Hypertension: Symptoms, Causes, Treatments, and Natural Approaches

Hypertension, or high blood pressure, is persistent pressure in the arteries. It is one of the most common chronic conditions yet is sometimes called a “silent killer” due to its typical lack of symptoms.

Over 119 million American adults, or almost 50 percent of the adult population, suffer from high blood pressure, but only around 25 percent have their condition under control. If left untreated, hypertension can lead to various health problems, including cardiovascular disease, stroke, and kidney failure.

Depending on the activities you do, your blood pressure rises and falls throughout the day. Blood pressure is recorded as two numbers. Take 120/80 mm Hg. This is read as “120 over 80 (millimeters of mercury).” The first number is the systolic pressure, which represents the force of blood flow when the heart pumps. The second number is the diastolic pressure, which is the force between heartbeats when the heart fills with blood, or is at rest. Hypertension occurs when one or both blood pressures are persistently higher than normal.

In the United States, hypertension is a systolic pressure of 130 mm Hg or higher and/or a diastolic pressure above 80 mm Hg. In Europe, the diagnosis threshold set by the European Society of Hypertension is 140/90 mm Hg.

There are two types of hypertension: primary and secondary. They are described as follows:

• Primary: Also known as essential or idiopathic hypertension, primary hypertension accounts for 90 percent of all high blood pressure cases. Primary hypertension cases have no identifiable cause. Most cases of primary hypertension develop gradually with age.
• Secondary: Secondary hypertension is caused by various medical conditions, such as renal diseases and endocrine disorders.

Hypertension has several subtypes, which can also be primary or secondary. They are as follows:

Isolated Systolic Hypertension

A main type of hypertension seen in older adults is isolated systolic hypertension, affecting around 15 percent of those aged 60 and older. This condition is characterized by a systolic pressure of at least 130 mm Hg while the diastolic pressure remains below 90 mm Hg.

Isolated systolic hypertension is usually primary. It often occurs because the arteries become less elastic with age. This is common in older adults due to the buildup of calcium and collagen in the artery walls. As the arteries stiffen, their ability to expand and contract diminishes, which leads to a higher systolic pressure and sometimes a lower diastolic pressure.

Malignant Hypertension

Malignant hypertension, marked by a systolic pressure of over 180 mm Hg and a diastolic pressure of over 120 mm Hg, is a hypertensive emergency due to its rapid disease advancement, multiple complications (e.g., end-organ damage), and a grim prognosis. Between 0.5 percent and 3 percent of visits to emergency departments involve individuals suspected of having a hypertensive emergency. However, hypertensive emergencies are rare, occurring at a rate of about one to two cases per million each year.

If left untreated, malignant hypertension can be fatal. A hypertensive emergency is one type of hypertensive crisis. Another common type of hypertensive crisis is a hypertensive urgency, which typically doesn’t exhibit symptoms and hasn’t visibly caused any organ damage.

Malignant hypertension can arise due to various causes:

• Noncompliance with medication
• Renovascular diseases
• Renal parenchymal diseases, such as glomerulonephritis, tubulointerstitial nephritis, systemic sclerosis, and systemic lupus erythematosus
• Endocrine issues
• Narrowing of the aorta
• Exposure to substances such as cocaine, phencyclidine, sympathomimetics, erythropoietin, and cyclosporine
• Abrupt withdrawal of antihypertensive medications
• Use of amphetamines
• Central nervous system disorders, such as head injury and cerebral hemorrhage

Resistant Hypertension

Resistant hypertension is characterized by persistent blood pressure readings above 130/80 mm Hg despite the optimal administration of three distinct antihypertensive medications, including a diuretic. Some sources define resistant hypertension as controlled blood pressure while taking four or more drugs. It significantly raises the risk of experiencing a heart attack, stroke, or kidney failure.

In about 25 percent of resistant hypertension cases, a secondary cause contributes to the condition. The higher the resistance, the greater the likelihood of a secondary cause.

