Blood pressure, reported as systolic over diastolic pressure, is the force of blood pushing against the walls of the arteries as the heart beats and relaxes. Normal blood pressure is considered to be less than 120/80 mmHg, but nearly half of American adults have high blood pressure, called hypertension.

Hypertension is a major risk factor for cardiovascular disease and can lead to heart attack, heart failure, kidney damage, stroke, and vision loss if not appropriately managed. Moreover, hypertension has been coined the "silent killer" because it is often present without symptoms; 46% of adults with high blood pressure are unaware they have it. (1, 2)

Blood pressure management is a critical aspect of longevity and disease prevention. Measuring blood pressure routinely and understanding your numbers is the first step in taking control of hypertension. Adapting healthy lifestyle habits and implementing complementary and integrative medicine therapies can positively affect health outcomes and be considered part of an evidence-based approach to treating hypertension.

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What is Blood Pressure's Role in The Body?

Blood pressure is a vital body function; many arterial regulatory mechanisms ensure it stays within a normal range. Normal pressure ensures proper perfusion of body tissues and organs with blood cells, oxygen, and nutrients. When blood pressure is too low or high, bodily harm can occur. (3)

What is Considered High Blood Pressure?

The classification and management of high blood pressure in adults depend on which guidelines you are referring to.

JNC 8 Blood Pressure Guidelines

In 2014, the Eight Joint National Committee (JNC 8) published evidence-based guidelines for managing high blood pressure in adults. These guidelines define hypertension as a blood pressure of 140/90 mmHg or higher. Per these management recommendations, pharmacologic treatment of hypertension should be initiated in the general population when blood pressure is at least 150/90 mmHg in adults 60 years and older or 140/90 mmHg or higher in adults younger than 60 years. Regardless of age, patients with hypertension and diabetes should be treated when blood pressure is 140/90 mmHg or higher. (4)

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2017 ACC/AHA Blood Pressure Guidelines

In 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) released new guidelines for diagnosing and treating high blood pressure. Per these new guidelines, hypertension is diagnosed regardless of age when blood pressure is 130/80 mmHg or higher. (5)

Pediatric Hypertension

Healthy blood pressure levels change as children grow, so hypertension is diagnosed differently in children less than 13 years. Children and preadolescents are diagnosed with hypertension when their average blood pressure is at or above the 95th percentile for their age, sex, and height. The 2017 ACC/AHA hypertension guidelines apply to children over 13 years.

What Causes High Blood Pressure?

Essential, or primary, hypertension is high blood pressure that is not caused by an underlying disease and accounts for 95% of all cases of hypertension. Risk factors for essential hypertension include obesity, insulin resistance, excess alcohol and salt intake, low potassium and calcium intake, age, sedentary lifestyle, and stress. (6)

Conversely, secondary hypertension is high blood pressure caused by a medical disease or condition. Possible causes of secondary hypertension include adrenal disorders, thyroid disease, kidney disease, vascular disorders, obstructive sleep apnea, pregnancy, and medication side effects. (2, 7)

Symptoms of High Blood Pressure

In most cases, hypertension presents without symptoms; a high blood pressure measurement is the only sign. If symptoms occur, they typically do so during a hypertensive crisis, an emergent situation when blood pressure is 180/120 mmHg or higher. (2, 7)

• Altered mental status
• Anxiety
• Changes in vision
• Chest pain
• Decreased urine output
• Dizziness
• Headache
• Nausea and vomiting
• Shortness of breath

Functional Medicine Labs to Test for Root Cause of High Blood Pressure

Along with an in-depth patient history and physical exam, standard and functional medicine labs are important in ruling out secondary causes of high blood pressure and identifying risk factors for hypertension and other cardiovascular diseases.

Comprehensive Metabolic Panel (CMP)

The CMP is a metabolic assessment that can be used as a simple, cost-effective metabolic screening. Looking at markers of blood glucose, electrolyte balance, and kidney function can provide early clues into cardiometabolic dysfunction and the presence of disease.

