Hypertension – eating the right diet to lower high blood pressure

Thu 29.03.2018

Bildquelle: Piotr Marcinski / shutterstock.com

Hypertension – more commonly known as high blood pressure – is one of the most common diseases in industrialised countries. Forty percent of people over the age of 25 are affected by the disease, which, in turn, is a major risk factor for cardiovascular and renal diseases. A diet based on vegetarian or vegan food is suitable for both the prevention and treatment of hypertension.

The cardiovascular system

The cardiovascular system is one of the most important organ systems in the human body. It allows blood to distribute all necessary nutrients, hormones, the oxygen we breathe, and many other chemical compounds from and to all cells and organs in the body. In this way, it also helps with regulating, stabilising, and maintaining body temperature, pH, and homeostasis, as well as fighting diseases. The cardiovascular system consists of the blood, heart, and blood vessels. Blood pressure is one of the body’s key vital signs and describes the pressure of the circulating blood on the walls of the blood vessels. Normal blood pressure is considered to be less than 120/80 mmHg.1American Heart Association (2018): Understanding Blood Pressure Readings. Available at http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/KnowYourNumbers/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp#.WrqIdHzfPIU [14.03.2018]

Systolic and diastolic blood pressure

The muscle activity of the heart can be divided into two phases: In the systolic phase, blood is pumped from the heart chambers into the body’s and the lungs’ circulatory system; in the diastolic phase, the heart chambers fill with blood again. Both phases of muscle activity can be mapped using a blood pressure monitor. The first reading indicates the maximum pressure the heart exerts when it beats (systolic). Diastolic blood pressure refers to the pressure in the arteries between heartbeats.2Sheps, S. G. (2016): Pulse pressure: An indicator of heart health? Mayo Clinic. Available at https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/pulse-pressure/faq-20058189 [14.03.2018]

What is hypertension?

Hypertension is a cardiovascular disease. High blood pressure is defined as systolic blood pressure above 140 mmHg or diastolic blood pressure above 90 mmHg (see table 1). Blood pressure is commonly measured in millimetres of mercury (mmHg).3Lennon, S. L., DellaValle, D. M. et al. (2017): 2015 Evidence analysis library evidence-based nutrition practice guideline for the management of hypertension in adults. J Acad Nutr Diet. 117(9):1445–1458.e17. Available at http://www.ncbi.nlm.nih.gov/pubmed/28578899 [14.03.2018] Depending on the development of the disease, a distinction is made between primary (essential) and secondary (symptomatic) hypertension. About 90% of all patients suffer from primary hypertension, which – unlike secondary hypertension – is not caused by another underlying disease.4Messerli, F. H., Williams, B. & Ritz, E. (2007): Essential hypertension. Lancet.370(9587):591-603. Available at https://www.ncbi.nlm.nih.gov/pubmed/17707755 [14.03.2018]

Classification of Hypertension

High blood pressure is divided into one of two categories, depending on the severity of the condition (see Table 1). It should be taken into account that systolic blood pressure increases with age. The reason for this is that the elastic walls of our blood vessels become more rigid as we grow older. If blood pressure values are elevated, that is, above 120/80 mmHg, there is a high risk of hypertension developing. Values above 140/90 mmHg, meaning a systolic blood pressure higher than 140 and a diastolic pressure of more than 90, are considered to be the markers of high blood pressure. A precise classification can be made using the following table.5Harris, I. & Lipkin, I. J. (1930): High blood pressure and cholesterin. Br Med J. 1(3612): 587–588. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2313010/pdf/brmedj07485-0011.pdf [14.03.2018] 6National Heart, Lung, and Blood Institute (2004):The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Available at https://www.ncbi.nlm.nih.gov/books/NBK9633/ [14.03.2018]


Table 1: Classification of blood pressure levels in adults 7National Heart, Lung, and Blood Institute (2004):The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Available at https://www.ncbi.nlm.nih.gov/books/NBK9633/table/A32/?report=objectonly [14.03.2018]