Other Subtypes

Some hypertension subtypes are more situational, such as:

• White-coat hypertension: Also known as white-coat syndrome, white-coat hypertension refers to increased blood pressure readings that occur only in a medical setting (e.g., a doctor’s office) but are normal at other times. This can be due to anxiety or stress related to medical environments.
• Masked hypertension: In contrast to white-coat hypertension, masked hypertension is when blood pressure is normal in a clinical setting but rises outside of it. This type of hypertension can go unnoticed without regular monitoring outside of medical visits.
• Gestational hypertension: Hypertension accounts for approximately 15 percent of maternal deaths in the United States, making it the second most frequent cause of maternal mortality. Gestational hypertension, also known as pregnancy-induced hypertension, is characterized by high blood pressure (systolic pressure equal to or exceeding 140 mm Hg and/or diastolic pressure equal to or exceeding 90 mm Hg) that develops after 20 weeks of gestation in women who did not have hypertension before pregnancy. It occurs in 6 percent to 10 percent of pregnancies and can lead to complications for both the mother and the baby if not managed properly.

High blood pressure, especially primary hypertension, usually has no symptoms. Thus, the condition may go undetected until a medical examination or the development of complications, such as heart disease or kidney problems. Commonly attributed symptoms, including headaches, nosebleeds, dizziness, a flushed face, and fatigue, are unreliable indicators, as they occur just as often in people with normal blood pressure.

However, certain signs and symptoms do manifest in some types of hypertension.

Signs that suggest the need to investigate secondary causes of hypertension include:

• Resistant hypertension.
• A sudden increase in blood pressure in someone who previously had stable readings.
• Hypertension starting before puberty.
• Non-dipping or reverse-dipping blood pressure patterns. Reverse dipping blood pressure is higher at night than during the day. Non-dipping blood pressure remains unchanged throughout the night, even though it is supposed to decrease.

People with malignant hypertension may experience the following symptoms:

• Intense headache
• Nausea and vomiting
• Confusion
• Changes in vision, such as blurred vision
• Nosebleeds
• Seizure
• Weakness or numbness of the arms, legs, face, and other body parts
• Breathlessness

Hypertensive emergencies occur when blood pressure rises rapidly in a short time. This can damage organs because it constricts the blood vessels, leading to reduced blood flow and oxygen supply. Symptoms of damage to vital organs may manifest as headaches, blurred vision, difficulty breathing, and chest discomfort. The small blood vessels can also get damaged, causing tissue death called fibrinoid necrosis.

Although its exact cause is unknown, primary hypertension risk is influenced by genetics, age, and lifestyle, which includes diet and physical activity levels. Additionally, as people age, their blood vessels tend to become stiffer, thus raising blood pressure levels.

Secondary Hypertension

As for secondary hypertension, many medical conditions can lead to its development, such as:

• Diabetic nephropathy
• Chronic kidney disease
• Glomerulonephritis, a kidney disease involving inflammation of the glomeruli
• Interstitial renal parenchymal diseases (kidney diseases that develop in the functional part of the kidney)
• Primary aldosteronism (Conn’s syndrome, an overproduction of a hormone)
• Cushing’s syndrome
• Narrowing of the aorta
• Narrowing of one or both renal arteries
• Obstructive sleep apnea
• Polycystic ovarian syndrome
• Preeclampsia

Some medications and other substances may also be the cause, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Sodium-containing antacids
• Certain herbal supplements, such as St. John’s wort
• Systemic corticosteroids
• Antidepressants, such as monoamine oxidase inhibitors
• Recreational drugs like cocaine and methamphetamine
• Nicotine
• Alcohol
• Estrogens, androgens, and oral contraceptives

According to the guidelines from the American College of Cardiology (ACC), hypertension is classified and staged as follows:

• Normal: Systolic blood pressure (SBP) is less than 120 mm Hg, AND diastolic blood pressure (DBP) is less than 80 mm Hg.
• Elevated: SBP is between 120 and 129 mm Hg, AND DBP is less than 80 mm Hg.
• Stage 1 hypertension: SBP is between 130 and 139 mm Hg, OR DBP is between 80 and 89 mm Hg.
• Stage 2 hypertension: SBP is 140 mm Hg or higher, OR DBP is 90 mm Hg or higher
• Hypertensive crisis: SBP is 180 mmHg or higher, AND/OR DBP is 120 mmHg or higher