Advanced Lipid Panel

High cholesterol is a risk factor for high blood pressure, as it can contribute to atherosclerosis and a narrowing of the arteries. An advanced lipid panel includes many sensitive biomarkers to estimate an individual's risk for atherosclerotic cardiovascular disease. This advanced panel measures standard lipid markers and the cholesterol-carrying particle number and size, inflammatory marker hs-CRP, Apo A1, ApoB, and Lp(a).

Diabetes Panel

The diabetes panel measures six biomarkers, including blood glucose, insulin, and hemoglobin A1c, to assess cell utilization and metabolism of glucose and screen for insulin resistance and diabetes.

Hormonal Panel

Many endocrine disorders can consequently cause high blood pressure. Depending on the patient's symptoms, ordering a thyroid panel, serum aldosterone, and serum cortisol may be beneficial to rule out thyroid disease, hyperaldosteronism, and Cushing's syndrome.

Sleep Study

Undiagnosed and untreated obstructive sleep apnea (OSA) is linked to a significantly higher risk of hypertension and death from other cardiovascular complications. A referral to a sleep specialist for a sleep study should be considered for patients with diagnosed hypertension who also report insomnia, snoring, witnessed apneas, or gasping/choking episodes during sleep.

Functional Medicine Labs That Can Help Individualize Treatment for Patients with High Blood Pressure

Functional medicine labs help practitioners personalize treatment options for their patients. Below are some of the most common labs ordered for patients with high blood pressure.

Comprehensive Stool Test

A healthy oral and gut microbiome and normal stomach acid levels are required to produce nitric oxide, an endogenous signaling molecule that dilates blood vessels. Along with using nitric oxide test strips to measure the amount of nitric oxide in circulation, a comprehensive stool analysis evaluates the gut microbiome to identify dysbiotic patterns contributing to nitric oxide deficiency, if present.

Micronutrient Panel

Deficiencies in potassium, B vitamins, magnesium, vitamin D, and excess sodium and selenium are associated with endothelial dysfunction and elevated blood pressure (8). A comprehensive micronutrient panel measures essential nutrients for cardiovascular health and function to personalize integrative treatment plans.

Salivary Cortisol Testing

Although serum cortisol is an accurate marker of overt adrenal pathology, it is less sensitive in identifying functional disorders of the adrenal glands because a single measurement cannot accurately represent cortisol secretion patterns throughout the day. A four-to-six-point salivary cortisol test can qualify and quantify the stress axis to recognize functional dysregulation as a response to chronic stress and a contributor to high blood pressure.

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Conventional Treatment for High Blood Pressure

Conventional treatment for high blood pressure relies on lifestyle modifications (discussed in more detail below) and antihypertensive medications. First-line agents in managing hypertension include thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers. (5)

Integrative Approaches To Managing High Blood Pressure

Approaches to managing high blood pressure include lifestyle changes, medication, and integrative therapies. Integrative approaches combine conventional medical treatments with complementary and alternative therapies to provide a more comprehensive and holistic approach to managing hypertension. Here are some integrative approaches to controlling high blood pressure:

Nutrition for High Blood Pressure

A heart-healthy diet incorporates whole, unprocessed foods and limits foods high in saturated and trans-fats, added sugar, and salt. The Mediterranean and DASH diets follow these principles and, per the literature, can improve blood pressure and other cardiovascular risk factors like high cholesterol, systemic inflammation, and obesity. (8, 9)

If you choose against starting one of these specific dietary protocols, make heart-conscious dietary choices by predominantly eating whole fruits, vegetables, whole grains, low-fat dairy products, skinless poultry, fish, nuts, legumes, and non-tropical vegetable oils. A plant-based diet reduces the intake of unhealthy fats, food additives, and ingredients that can contribute to high blood pressure. It also makes meeting nutritional intake goals for fiber and micronutrients important for cardiovascular health easier. (10)

If buying packaged foods, carefully read nutrition labels and avoid purchasing those with added ingredients, especially sugars, sodium, and trans-fats. The AHA Heart-Check mark on food packaging means that a product has been certified to meet the AHA criteria for saturated fat, trans fat, and sodium for a single serving.

