High blood pressure is an important medical condition that does not cause any primary problems in and of itself (high blood pressure typically causes no symptoms at all) but does significantly increase the risk of developing complications like heart attack, stroke, poor circulation, and more. For this reason – the lack of primary symptoms but the real risk of serious longer-term complications – blood pressure screening (regular checks) and long-term treatment if needed, are very much part of mainstream medical care today.

The treatment of high blood pressure, for most patients, is experienced as being mainly about the use of long-term (chronic) medications to lower the blood pressure and reduce the risk of long-term complications like heart disease. These treatments have been widely researched and shown to be effective as well as safe (in the main, for most people most of the time, the risk-lowering benefits outweigh any side effects and or medication-related risks). But many people are resistant to the idea of taking pills every day. There are several possible reasons for this, including:

  • Fear of side effects (even though the risk-benefit ratio is clearly in favour of using blood pressure medications).
  • Cost (no explanations needed here).
  • Inconvenience (the need to take pills daily, collect pills monthly, and visit the doctor regularly, is just too much for some folks).
  • A “philosophical” view that medications are unnatural and therefore “bad” and or not to be trusted (a view that may be on the increase in recent times).

…and in many cases, the resistance arises from a combination of these.

So what can be done to manage high blood pressure, without medications? It turns out that the answer is “quite a lot”. Here are the main lifestyle measures that have been shown to help lower blood pressure:

  • Weight control – maintain a BMI in the “healthy range” (18.5 to 25.0) helps lower blood pressure. Those who are overweight (BMI 25-30) or obese (BMI 30+) will benefit from any weight loss.
  • Stop smoking. Nicotine has a powerful blood-pressure-raising impact. Smokers should quit.
  • Moderate alcohol. Heavy drinking (21+ drinks a week for men, 14+ drinks a week for women) increases blood pressure.
  • Healthy eating. A balanced diet (e.g. Mediterranean diet, so-called DASH diet) that is low in salt, low in sugar, low or moderate in fat, low in animal fats, low in processed foods, will help to lower blood pressure. For those who are overweight but also for those who are of normal or healthy weight.
  • Active living. Exercising and living actively has been repeatedly shown to lower blood pressure. Any increase in activity is likely to be helpful but ideally we should aim for 30+ minutes of gentle/moderate activity daily and 3+ hours of actual exercise (sweaty, short-of-breath exercise) per week.

Each of these has been shown to be helpful. In multiple research studies involving tens of thousands of people over several decades. This is not controversial or in doubt really. The extent of the benefit (how powerful each change is) varies in some studies and is complicated to measure but it is probably safe to say that:

  • Lifestyle changes have the potential to be as effective as 1-2 blood pressure medications, offering the possibility that many patients could reduce their medication usage or do without medication entirely.
  • “Potential” is not the same as “works in the real world”. Nearly all the research shows that a great many patients struggle to implement and or maintain these lifestyle changes. The potential is real and proven (those who maintain the lifestyle do have lower blood pressure) but the reality is that it requires patient-action that is a real-world challenge for many.

High blood pressure is a serious condition that should concern all of us. It can, potentially, be prevented and managed with lifestyle changes. In the real world, many people battle to maintain the necessary lifestyle changes and it is really for this reason that long-term blood pressure medications are so commonly required. Happily, modern blood pressure medications are both safe and effective for the vast majority of patients.

In one sentence: you probably can manage your blood pressure without pills but the lifestyle changes required may be a major challenge for you to maintain.

Written by Dr Colin Burns