Factors that make one more likely to have hypertension include the following:

• Overweight or obesity.
• Race: High blood pressure is more prevalent among black adults than other races. Over 57 percent of the non-Hispanic black population had hypertension, according to a 2017–2018 National Health and Nutrition Examination Survey (NHANES), whereas about 43 percent of the white population had it.
• Sex: Men are more likely to develop hypertension during middle age, while older women are more likely than men to develop it.
• Age: As per the NHANES, the prevalence of hypertension among American adults aged 60 and older was about 73 percent among women and over 75 percent among men. For Americans between 55 and 65, their lifetime risk of developing hypertension is over 90 percent.
• Excessive alcohol intake: A quantity exceeding one drink daily for women or two drinks for men is considered excessive.
• Diet: People who eat a lot of processed food or are on high-salt, high-fat, high-sugar diets are more at risk.
• Lack of physical activity.
• Stress: Stress typically leads to a temporary increase in blood pressure. High blood pressure usually returns to normal after the stressful situation no longer exists (like in white-coat hypertension). However, people who are continuously stressed or who have experienced stressful, traumatic events, especially during childhood, are at increased risk.
• A family history of high blood pressure.
• Diabetes.
• Smoking or tobacco use.
• High serum uric acid levels: Elevated serum uric acid levels have consistently been found to predict the development of hypertension.
• Shift work: People who work early or late shifts are more at risk.

Before diagnosing hypertension, your health provider will likely measure your blood pressure several times, as it can vary throughout the day. Adults over 18 should have annual blood pressure checks, with more frequent monitoring for those with a history of high readings or risk factors. The ACC advises a minimum of two office measurements on two distinct occasions to diagnose hypertension. It also supports using higher blood pressure readings and categorizing patients into higher stages to ensure appropriate medical treatment.

Home blood pressure readings are often more accurate than those taken at a doctor’s office. When measuring your own blood pressure, use a high-quality home monitor with an appropriately sized cuff and a digital readout.

Some tests and monitoring methods measure your blood pressure and cholesterol levels and check for heart, kidney, and other diseases and end-organ damage. These tests include:

• Ambulatory blood pressure monitoring (ABPM): ABPM is recommended in some instances as it gives a comprehensive view of overall blood pressure levels. It involves wearing a small battery-powered monitor for 24 hours during daily activities. ABPM is helpful when a patient experiences symptoms such as dizziness on blood pressure medication or has higher readings in the doctor’s office than at home. It’s considered the gold standard for assessing blood pressure.
• 12-Lead electrocardiogram (ECG): A 12-lead electrocardiogram is a diagnostic test that records the heart’s electrical activity with 12 different nodes or “leads.” It translates this activity into graphical data, identifying any irregularities in rhythm, conduction, or structure, as well as left ventricular hypertrophy.
• Fundoscopy: A fundoscopy is an exam using a magnifying lens and light to inspect the eye’s fundus, the inside back surface. It can detect signs of blood vessel problems in the retina and issues with the macula, the central part of the retina.
• Urine albumin–creatinine ratio (uACR): The uACR measures the amount of albumin (a type of protein) relative to the amount of creatinine (a waste product) in a urine sample. This ratio is used to detect kidney damage.
• Ankle brachial index (ABI) test: This test compares the blood pressure between the upper and lower limbs. It may indicate the presence of peripheral arterial disease.

Imaging tests may include:

• Carotid Doppler ultrasound: Carotid Doppler ultrasonography can assess atherosclerosis in the carotid artery.
• Echocardiography: This is a heart ultrasound.
• Brain imaging tests: These may include computed tomography (CT) scan, functional magnetic resonance imaging (fMRI), and positron emission tomography (PET) scan.

