Hypertension

Long-term effects from hypertension can lead to serious complications later in life. Lifestyle changes can dramatically improve the effect of hypertension.

Hypertension is the medical term for sustained high blood pressure.

According to the Global Burden of Disease Study, high blood pressure contributes to more deaths worldwide than any other risk factor, accounting for 10.8 million deaths in 2019 alone 1. Worldwide, 1.3 billion people have hypertension. It’s extremely prevalent in the US, affecting over 103 million people, or 46% of the population 2

So what’s the solution to reversing the tide against hypertension? 

Incredibly, most of these cases can be prevented and reversed with a whole-food plant-based lifestyle, with evidence dating back almost a century ago. 

What is hypertension?

Hypertension (high blood pressure) is where you have sustained high blood pressure readings. 

Blood pressure is the force of the blood pushing against the walls of the arteries, as it flows from the heart to the rest of the body. 

Are there any symptoms? 

Hypertension is often referred to as the ‘silent killer’ because most people have no symptoms. However, those with more severe high blood pressure may experience symptoms such as headaches, chest pain, and shortness of breath. 

How do I get diagnosed with high blood pressure?

Your blood pressure reading is taken with a blood pressure monitor (sphygmomanometer). 

When you have a blood pressure reading, you get two measurements:

  • The top number is systolic blood pressure - this is the pressure in your arteries when the heart contracts and sends blood around the body  
  • The bottom number is diastolic blood pressure - this is the lowest pressure in your arteries, when the heart relaxes and refills with blood, ready to pump again  

The readings correlate to different stages of hypertension:

Stage, Systolic and/or Diastolic

  • Normal blood pressure, Less than 120 and Less than 80
  • Elevated blood pressure, 120 - 129 and Less than 80
  • High blood pressure (hypertension), 130-139 or 80-9

If your systolic blood pressure is above 140 mmHg, or your diastolic pressure is above 90 mmHg, the American Heart Association defines this as stage 2 hypertension.  

What are the risks of having high blood pressure? 

Sustained high blood pressure is the leading risk factor for death because of its far-reaching detrimental effects. It puts strain on the heart, and can damage blood vessels in the eyes and kidneys. High blood pressure increases your risk of heart attack, heart failure, stroke, and kidney failure, as well as damage to other organ systems 3. It also increases the risk of conditions such as vascular dementia. 

Whilst this may seem all doom and gloom, we have lots of positives on this page on how easy it can be to lower blood pressure with a whole-food plant-based lifestyle. 

What causes high blood pressure? 

Primary hypertension represents most cases, where there is no single cause of high blood pressure; it is mostly due to diet and lifestyle factors including lack of physical activity, too much salt in the diet, and too much alcohol. 

Secondary hypertension is when the hypertension can be linked to a specific cause e.g. medication or a medical condition. 

The role of sodium in raising blood pressure 

Salt is made up of sodium and chloride. It’s the sodium in salt which  is an essential nutrient (which means we need to obtain it from our diet). Too much salt causes your body to retain more water. In response, your blood pressure rises in an attempt to push out the excess salt and fluid from your system 4.

The average American now consumes way too much salt, and this is a big problem. Whether you get it from processed foods like chips, or sprinkle it on your dinner, too much salt raises your blood pressure and kills up to 3 million people each year 5

Lifestyle recommendations 

The American Heart Association (AHA) and the American College of Cardiology (ACC) recommend diet and lifestyle changes as the first treatment for high blood pressure. The diet they recommend is the DASH diet - ‘dietary approaches to stop hypertension’. It’s not strictly vegetarian, but is based on the concept of a vegetarian diet and promotes eating more fruits, vegetables, and whole grains, whilst reducing meat and fat intake. 

The evidence shows us that diets even higher in plant-foods and lower in animal foods have bigger impacts on lowering blood pressure, for example strict vegetarian populations were found to have the lowest blood pressures and lower age-related increases in blood pressure 3. Therefore, these recommendations don’t give people strong enough advice to reach their full pressure-lowering potential. The scientists wanted to create a diet that was healthier than the American ‘western’ diet but something people would still recognise and follow.

At Mora, however, we’ve seen people thrive on a plant-based diet and, with support, make an easy transition, given all the evidence to make these choices themselves and lower their blood pressure. 

What can a plant-based diet do?

Scientists looking at the role of diet in hypertension combined the data from 39 separate studies and found that plant-based diets lowered both systolic and diastolic blood pressure, compared to omnivorous diets. A more recent study found the same results: vegetarian diets significantly lowered blood pressure. When the researchers looked specifically at vegan diets, they found the vegan diet was even better than the vegetarian diet at lowering blood pressure 6

Vegetarians and vegans had up to a 60% reduced risk of high blood pressure compared to omnivores in the Adventist Health Studies and EPIC-Oxford study 7. Compared to vegetarians, vegans again seem to have additional protection against hypertension 8 9 10 11.