Frequency of hypertension

Hypertension, also called ‘the silent killer’, often develops slowly and is sometimes asymptomatic. Worldwide, four out of 10 adults over the age of 25 are affected by arterial hypertension high blood pressure in the arteries. According to the Global Burden of Disease (GBD) study, hypertension is the second most common risk factor for premature death worldwide.8Campbell, N.R., Khalsa, T. et al. (2016): High blood pressure 2016: why prevention and control are urgent and important. The World Hypertension League, International Society of Hypertension, World Stroke Organization, International Diabetes Foundation, International Council of Cardiovascular Prevention and Rehabilitation, International Society of Nephrology. J Clin Hypertens. 18(8):714–7. Available at http://doi.wiley.com/10.1111/jch.12840 [14.03.2018] The World Hypertension League (WHL) estimates that approximately 10% of 2016’s global healthcare costs were due to high blood pressure.9Campbell, N. R., Khalsa, T. et al. (2016): High blood pressure 2016: why prevention and control are urgent and important. The World Hypertension League, International Society of Hypertension, World Stroke Organization, International Diabetes Foundation, International Council of Cardiovascular Prevention and Rehabilitation, International Society of Nephrology. J Clin Hypertens. 18(8):714–7. Available at http://doi.wiley.com/10.1111/jch.12840 [14.03.2018] In low and middle-income countries, the treatment of people with high blood pressure could save 4.7 million lives over the course of a decade.10Heller, D. J., Kishore, S. P. (2017): Closing the blood pressure gap: an affordable proposal to save lives worldwide. BMJ Glob Heal. BMJ Publishing Group; 2(3):e000429. Available at http://www.ncbi.nlm.nih.gov/pubmed/29018587 [14.03.2018]

Effects and symptoms of hypertension

Hypertension poses several health risks. It is estimated that the risk of dying from cardiovascular disease doubles with every 20 mmHg added to systolic blood pressure or every 10 mmHg increase in diastolic blood pressure.11Coulston, A. M., Boushey, C. et al. (2017): Nutrition in the prevention and treatment of disease. 4th Edition. Academic Press; 1072 p. Available at http://www.sciencedirect.com/science/book/9780128029282 [14.03.2018] The increased pressure on the arteries can lead to them becoming damaged or constricted. This, in turn, can develop into arteriosclerosis. In addition, aneurysms (bulges in the arterial walls) may develop. In the worst-case scenario, an aneurysm will tear and cause internal bleeding. People suffering from high blood pressure are also at greater risk of vascular dementia, strokes, nerve damage to the eyes, and sexual dysfunction. Additionally, hypertension is also considered one of the most common causes of kidney failure, since high blood pressure can damage the kidneys’ small blood vessels, preventing waste products from being expelled.12Whelton, P. K., Carey, R. M. et al. (2017): 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Pr. Hypertension.HYP.0000000000000066. Available at http://www.ncbi.nlm.nih.gov/pubmed/29133354 [14.03.2018] 13Mayo Clinic: High blood pressure dangers: Hypertension’s effects on your body. Available at https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20045868 [14.03.2018]

Causes of Hypertension

Diet and lifestyle have a major influence on the development of hypertension. In addition to genetic predisposition and pre-existing conditions such as diabetes mellitus type 2 and kidney disease, a high consumption of alcohol, tobacco, salt, and saturated fatty acids play a role as risk factors. On the other hand, regular exercise, a body weight in the ideal range, and an adequate supply of potassium can reduce blood pressure. A well-planned diet can therefore guard against the development of hypertension and be used to treat the condition.

Hypertension and animal products

Several studies have shown that there is a correlation between the consumption of red meat and high blood pressure.14Austin J Pulm Respir Med (2015): Does Red Meat Metabolism Induce Hypertension? Available at http://austinpublishinggroup.com/pulmonary-respiratory-medicine/fulltext/ajprm-v2-id1019.php [14.03.2018] 15Ophir, O., Peer, G., Gilad, J., Blum, M., Aviram, A. (1983): Low blood pressure in vegetarians: The possible role of potassium. Am J Clin Nutr. 37(5):755-62. Available at https://www.ncbi.nlm.nih.gov/pubmed/6846214 [14.03.2018] In addition to foods containing large amounts of saturated fatty acids, a high consumption of sodium, salt, or cholesterol also has a negative effect on blood pressure. Cholesterol can accumulate on the walls of blood vessels, resulting in a loss of flexibility.16Schorling, E., Niebuhr, D., Kroke, A. (2017): Cost-effectiveness of salt reduction to prevent hypertension and CVD: a systematic review. Public Health Nutr;20(11):1993–2003. Available at http://www.ncbi.nlm.nih.gov/pubmed/28487006 [14.03.2018] 17Harris, I. & Lipkin, I. J. (1930): High blood pressure and cholesterin. Br Med J. 1(3612): 587–588. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2313010/pdf/brmedj07485-0011.pdf [14.03.2018] Processed animal products, in particular, such as cheese, sausage, other meat products, and ready meals, are often very rich in salt, fat, and cholesterol.