Your health provider may conduct a comprehensive blood workup, too, including:

• Complete blood count (CBC): This test measures the different types of cells in your blood, including red blood cells, white blood cells, and platelets.
• Erythrocyte sedimentation rate (ESR): This test measures the rate at which erythrocytes (red blood cells) settle in a tube over time. It is often used as a nonspecific indicator of inflammation in the body.
• Creatinine and estimated glomerular filtration rate (eGFR): These tests assess kidney function. The eGFR calculation uses creatinine levels, age, sex, and race to estimate how well your kidneys filter waste.
• Electrolyte panel: This panel includes tests for sodium, potassium, chloride, bicarbonate, and other electrolytes in your blood.
• Hemoglobin A1C test (HbA1c): The HbA1c blood test helps diagnose Type 2 diabetes and tracks blood glucose management in diabetic individuals.
• Thyroid profile panel: This includes tests for thyroid hormones such as thyroid stimulating hormone (TSH). It helps diagnose thyroid disorders, including hypothyroidism and hyperthyroidism, which can cause hypertension.
• Blood cholesterol level test.
• Serum uric acid test: This test measures the uric acid level in your blood.

Hypertension is not typically an immediate concern for most individuals, as it is usually asymptomatic. However, it becomes worrisome when blood pressure remains consistently elevated over extended periods, often spanning 10 years or more. At this point, the risk of experiencing complications, such as severe cardiovascular events, escalates significantly.

Possible complications of hypertension include:

• Cardiovascular diseases: Hypertension is the leading risk factor for cardiovascular diseases.
• Angina: This is chest pain resulting from constricted blood vessels or a weakened heart muscle.
• Heart attack: When blood flow to the heart is obstructed, the heart muscle starts to die due to insufficient oxygen. The longer the blockage persists, the more severe the damage to the heart becomes.
• Heart failure: This is when the heart lacks the capacity to circulate blood and oxygen to other organs adequately.
• Kidney failure: Kidney failure occurs when the kidneys cannot efficiently filter metabolic waste substances from the bloodstream.
• Stroke.
• Seizures.
• Peripheral artery disease: This condition is characterized by narrowed arteries that restrict blood flow to the limbs.
• Vascular dementia and memory problems: Vascular dementia results from reduced blood flow, oxygen, and nutrients to parts of the brain due to blockages or restrictions, leading to a decline in cognitive abilities. Memory may also become impaired.
• Atherosclerosis: This is the thickening or hardening of arteries due to plaque buildup in their inner linings. High blood pressure contributes to vessel wall thickening and increases the risk of atherosclerosis.
• Permanent blindness: Hypertension can damage blood vessels in the eye.
• Pulmonary edema: This refers to an unusual fluid accumulation in the lungs. It may be caused by high blood pressure, which worsens the heart’s diastolic dysfunction, or congestive heart failure due to sudden hypertension.
• Aortic aneurysm: This is a bulge or swelling that can form anywhere along the aorta, the body’s largest artery responsible for carrying oxygen-rich blood from the heart to the body. This condition is dangerous, as the aneurysm can grow larger and rupture, causing severe internal bleeding and life-threatening complications.
• Nerve damage in Type 1 diabetes patients.
• Erectile dysfunction.

Since the precise origins of primary hypertension remain unidentified, this form of hypertension is currently incurable. Nonetheless, effective management is attainable through a combination of pharmacological and non-pharmacological interventions.

On the other hand, secondary hypertension can be mitigated by addressing its underlying causes and implementing many of the same treatment approaches used for primary hypertension. The treatment objective is to decrease blood pressure, lowering the risk of complications.

In hypertensive emergencies, prompt reduction of blood pressure is crucial. Patients typically receive treatment in hospital intensive-care units by using medications such as fenoldopam, nitroprusside, nicardipine, or labetalol, which are usually administered intravenously.

Depending on your blood pressure level, your health provider may recommend one or a combination of the treatment options below.

