Chapter 25: Treating Hypertension without Drugs

As a medical student, I did an elective rotation at a major medical center in New Delhi and attended rounds in two cardiology clinics: the valve clinic and the coronary clinic. In the valve clinic, I needed an interpreter because the patients could not speak English. They were mostly young, poor, and undernourished, and came from farm villages complaining of the symptoms of heart failure. Years before, they had acquired a streptococcal infection and, without easy access to penicillin, had developed rheumatic fever that destroyed their heart valves.

In the coronary clinic every patient spoke perfect, cultured English with a hint of a British accent. They were from business and professional families from the city and well fed. I never needed an interpreter. It didn’t take me long to conclude that our modern epidemic of vessel disease and its primary risk factors (hypertension, diabetes, obesity, smoking, lack of exercise and high cholesterol) could mostly be eliminated if we could somehow abandon our overfed, sedentary and stressful lifestyles.

A large national survey reported in the New England Journal of Medicine showed that less than a quarter of the population with high blood pressure had adequate control.156 Other studies have demonstrated that half of people who start medications will have stopped them in a year, allowing their blood pressure to rise because they could not tolerate the side effects. Half of the hypertensive patients consulting me for Vedic medicine will also have stopped their medication –  but their pressure will be controlled without drugs.

Ayurveda has a long history of treating hypertension, even pre-dating the invention of the blood pressure cuff. In fact, the first antihypertensive medication was an Ayurvedic plant, Rauwolfia serpentina, known as sarpagandha in Sanskrit.157

Aggressive treatment of blood pressure dramatically reduces the risk of the commonest diseases you least want to get, starting with strokes and heart attacks. It is never too late to start; in the elderly, careful control of blood pressure has been shown to reduce the onset of dementia by half. Even white coat hypertension has documented risks. In rush hour traffic, your vessels undergo the same stresses as when the nurse takes your blood pressure. Your vessels constrict in response to adrenaline. This increases the resistance to the easy flow of blood through your arterial beds, stressing your heart muscles and placing shearing forces on the delicate endothelium that lines the vessels of your vital organs –  especially your brain, kidneys and heart. Too many traffic jams and thirty years later you have the makings for a sudden, often unheralded, vascular event. Not a good moment for people who are wimps about growing older.

However, aggressive lifestyle changes can reduce or even eliminate the need for pills. People who make these changes and who no longer require their medications are probably even better off, because in addition to reducing their blood pressure, they have made dietary and lifestyle changes that improve their well-being and reduce the risks of many other diseases, including diabetes.

Owning your own blood pressure cuff is the ticket off your pills, because when you see your doctor your blood pressure will be always be higher than it is at home (white coat hypertension), especially if you are motivated to get off your medications. Show your doctor a diary with 20 to 30 home readings each time you get checked. A reliable electronic cuff that you apply to the upper arm (not the wrist or finger) is a good investment because these cuffs are easier to operate and will not fudge the reading. Calibrate your cuff with your doctor’s reading. Record the date, time of day and comments about your frame of mind, diet and lifestyle next to the reading so you can identify factors that raise or lower your pressure.

Besides herbs, there are other scientifically documented ways anyone can reduce their blood pressure without drugs.

Here is my short list:

1. Avoid salt. Add it only in moderation while cooking and refrain from reaching for the saltshaker at the table. Especially avoid packaged and prepared foods that are high in sodium such as snacks, frozen meals, macaroni and cheese and other convenience meals. Use more spices, lemon juice or shavings from a good, smelly cheese for extra flavoring. Good for a systolic reduction of 3-5 mm Hg.

2. Lighten your diet. Cultivate a taste for a diet that focuses on fresh produce, whole grains and low-fat dairy. Favor fruits and vegetables in abundance and reduce meat and other high fat foods. This ancient Ayurvedic prescription for long life has now been dubbed the DASH diet (Dietary Approaches to Stop Hypertension). Combined with salt reduction, it’s good for another 5-10 mm Hg.

3. Lose extra pounds. Today’s high blood pressure epidemic is partially related to our epidemic of obesity. Extra pounds increase the resistance to blood flow and make your heart pump blood through a few more miles of capillaries. This can be good for 1 mm Hg for every pound lost. A drug free way to knock off another 5-10 mm Hg.

4. Get fit. Exercise promotes the flow of blood to muscles and other organs, thereby lowering the resistance to blood flow that causes hypertension. It’s that simple. 3-4 mm Hg.

5. Stop smoking. Have you noticed how smoking makes your hands and feet feel cold? This is the result of constriction of your blood vessels. Count on 3-5 mm Hg.