One interesting study compared 3 groups: sedentary vegans, endurance running omnivores, and sedentary omnivores. Whilst the endurance athlete-omnivores had lower blood pressure than sedentary omnivores, the sedentary vegans actually had lower blood pressure than the endurance athletes! This was a small study, yet the results provide positive data for plant-based diets. If blood pressure is your ultimate goal, it’s possibly better to be lazy and plant-based, than an omnivore who runs 48 miles a week! (at Mora we advocate both a plant-based diet, as well as exercise) 12

What’s in a plant-based diet to lower blood pressure that well?

Several mechanisms are behind the pressure-lowering power of a plant-based diet. Firstly, those who eat plant-based diets have lower BMIs and a lower risk of obesity 13. This is mostly due to the high fiber and low fat content of the diet, reducing its overall energy density 14. Obesity is a known risk factor for high blood pressure.

Plant-based diet are high in compounds that regulate blood pressure: 

  1. Plant-based diets are high in potassium which lowers blood pressure and reduces the risk of stroke. It relaxes blood vessels, whilst reducing both the reabsorption of sodium into the kidney, and the production of reactive oxygen species 15 16. Most Americans on a typical western diet do not consume enough potassium 17
  2. Dietary nitrate is also a friend of low blood pressure. It gets converted to nitrites, and then to nitric oxide which relaxes our blood vessels and maintains low blood pressure. Leafy green vegetables and beetroot are excellent sources. They help to improve endothelial function and arterial stiffness, which both affect blood pressure 18. The nitrites added to processed meats, like bacon, do not have the same healthful effects. Combined, their protein content and high cooking temperatures convert nitrites into nitrosamines, instead of nitric oxide, which can increase cancer risk 19 20
  3. Plant-based diets are high in whole grains, which have been shown to significantly lower blood pressure. Scientists estimate that 3 portions of whole grains a day reduces blood pressure and subsequent risk of coronary artery disease by more than 15%, and stroke by 25%. You could cut your risk of stroke by a quarter, just by having some oats for breakfast, and buckwheat and barley for tea! 21

Plant-based diets are also low in compounds that increase blood pressure:

  1. Low in saturated fat. Saturated fat increases blood pressure because it impairs endothelial function, which affects how much the blood vessels can relax. Red and processed meat, and poultry are major sources of saturated fat on a western diet, and all independently increase blood pressure 22 23. In contrast, polyunsaturated fats can lower blood pressure, found in walnuts and flaxseeds 24
  2. Low in AGE content. The cooking of meat, poultry, and fish can generate advanced glycation end-products (AGEs) that increase levels of inflammation and oxidative stress, known risk factors for high blood pressure. Plant-based foods including fruits, carbohydrates, and vegetables contain much lower levels of AGEs, and are high in antioxidants which combat oxidative stress 23
  1. Reduced sodium. A plant-based diet cuts out processed foods and meats filled with excess salt, which we know is a major risk factor for high blood pressure.
  2. Reduced alcohol consumption is encouraged as part of a whole-food plant-based diet. Excess alcohol increases the risk of high blood pressure through several mechanisms, it can directly affect the heart and decrease nitric oxide production 3 25

Can specific foods help to lower my blood pressure?

An overall plant-based diet can lower blood pressure, but if you’re looking for specific foods that can pack an extra punch, the evidence points to these:

  • Flaxseed - can help lower blood pressure and is an excellent addition to a WFPB diet, or any diet for that matter 26. Aim for 30g a day, which can be added to porridge, smoothies, salads, and more!
  • Beetroot - for the dietary nitrate, also found in leafy green vegetables, add to salads and sandwiches
  • Foods high in potassium - fresh fruits, vegetables, and legumes 
  • Whole grains - brown rice, barley, buckwheat, oats, and many more

Remember, what matters most is the overall dietary pattern, so these foods are best enjoyed as part of a whole-food plant-based diet. 

Takeaway

High blood pressure is the leading risk factor for death, taking this risk is a choice. 

A whole-food plant-based diet is low in salt, processed foods, and fat; whilst also being high in whole grains, dietary nitrates and potassium. This diet could make all the difference to your blood pressure readings. 

Start by removing red meat, processed meat, and poultry to reduce saturated fat and AGE intake. This can be replaced with tofu, or legumes, which can be made into burger-type patties, tofu ‘steaks’ or dishes like our spinach and chickpea recipe. Add flaxseed to your breakfast or salads daily and enjoy beetroot for added blood pressure benefits.

Choose an active plant-based lifestyle and take the pressure off for good. 

References

1. Murray, C. J. L. et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet 396, 1223–1249 (2020).

2. Joshi, S., Ettinger, L. & Liebman, S. E. Plant-Based Diets and Hypertension. Am. J. Lifestyle Med. 14, 397–405 (2020).