Vegetarians and vegans are less likely to suffer from high blood pressure

According to several studies, vegans have lower blood pressure levels compared to people who eat meat.18Yokoyama, Y., Nishimura, K., Barnard, N. D., Takegami, M., Watanabe, M. et al. (2014): Vegetarian diets and blood pressure: a meta-analysis. JAMA Intern Med. 174(4):577-87. doi: 10.1001/jamainternmed.2013.14547. Available at https://www.ncbi.nlm.nih.gov/pubmed/24566947 [14.03.2018] Some studies have shown that a high potassium intake, as found in a balanced vegetarian/vegan diet, lowers hypertension.19Aburto, N. J., Hanson, S., Gutierrez, H., Hooper, L., Elliott, P., Cappuccio, F. P. (2013): Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ. 346:f1378. Available at http://www.ncbi.nlm.nih.gov/pubmed/23558164 [14.03.2018] Sources of potassium include fruit, vegetables, and nuts.20Rizzo, N.S., Jaceldo-Siegl, K., Sabate, J., Fraser, G. E. (2013):: Nutrient profiles of vegetarian and nonvegetarian dietary patterns. J Acad Nutr Diet. 113(12):1610–9. Available at http://www.ncbi.nlm.nih.gov/pubmed/23988511 [14.03.2018] Since potassium also has a physiologically antagonistic effect on sodium, this nutrient improves the function of blood vessels.21McDonough, A. A., Nguyen, M. T. (2012): How does potassium supplementation lower blood pressure? Am J Physiol Physiol. American Physiological Society; 302(9):F1224-5. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362178/ [14.03.2018] Magnesium and calcium also have a positive effect on high blood pressure. Both are found in kale, fennel, and spinach. However, seeds and nuts, such as hemp seeds, pumpkin seeds, and sunflower seeds, contain greater concentrations of magnesium than is found in vegetables.22Houston, M. (2011): The role of magnesium in hypertension and cardiovascular disease. J Clin Hypertens (Greenwich). 13(11):843-7. doi: 10.1111/j.1751-7176.2011.00538.x. Epub 2011 Sep 26. Available at https://www.ncbi.nlm.nih.gov/pubmed/22051430 [14.03.2018] 23Simonetti, G. & Mohaupt, M. (2007): Calcium and blood pressure. Ther Umsch. 64(5):249-52. Available at https://www.ncbi.nlm.nih.gov/pubmed/17685082 [14.03.2018] 24U.S. Department of Agriculture, Agricultural Research Service (2018): USDA Branded Food Products Database . Nutrient Data Laboratory Home Page, Available at http://ndb.nal.usda.gov [14.03.2018]

Rapeseed oil, linseeds, and linseed oil, can also reduce blood pressure25Rodriguez-Leyva, D., Bassett, C. M. C., McCullough, R. & Pierce, G. N. (2010):The cardiovascular effects of flaxseed and its omega-3 fatty acid, alpha-linolenic acid. Can J Cardiol. 26(9): 489–496.
Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989356/ [14.03.2018]
due to the presence of alpha-linolenic acid. Alpha-linolenic acid is a polyunsaturated omega-3 fatty acid, and as such, has a vasodilative effect (like all unsaturated fatty acids).26M. B. Schulze und H. Boeing: Fettzufuhr und Prävention der Hypertonie. Available at https://www.dge.de/fileadmin/public/doc/ws/ll-fett/v2/07-Hypertonie-DGE-Leitlinie-Fett-2015.pdf [14.03.2018] Studies have shown that consuming 2.8% more calories in the form of vegetable protein is associated with reduced levels of systolic blood pressure (−2.14 mmHg) and diastolic blood pressure (−1.35 mmHg).27Elliott, P., Stamler, J., Dyer, A. R., Appel, L., Dennis, B., Kesteloot, H. et al. (2006): Association between protein intake and blood pressure: the INTERMAP Study. Arch Intern Med. 166(1):79. Available at http://www.ncbi.nlm.nih.gov/pubmed/16401814 [14.03.2018]

People who do not consume meat and other animal products usually have a healthy body weight, are physically active, and follow a varied diet high in fruits and vegetables.28Tonstad, S., Butler, T., Yan, R. & Fraser, G. E. (2009): Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care. American Diabetes Association. ;32(5):791-6. doi: 10.2337/dc08-1886. Epub 2009 Apr 7. Available at http://www.ncbi.nlm.nih.gov/pubmed/19351712 [14.03.2018] Vegetarian/vegan lifestyles are therefore not only suitable for preventing high blood pressure, but also for treating it.29Alexander, S., Ostfeld, R. J., Allen, K. & Williams, K. A. (2017): A plant-based diet and hypertension. J Geriatr Cardiol. 14(5): 327–330. doi: 10.11909/j.issn.1671-5411.2017.05.014. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466938/ [14.03.2018] Switching to a plant-based diet is a natural way to lower blood pressure.