1. Lifestyle Changes

Lifestyle changes are advised for individuals with elevated blood pressure, irrespective of age, sex, presence of other health conditions, or cardiovascular risk level. Changes in lifestyle alone can lead to a decrease of up to 15 percent in all cardiovascular-related incidents. Examples include:

• A healthy diet: One’s diet should be rich in potassium and fiber. Examples of diets include Dietary Approaches to Stop Hypertension (DASH) eating plans and the Mediterranean diet. The DASH eating plan lowers high blood pressure and improves cholesterol levels, reducing the risk of heart disease. It emphasizes vegetables, fruits, whole grains, lean proteins, and healthy fats while limiting saturated fats, sugar-sweetened beverages, and sweets.
• Hydration.
• Regular exercise: Get at least 40 minutes of moderate to vigorous aerobic exercise three to four days a week.
• Avoiding smoking or tobacco use.
• Quitting or limiting alcohol consumption to one drink daily for women and two for men.
• Restricting sodium intake to below 1,500 milligrams per day may be advised.
• Stress management.
• Maintaining a healthy body weight: Losing weight is linked to a reduction of around 2.5/1.5 mm Hg in blood pressure for every kilogram lost.
• Limiting caffeine intake.
• Sufficient sleep time: Seven or eight hours a night is recommended.

2. Medication

Your health care provider will typically recommend lifestyle changes and monitor your blood pressure multiple times before considering medication. However, if your readings consistently show a systolic pressure of 130 mm Hg or higher or a diastolic pressure of 80 or higher, your health provider may recommend medications from the beginning. You often must take two or more medications at the same time. The different types of hypertension medications are as follows:

• Angiotensin-converting enzyme inhibitors (ACE) inhibitors reduce certain chemicals that constrict blood vessels, leading to smoother blood flow and improved heart pumping efficiency. One example is captopril.
• Beta adrenoreceptor blockers work by relaxing blood vessels and slowing the heart rate, reducing cardiac output, and improving blood flow. One example is labetalol.
• Calcium channel blockers work by stopping calcium from entering certain muscle cells in the blood vessels, which then causes the blood vessels to dilate. There are three types: dihydropyridines, phenylalkylamine derivatives, and benzothiazepines. Examples are amlodipine and nicardipine.
• Peripherally acting alpha adrenergic blockers relax blood vessels, making blood flow more easily throughout the body. One example is prazosin.
• Angiotensin II receptor blockers (ARBs) block the action of the natural hormone angiotensin II, which constricts blood vessels, promoting smoother blood flow and improved heart efficiency. One example is losartan.
• Vasodilators relax blood vessels, making it easier for blood to circulate. One example is nitroprusside.
• Centrally acting alpha adrenergics decrease heart rate and relax blood vessels, facilitating easier blood flow. They are currently less widely used than before due to a risk of rebound hypertension.
• Renin inhibitors reduce renin, which is important for the production of angiotensin II, thus leading to vessel relaxation and improved heart pumping. One example is aliskiren.
• Diuretics (water pills) work in the kidneys to remove excess water and salt from the body through urine. The one most often used is thiazide.

According to recent recommendations, if there are no strong reasons to favor other medications, the initial preference should be a thiazide diuretic, calcium channel blocker, ACE inhibitor, or ARB.

3. Other Methods

In Europe and Australia, percutaneous catheter-based radiofrequency ablation of the sympathetic nerves in the renal artery is used for resistant hypertension. However, although it can successfully lower blood pressure, its effectiveness in reducing major cardiovascular events is still uncertain. Therefore, this procedure should be considered experimental and reserved for centers with significant expertise.

Another new treatment method for treating resistant hypertension is called baroreflex activation therapy. One 2017 study involving 383 patients demonstrated that around 25 percent reduced their number of medications from an average of six to three after receiving this therapy. While temporary side effects could occur, they typically resolved on their own and didn’t need specific interventions. Over a six-year follow-up, this therapy maintained its effectiveness in lowering blood pressure without significant safety concerns.

Mindset can play a significant role in hypertension, both in terms of its development and management. A negative mindset can lead to anxiety, sadness, and hopelessness, thus creating a negative cycle of emotions. In turn, negative emotions trigger the release of stress hormones and a physical stress response, leading to an increased heart rate and higher blood pressure.

