real key is very low sodium. Meat and fish eaters have higher blood pressure because have you ever tried eating a piece of meat, or fish without salt? It really isn’t very tasty. The reason so many people in rural third world populations have lower blood pressure is because they don’t have processed food to fall back on. And processed food is where the Westernized world gets 75/80 percent of their sodium. Of course anyone who eats restaurant food gets a whopping dose of this poison every time they eat out. Walter Kempner discovered it was the sodium way back in the 30’s. The reason so many eating a plant based diet reduce their blood pressure is because they give up more of their processed and restaurant food. But, that is changing as the corporate food world starts producing more and more vegan food. Sadly, this stuff is load with more sodium than the meat equivalent. One very obvious example of that is the Impossible Whopper which contains more sodium than a regular whopper. And sadly, China is switching to street food in the cities which are loaded with sodium and fried in oil that is never exchanged. The oil is literally black and even the food vloggers think more of this street food is very salty.

  19. Michael,

    Interesting that you bring up the Impossible burger as part of their corporate rap is that they are working on reducing the sodium content.

    You’re on the mark with the amounts that are now very typical in the American diet. Watch any cooking show and note the extensive “seasoning” demanded to make the products “acceptable”. Too bad using the wide array of herbal products is not the norm.

    Your assessment with “eating out” is on point. So back to the options, ask for low salt prep of your order when possible and avoid the house dressings and gravies…..Or find a chef who get’s it and is on with herbs as a seasoning agents.

    Dr. Alan Kadish moderator for Dr. Greger http://www.Centerofhealth.com

    1. Alan,

      I hate to break your heart,but the idea of asking for a low salt prep at restaurants sounds good, but in practise doesn’t work, UNLESS you eat in VERY high end restaurants. The vast majority of restaurant food isn’t prepared in house and certainly isn’t prepared to order. In the case of chain eateries the stuff is make in their central kitchens and shipped into each location already seasoned to the hilt. All that is required is to heat and serve (review any single chain organizations nutrient web site. The amount of sodium in any single item will stagger you). Even smaller eateries rarely cook their own food. They depend on huge organizations to do their cooking which then is delivered frozen. One of the biggest of these food giants is Sysco. You see their trucks every week at your favorite local eateries. Even those who do their own cooking do so in batches on a biweekly basis and freeze the results to be thawed and served nightly. In other words the food is already pre-seasoned. About the only food items you might be able to control sodium when ordering are vegetables, and baked potatoes. Anything else is pre-seasoned and that includes rice, gravies, sauces, condiments, salsa, spag sauce, mashed potatoes, and every dish on the menu. Just look at the menu of your local Mexican, Italian, Chinese, Japanese, Indian, or Middle Eastern restaurant and you’ll discovered just about every dish is a salt bomb. Just give it some thought, how in the world can an eatery bring you an entire dinner in under a half hour if it wasn’t precooked? The reality is if you want to stay healthy you’ve got to cook the stuff yourself just as those folks in the Blue Zones do. The Adventists are healthier than the rest of America because they cook their own food and stay away from processed and fast food. Is it animal protein, dairy products, saturated fat, oils causing our health problems? Maybe. But, I place a bet that salt is the main culprit. Does True North Health center cure high blood pressure because you don’t eat food, OR is it because distilled water only fasting is the ultimate low salt diet because it is NO sodium diet? Do plant based doctors cure disease because they eliminate animal products and fat, or because those diets eliminate processed food where 75/80 percents of our sodium comes from? Did Walter Kempner cure high blood pressure because his diet was rice, sugar and fruit or because it contained about 65 mg of sodium per day? IT’S THE SALT, pure and simple.

      P.S.
      Sorry about all this but as you can see I’m passionate about this issue.

  20. Over the past nearly 6 years with change to low fat WFPB diet I’ve gotten off two BP meds, all. No longer have occasional falls. Sometimes it is quite low; occasionally higher than desired. Long was thought I had white-coat effect. Sad it was I who said to doc maybe 10 years ago, ok, if I have white coat issue, I no doubt have it at work with my anxieties there, please give me a second possibly carcinogenic (now we know) med, which I did for a few years until reading Dr Greger posts.

    Recall being a teenager & BP at a regular exam was 190/80 & doc freaked out, tried every BP reader in the clinic, concluded I had very reactive BP in doc office. Fast forward ~50 years, plus a mild stroke nearly 15 years ago. Better at relaxing now in retirement & with real food, qigong & yoga, weights & walking. Glad my doc advised me to request some quiet time before reading if nec., as most readers ask questions & stick thermometer in your mouth during the reading. Sometimes before a doc appt, I do alternate-nostril breathing to calm self.

  21. I’m sorry to say that the conclusions in the study you refer to are completely different, quote:

    ” Exchanging meat and eggs for vegetable products; increasing total dietary protein or replacing soy protein with dairy protein; exchanging saturated, monounsaturated, and polyunsaturated fatty acids; and changing the content of total dietary fat and carbohydrate all had no substantial effect on BP. Therefore, animal products, carbohydrate, and different types of fats do not appear to explain the low BP in vegetarians. Rather, modest intake of animal products may be a marker for a large intake of other potentially beneficial nutrients from vegetable products.”

    Link: https://www.ncbi.nlm.nih.gov/pubmed/3414588

    1. Hi Avi,

      He is specifically referring to Table 1 in the article where they found that those who eat strictly plant-based average a blood pressure of 110/65.

      The summary in the article concludes that “Vegetarians have lower BP than do non-vegetarians in the United States and Australia … It seems likely that a nutrient or nutrients eaten in greater amounts in vegetarian than nonvegetarian diets lower BP.”

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