6. Potassium supplementation. Adequate potassium can lower blood pressure by 20 points according to a Duke University study. In a twelve-year study of 859 hypertensives published in the New England Journal of Medicine, the 24 people dying of stroke had a significantly lower dietary intake of potassium even after adjusting for caloric intake. Forget potassium supplements.158 The large doses of potassium in the fruits (mangoes, pears, strawberries and melons) and vegetables (cucumbers, tomatoes, legumes) this book recommends as antioxidants for preventing cancer, aging and other problems should be equivalent.159,160 7. Extra magnesium. Adequate magnesium levels lower blood pressure by up to 11% (or about 15 points) in only two months for people with mild hypertension.161 Again, why take supplements when fruits and vegetables are nature’s perfectly balanced food, as well as much more fun to swallow. Go for spinach, artichokes, beans, figs, nuts, and seeds.

8. Calcium. Taken in a dose of 2000 mg per day (about double the recommended amount for the average postmenopausal woman for preventing bone mineral loss), calcium can have a modest effect on systolic pressure. The best source of calcium is dairy.162

9. Garlic. Only fresh, never powdered or extracts, which quickly become rancid and are often socially distasteful. Several studies have shown garlic can knock off 2-3 mm Hg.

10. Meditation. Twelve published studies, the most recent sponsored by the National Institutes of Health, have shown reductions of 8-10 mm Hg in practitioners of Transcendental Meditation not seen in control groups doing mindfulness meditation and progressive muscular relaxation. Several studies were done in the most resistant types of blood pressure including elderly, inner city African- Americans. Transcendental Meditation even lowered blood pressure in inner city black adolescents at high risk for hypertension.163 Groups doing Transcendental Meditation had a reduction in the thickness of the lining of their carotid artery, reflecting less deposition of plaque.

11. Deal with stress. Avoid traffic jams, needless confrontations, unreasonable deadlines and other behaviors that make you irritated. 2-5 mm Hg depending on your burden.

12. Chocolate. Yes, fellow chocoholics, you read right! Researchers from Cologne analyzed ten studies that met stringent criteria of reliability, including five randomized trials, and concluded that consumption of chocolate, but not tea, lowers systolic blood pressure by an impressive 4.7 mm Hg –  what you might expect from some medications.164 Phenols in cocoa may dilate arteries and increase endothelial production of nitric oxide, the same mechanism that causes vessels to dilate in erections and other vascular responses. If you eat 3 oz of dark chocolate containing beneficial polyphenols,165 keeping your total caloric consumption the same, your risk of stroke would be reduced by 20% and mortality from all causes by 8%. Your low pharmacy bills could pay for all that chocolate. No wonder chocolate was worshipped by the Mayans! Be conservative and lop off 3 mm Hg.

13. Herbs. Beside 70% Theobroma cacao disguised as fine Belgian dark chocolate, the most important single plant that anyone with hypertension can take is punarnava (Boerhaavia diffusa Linn., aka spreading hogweed). Nava in Sanskrit means new and punar means again. This creeper was held by the ancient physicians to make you new again. It is known to have potent anti-inflammatory properties and has been shown to relax the coronary arteries of goats due to a direct vasodilator effect. The roots and leaves have a mild diuretic effect and are used in many kidney disorders.166 The dried whole plant can be purchased in tablets or loose powder, and is taken in the dose of 250 mg twice daily. When taken together with Arjuna tree bark (See Chapter 24), punarnava is a simple herbal supplement for people with hypertension and another coronary risk. It should be used in this way after consulting your physician. Easily good for 3 mm Hg.

Add them up and knock off  some points just to be realistic. I rarely find a patient on blood pressure pills who cannot reduce or sometimes even discard them within a year. As you change your diet, lose weight, exercise and meditate, your blood pressure will trend down and your doctor may taper your dose. If, in spite of your best efforts, you still need your pills, the lifestyle changes will make you feel better and reduce other risks for stroke, heart attacks and cancer.

156 Characteristics of Patients with Uncontrolled Hypertension in the United States. Hyman DJ et al. N Engl J Med 345(7): 479-486 August 16, 2001.
157 See Chapter 22, Your Bag of Supplements, for a discussion of reserpine in the context of the fallacy of the active ingredient.
158 Unless you have been prescribed potassium to replace that which is lost with diuretics.
159 See Chapter 18 for a diet rich in antioxidants.
160 If you have kidney insufficiency or certain adrenal problems, ask your doctor before taking a diet high in potassium.
161 Am J Card 2003, Sep 15;92(6)665-9.
162 See Chapter 28, discussing calcium supplementation in osteoporosis.
163 Barnes V. American Journal of Hypertension, April 2004.
164 Taubert, D et al. Arch Intern Med. 2007;167:626-634.
165 Researchers have identified the highly bioavailable flavonoids catechin and epicatechin in cocoa and tea as active in blood pressure in animal models. Cocoa, however, possesses many procyanids that may be active antihypertensives. In any event, Ayurveda regards consuming the active ingredient of a plant to be risky and not holistic. See Chapter 22 for an extended discussion of the fallacy of the active ingredients.
166 If you have renal insufficiency, consult your doctor before taking any diuretics, herbal or otherwise.