Chronic stress or negativity can also lead to an overactive stress response in the body, which can elevate blood pressure. In a 2023 study, first responders who self-reported having a negative stress mindset also reported a higher prevalence of hypertension. However, a positive mindset can make one more proactive and motivate one to manage and reduce stress effectively. A 2019 meta-analysis of 15 studies involving nearly 230,000 participants found that an optimistic mindset was associated with a lower risk of heart attack, stroke, and all-cause mortality.

Mindset can also influence lifestyle choices and changes that affect blood pressure. For example, a positive mindset toward exercise and healthy eating can encourage individuals to engage in regular physical activity and eat a balanced diet. It can also improve adherence to treatment plans and medications. Believing in the effectiveness of drugs and having a positive attitude toward treatment can lead to better compliance with prescribed medication regimens.

Before using any of the below natural approaches to treat hypertension, please consult a health provider.

1. Medicinal Herbs

• Garlic (Allium sativum): Garlic can help prevent common diseases such as cancer, heart and metabolic issues, high blood pressure, and diabetes. These benefits stem from garlic’s antioxidant, anti-inflammatory, and lipid-reducing properties. A 2019 meta-analysis of 12 studies involving 553 participants with hypertension found that garlic supplements could lower systolic pressure by around 8.3 mm Hg and diastolic pressure by about 5.5 mm Hg, comparable to standard antihypertensive medications. This reduction is linked to a 16 percent to 40 percent reduction in cardiovascular risk. In addition, a type of aged garlic extract lowered blood pressure and improved central blood pressure, pulse pressure, pulse wave velocity, arterial stiffness, and gut health. Therefore, the researchers considered it safe and effective as a treatment for hypertension.
• Onion (Allium cepa): In a 2015 study of 70 participants, one group received 162 milligrams a day of quercetin from onion skin extract powder, and another group received a placebo. Each group underwent a six-week treatment followed by a six-week washout period. Among those with hypertension, the group taking quercetin experienced a decrease of 3.6 mm Hg in 24-hour systolic pressure compared to the placebo group. Quercetin also significantly reduced daytime and nighttime systolic pressure in hypertensive individuals.
• Tulsi (Ocimum sanctum): Tulsi, or holy basil, is a valued medicinal herb in Ayurvedic medicine. It can alleviate metabolic stress by normalizing blood glucose, blood pressure, and lipid levels. A 2017 systematic review of 24 human studies found that two studies reported significant improvements in blood pressure among hypertensive participants who were given 30 milliliters of fresh tulsi leaf juice once or twice daily for 10 and 12 days, respectively.

2. Supplements

• Vitamin C: Vitamin C can reduce blood pressure in people with both normal and high blood pressure. A 2002 study of people with Type 2 diabetes compared the effects of a daily dose of 500 milligrams of vitamin C supplements to a placebo over one month and discovered a notable reduction in blood pressure by 9.9/4.4 mm Hg. The researchers believed that vitamin C supplementation showed promise as a cost-effective and beneficial adjunctive therapy. In a 2020 study, supplementing with vitamin C also led to a notable decrease in blood pressure among individuals with essential (primary) hypertension.
• Fish oil: Fish oil is rich in omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). A 2022 meta-analysis revealed that individuals who regularly consumed 2 to 3 grams daily of a blend of the two omega-3 fatty acids experienced an average reduction of 2 mm Hg in both their systolic and diastolic pressures compared to those who did not consume EPA or DHA. In addition, omega-3 fatty acid intake exceeding the recommended 3 grams per day might offer extra advantages in reducing blood pressure, especially for those at high risk of cardiovascular diseases.
• Coenzyme Q10 (CoQ10): Coenzyme Q10 is a naturally occurring antioxidant found in the body, particularly in the mitochondria of cells. It plays a crucial role in energy production. CoQ10 supplements are commonly used to support cardiovascular health. In a 1999 study, 30 patients received 60 milligrams of CoQ10 twice daily for eight weeks. The results showed that they experienced a 16-mm Hg reduction in systolic pressure and a 9-mm Hg reduction in diastolic pressure.