ProVeg tips for the prevention and therapy of hypertension

Hypertension can be treated and counteracted with a healthy diet and lifestyle:

  • Eat a diet rich in fruit and vegetables, particularly those containing high levels of potassium and magnesium.
  • Try to choose vegetable protein.
  • Reduce the intake of saturated fatty acids and cholesterol. Instead, aim for a higher amount of monounsaturated and polyunsaturated fatty acids.
  • Switch to a plant-based diet.
  • Reduce salt consumption.
  • Avoid cigarettes and alcohol as far as possible.
  • Maintain a healthy weight.
  • Engage in sufficient physical activity.

Should blood pressure reach stage 1 or 2 and it is not possible to reduce it to the desired extent with a change in diet and lifestyle, medication should be administered by a doctor.30National Heart, Lung, and Blood Institute (2004):The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Available at https://www.ncbi.nlm.nih.gov/books/NBK9633/ [14.03.2018]

References   [ + ]

1. American Heart Association (2018): Understanding Blood Pressure Readings. Available at http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/KnowYourNumbers/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp#.WrqIdHzfPIU [14.03.2018]
2. Sheps, S. G. (2016): Pulse pressure: An indicator of heart health? Mayo Clinic. Available at https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/pulse-pressure/faq-20058189 [14.03.2018]
3. Lennon, S. L., DellaValle, D. M. et al. (2017): 2015 Evidence analysis library evidence-based nutrition practice guideline for the management of hypertension in adults. J Acad Nutr Diet. 117(9):1445–1458.e17. Available at http://www.ncbi.nlm.nih.gov/pubmed/28578899 [14.03.2018]
4. Messerli, F. H., Williams, B. & Ritz, E. (2007): Essential hypertension. Lancet.370(9587):591-603. Available at https://www.ncbi.nlm.nih.gov/pubmed/17707755 [14.03.2018]
5, 17. Harris, I. & Lipkin, I. J. (1930): High blood pressure and cholesterin. Br Med J. 1(3612): 587–588. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2313010/pdf/brmedj07485-0011.pdf [14.03.2018]
6, 30. National Heart, Lung, and Blood Institute (2004):The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Available at https://www.ncbi.nlm.nih.gov/books/NBK9633/ [14.03.2018]
7. National Heart, Lung, and Blood Institute (2004):The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Available at https://www.ncbi.nlm.nih.gov/books/NBK9633/table/A32/?report=objectonly [14.03.2018]
8. Campbell, N.R., Khalsa, T. et al. (2016): High blood pressure 2016: why prevention and control are urgent and important. The World Hypertension League, International Society of Hypertension, World Stroke Organization, International Diabetes Foundation, International Council of Cardiovascular Prevention and Rehabilitation, International Society of Nephrology. J Clin Hypertens. 18(8):714–7. Available at http://doi.wiley.com/10.1111/jch.12840 [14.03.2018]
9. Campbell, N. R., Khalsa, T. et al. (2016): High blood pressure 2016: why prevention and control are urgent and important. The World Hypertension League, International Society of Hypertension, World Stroke Organization, International Diabetes Foundation, International Council of Cardiovascular Prevention and Rehabilitation, International Society of Nephrology. J Clin Hypertens. 18(8):714–7. Available at http://doi.wiley.com/10.1111/jch.12840 [14.03.2018]
10. Heller, D. J., Kishore, S. P. (2017): Closing the blood pressure gap: an affordable proposal to save lives worldwide. BMJ Glob Heal. BMJ Publishing Group; 2(3):e000429. Available at http://www.ncbi.nlm.nih.gov/pubmed/29018587 [14.03.2018]
11. Coulston, A. M., Boushey, C. et al. (2017): Nutrition in the prevention and treatment of disease. 4th Edition. Academic Press; 1072 p. Available at http://www.sciencedirect.com/science/book/9780128029282 [14.03.2018]