3. Appel, L. J. et al. Dietary Approaches to Prevent and Treat Hypertension: A Scientific Statement From the American Heart Association. Hypertension 47, 296–308 (2006).

4. Grillo, Salvi, Coruzzi, Salvi, & Parati. Sodium Intake and Hypertension. Nutrients 11, 1970 (2019).

5. Afshin, A. et al. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet 393, 1958–1972 (2019).

6. Lee, K. W., Loh, H. C., Ching, S. M., Devaraj, N. K. & Hoo, F. K. Effects of Vegetarian Diets on Blood Pressure Lowering: A Systematic Review with Meta-Analysis and Trial Sequential Analysis. Nutrients 12, 1604 (2020).

7. Segovia-Siapco, G. & Sabaté, J. Health and sustainability outcomes of vegetarian dietary patterns: a revisit of the EPIC-Oxford and the Adventist Health Study-2 cohorts. Eur. J. Clin. Nutr. 72, 60–70 (2019).

8. Le, L. & Sabaté, J. Beyond Meatless, the Health Effects of Vegan Diets: Findings from the Adventist Cohorts. Nutrients 6, 2131–2147 (2014).

9. Pettersen, B. J., Anousheh, R., Fan, J., Jaceldo-Siegl, K. & Fraser, G. E. Vegetarian diets and blood pressure among white subjects: results from the Adventist Health Study-2 (AHS-2). Public Health Nutr. 15, 1909–1916 (2012).

10. Appleby, P. N., Davey, G. K. & Key, T. J. Hypertension and blood pressure among meat eaters, fish eaters, vegetarians and vegans in EPIC–Oxford. Public Health Nutr. 5, 645–654 (2002).

11. Fraser, G. et al. Vegetarian diets and cardiovascular risk factors in black members of the Adventist Health Study-2. Public Health Nutr. 18, 537–545 (2015).

12. Fontana, L., Meyer, T. E., Klein, S. & Holloszy, J. O. Long-Term Low-Calorie Low-Protein Vegan Diet and Endurance Exercise are Associated with Low Cardiometabolic Risk. Rejuvenation Res. 10, 225–234 (2007).

13. Tonstad, S., Butler, T., Yan, R. & Fraser, G. E. Type of Vegetarian Diet, Body Weight, and Prevalence of Type 2 Diabetes. Diabetes Care 32, 791–796 (2009).

14. Kahleova, H. et al. Effect of a Low-Fat Vegan Diet on Body Weight, Insulin Sensitivity, Postprandial Metabolism, and Intramyocellular and Hepatocellular Lipid Levels in Overweight Adults: A Randomized Clinical Trial. JAMA Netw. Open 3, e2025454 (2020).

15. McDonough, A. A. & Nguyen, M. T. X. How does potassium supplementation lower blood pressure? Am. J. Physiol.-Ren. Physiol. 302, F1224–F1225 (2012).

16. Aburto, N. J. et al. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ 346, f1378–f1378 (2013).

17. Hoy, M. K. & Goldman, J. D. Potassium Intake of the U.S. Population, What We Eat In America, NHANES 2009–2010. FASEB J. 27, (2013).

18. Kapil, V., Khambata, R. S., Robertson, A., Caulfield, M. J. & Ahluwalia, A. Dietary Nitrate Provides Sustained Blood Pressure Lowering in Hypertensive Patients: A Randomized, Phase 2, Double-Blind, Placebo-Controlled Study. Hypertension 65, 320–327 (2015).

19. Scanlan, R. A. Formation and occurrence of nitrosamines in food. Cancer Res. 43, 2435s–2440s (1983).

20. Brown, J. L. N-Nitrosamines. Occup. Med. Phila. Pa 14, 839–848 (1999).

21. Tighe, P. et al. Effect of increased consumption of whole-grain foods on blood pressure and other cardiovascular risk markers in healthy middle-aged persons: a randomized controlled trial. Am. J. Clin. Nutr. 92, 733–740 (2010).

22. Steffen, L. M. et al. Associations of plant food, dairy product, and meat intakes with 15-y incidence of elevated blood pressure in young black and white adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am. J. Clin. Nutr. 82, 1169–1177 (2005).

23. Borgi, L. et al. Long-term intake of animal flesh and risk of developing hypertension in three prospective cohort studies. J. Hypertens. 33, 2231–2238 (2015).

24. Wang, L. et al. Dietary Fatty Acids and the Risk of Hypertension in Middle-Aged and Older Women. Hypertension 56, 598–604 (2010).

25. Sesso, H. D., Cook, N. R., Buring, J. E., Manson, J. E. & Gaziano, J. M. Alcohol Consumption and the Risk of Hypertension in Women and Men. Hypertension 51, 1080–1087 (2008).

26. Rodriguez-Leyva, D. et al. Potent Antihypertensive Action of Dietary Flaxseed in Hypertensive Patients. Hypertension 62, 1081–1089 (2013).

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