3. Diet

• Dark chocolate and cocoa products: Dark chocolate and cocoa products are rich in chemical compounds called flavanols, which have been demonstrated to enhance endothelial nitric oxide production, leading to vasodilation and consequently reducing blood pressure. A 2017 meta-analysis of 40 treatment comparisons showed a statistically significant but modest decrease in blood pressure (both systolic and diastolic) by 1.8 mm Hg. Although small, this reduction could complement existing treatments and potentially lower the risk of cardiovascular disease.
• Green tea: Green tea is rich in polyphenols, including flavanols, flavandiols, flavonoids, and phenolic acids. A 2023 meta-analysis of nine studies discovered that drinking green tea lowered systolic pressure by 2.99 mm Hg and diastolic pressure by 0.95 mm Hg among healthy individuals.
• Hibiscus tea: A 2022 meta-analysis found that hibiscus tea had a pronounced effect on reducing systolic pressure. Furthermore, it effectively lowered low-density lipoprotein (LDL) levels compared to other teas.

4. Mindfulness-Based Interventions

Mindfulness-based interventions, including meditation, yoga, mindfulness-based cognitive therapy, and others, are also effective at lowering blood pressure. A 2024 meta-analysis of 12 trials demonstrated a decrease in systolic pressure (with an average difference of 9.12 mm Hg) and diastolic pressure (with an average difference of 5.66 mm Hg). A more substantial impact was noted among individuals with higher pre-intervention blood pressure levels.

5. Traditional Chinese Medicine and Practices

• Qigong: This ancient Chinese practice involves poses, meditation, and breathing exercises to move qi, or energy, through the body. A 2007 meta-analysis of two trials with sufficient data showed that qigong had decreased systolic pressure by 12.1 mm Hg and diastolic pressure by 8.5 mm Hg. In two other trials, qigong was compared against a waiting list control and demonstrated a significant reduction in systolic blood pressure with a weighted mean difference of 18.5 mm Hg. A 2015 meta-analysis of 20 trials found that qigong significantly lowered systolic pressure compared to no intervention, with a weighted mean difference of 17.40 mm Hg.
• Acupuncture: Acupuncture can effectively decrease blood pressure and be used alone or in conjunction with antihypertensive medicines, significantly reducing medication dosage and associated side effects. However, this modality must be used with caution, as acupuncture may sometimes lead to a sudden drop in blood pressure. A 2022 meta-analysis of 10 trials involving 1,196 patients found that acupuncture was more effective than a placebo, no treatment, or lifestyle interventions alone in treating Grade 1 hypertension. The analysis showed significant improvements in systolic and diastolic pressures (with average reductions of 3.62 mm Hg and 3.12 mm Hg, respectively) and treatment efficacy, with minimal adverse effects.
• Moxibustion: Moxibustion is a traditional Chinese medicine therapy that involves burning dried mugwort (Artemisia vulgaris) near specific acupoints on the body. A 2021 meta-analysis of 18 randomized controlled trials discovered that moxibustion reduced systolic pressure by 7.85 mm Hg and diastolic pressure by 4.09 mm Hg among patients with primary hypertension, as observed over a median four-month duration.

The key to preventing high blood pressure is adopting a healthy lifestyle by:

• Eating a balanced diet with less salt and more potassium and following meal plans such as DASH and the Mediterranean diet. The American Heart Association (AHA) advises limiting daily sodium intake to 2,300 milligrams and suggests that most adults aim for an ideal limit of 1,500 milligrams per day. However, there is conflicting evidence that health agencies may restrict salt intake too much and that our bodies function better with more.
• Staying physically active by exercising 30 minutes a day, five days a week.
• Maintaining a healthy weight.
• Limiting alcohol consumption.
• Avoiding smoking.
• Getting enough good-quality sleep.
• Regularly monitoring blood pressure.