12. Whelton, P. K., Carey, R. M. et al. (2017): 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Pr. Hypertension.HYP.0000000000000066. Available at http://www.ncbi.nlm.nih.gov/pubmed/29133354 [14.03.2018]
13. Mayo Clinic: High blood pressure dangers: Hypertension’s effects on your body. Available at https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20045868 [14.03.2018]
14. Austin J Pulm Respir Med (2015): Does Red Meat Metabolism Induce Hypertension? Available at http://austinpublishinggroup.com/pulmonary-respiratory-medicine/fulltext/ajprm-v2-id1019.php [14.03.2018]
15. Ophir, O., Peer, G., Gilad, J., Blum, M., Aviram, A. (1983): Low blood pressure in vegetarians: The possible role of potassium. Am J Clin Nutr. 37(5):755-62. Available at https://www.ncbi.nlm.nih.gov/pubmed/6846214 [14.03.2018]
16. Schorling, E., Niebuhr, D., Kroke, A. (2017): Cost-effectiveness of salt reduction to prevent hypertension and CVD: a systematic review. Public Health Nutr;20(11):1993–2003. Available at http://www.ncbi.nlm.nih.gov/pubmed/28487006 [14.03.2018]
18. Yokoyama, Y., Nishimura, K., Barnard, N. D., Takegami, M., Watanabe, M. et al. (2014): Vegetarian diets and blood pressure: a meta-analysis. JAMA Intern Med. 174(4):577-87. doi: 10.1001/jamainternmed.2013.14547. Available at https://www.ncbi.nlm.nih.gov/pubmed/24566947 [14.03.2018]
19. Aburto, N. J., Hanson, S., Gutierrez, H., Hooper, L., Elliott, P., Cappuccio, F. P. (2013): Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ. 346:f1378. Available at http://www.ncbi.nlm.nih.gov/pubmed/23558164 [14.03.2018]
20. Rizzo, N.S., Jaceldo-Siegl, K., Sabate, J., Fraser, G. E. (2013):: Nutrient profiles of vegetarian and nonvegetarian dietary patterns. J Acad Nutr Diet. 113(12):1610–9. Available at http://www.ncbi.nlm.nih.gov/pubmed/23988511 [14.03.2018]
21. McDonough, A. A., Nguyen, M. T. (2012): How does potassium supplementation lower blood pressure? Am J Physiol Physiol. American Physiological Society; 302(9):F1224-5. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362178/ [14.03.2018]
22. Houston, M. (2011): The role of magnesium in hypertension and cardiovascular disease. J Clin Hypertens (Greenwich). 13(11):843-7. doi: 10.1111/j.1751-7176.2011.00538.x. Epub 2011 Sep 26. Available at https://www.ncbi.nlm.nih.gov/pubmed/22051430 [14.03.2018]
23. Simonetti, G. & Mohaupt, M. (2007): Calcium and blood pressure. Ther Umsch. 64(5):249-52. Available at https://www.ncbi.nlm.nih.gov/pubmed/17685082 [14.03.2018]
24. U.S. Department of Agriculture, Agricultural Research Service (2018): USDA Branded Food Products Database . Nutrient Data Laboratory Home Page, Available at http://ndb.nal.usda.gov [14.03.2018]
25. Rodriguez-Leyva, D., Bassett, C. M. C., McCullough, R. & Pierce, G. N. (2010):The cardiovascular effects of flaxseed and its omega-3 fatty acid, alpha-linolenic acid. Can J Cardiol. 26(9): 489–496.
Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989356/ [14.03.2018]
26. M. B. Schulze und H. Boeing: Fettzufuhr und Prävention der Hypertonie. Available at https://www.dge.de/fileadmin/public/doc/ws/ll-fett/v2/07-Hypertonie-DGE-Leitlinie-Fett-2015.pdf [14.03.2018]
27. Elliott, P., Stamler, J., Dyer, A. R., Appel, L., Dennis, B., Kesteloot, H. et al. (2006): Association between protein intake and blood pressure: the INTERMAP Study. Arch Intern Med. 166(1):79. Available at http://www.ncbi.nlm.nih.gov/pubmed/16401814 [14.03.2018]
28. Tonstad, S., Butler, T., Yan, R. & Fraser, G. E. (2009): Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care. American Diabetes Association. ;32(5):791-6. doi: 10.2337/dc08-1886. Epub 2009 Apr 7. Available at http://www.ncbi.nlm.nih.gov/pubmed/19351712 [14.03.2018]
29. Alexander, S., Ostfeld, R. J., Allen, K. & Williams, K. A. (2017): A plant-based diet and hypertension. J Geriatr Cardiol. 14(5): 327–330. doi: 10.11909/j.issn.1671-5411.2017.05.014. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466938/ [14.03.2018]