Supplements and Herbs for High Blood Pressure

Many evidence-based supplements are used effectively in an integrative approach to treating hypertension. Some of the most commonly recommended dietary and herbal supplements for high blood pressure are listed below:

Magnesium

Magnesium is required for muscle relaxation and energy metabolism. Magnesium insufficiency is often caused by a poor diet (lacking green leafy vegetables, nuts, and whole grains) and physiologic stress. Magnesium supplementation of 500-1,000 mg daily can support heart contractility and vasodilation, effectively reducing blood pressure up to 5.6/2.8 mmHg.

Hibiscus

The antioxidant, anthocyanin-rich hibiscus flower has been traditionally used to treat high blood pressure and cholesterol. Human studies show that drinking hibiscus tea, generally at doses of one cup three times daily for 4-6 weeks, effectively reduces systolic and diastolic blood pressures. (11)

Garlic

Aged garlic extract formulations stimulate nitric oxide production and activity while inhibiting angiotensin-II, a hormone that raises blood pressure (7). Garlic preparations have been proven to lower blood pressure and positively regulate serum cholesterol levels.

Coenzyme Q10 (CoQ10)

CoQ10 is a potent antioxidant and integral component of mitochondrial energy production that is indicated in treating congestive heart failure, atherosclerosis, and high cholesterol. A meta-analysis of 12 clinical trials concluded that CoQ10 also lowers blood pressure by as much as 16.6/10.3 mmHg when given in doses of 60-120 mg daily for 6-12 weeks. (12)

Exercise for High Blood Pressure

Regular physical activity makes the heart stronger and encourages vasodilation. An efficient heart and wider blood vessels decrease the force on the arteries, reducing blood pressure. (13)

Partaking in at least 150 minutes of moderate-intensity or 75 minutes of high-intensity aerobic exercise weekly has been shown to reduce blood pressure by 3-6/4-12 mmHg. Aerobic exercise includes walking, running, swimming, cycling, and dancing. Strength training can also lower blood pressure and improve glucose metabolism, so it is recommended to incorporate strength training into your exercise routine at least twice weekly. (13)

Mind-Body Therapies for High Blood Pressure

Mind-body therapies activate the body's relaxation response to relieve stress and its physical and emotional manifestations.

Qigong is a traditional Chinese medicine (TCM) system of exercises to optimize energy within the body, mind, and spirit. Its incorporation of breathwork, gentle movement, and mindful meditation significantly decreases blood pressure by at least 12/8.5 mmHg. (12)

Slow, deep breathing and meditation increase parasympathetic nervous system activity by activating the vagal nerve. Multiple clinical trials have demonstrated the benefits of deep breathing and transcendental meditation in treating hypertension. (12)

Acupuncture for High Blood Pressure

Acupuncture is another modality anchored in TCM that uses very fine needles to stimulate specific points on the body to elicit physiologic responses. A randomized control trial with 160 patients with mild-to-moderate hypertension concluded that acupuncture led to an average reduction in blood pressure of 6.4/3.7 mmHg after six weeks of treatment. (12)

Biofeedback for High Blood Pressure

Biofeedback is a specific type of mind-body medicine that incorporates the measurement of vitals to help patients learn how to create positive physiologic changes in the body. A systematic review including studies that evaluated 462 hypertensive subjects concluded that biofeedback was an effective adjunctive therapy to the pharmacologic treatment of hypertension; health outcomes of biofeedback therapy included improvement in diastolic blood pressure and reductions in perceived stress levels.

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Summary

Hypertension is a prevalent chronic disease and a strong influencer of cardiovascular disease and premature death. Because there are typically no symptoms indicative of high blood pressure, regular blood pressure monitoring is essential to health maintenance and disease prevention. When elevated blood pressure and hypertension are detected early, an integrative approach to management can be effective in correcting blood pressure without pharmacologic treatment. Otherwise, the treatment options discussed in this article can be safely used with medications to amplify their effects and decrease the dose and reliance on them.