When do you say you have hypertension? What are the foods to avoid? Are there any natural treatments?
All the answers to your questions about high blood pressure can be found on this sheet.
What is Arterial hypertension?
Arterial hypertension, or high blood pressure, is characterized by abnormally high blood pressure on the walls of the arteries.
In a stressful situation or during physical exertion, it is normal for blood pressure to rise. But in people with hypertension, blood pressure remains elevated at all times, even at rest or in the absence of stress.
In the long term, high blood pressure is an important risk factor for several diseases:
- cardiac and vascular disorders (angina, myocardial infarction, and stroke). High blood pressure means that the blood exerts greater pressure on the walls of the arteries, which weakens them and increases the risk that the artery is blocked by atherosclerosis;
- heart failure. By putting extra work on the heart, high blood pressure can cause exhaustion of the heart muscle;
- kidney problems (kidney failure) and eye problems (damage to the retina which can lead to loss of sight). Again, due to the weakening of blood vessels.
Since high blood pressure is usually not accompanied by any symptoms, a significant number of hypertensives are unaware of their condition. This is also why it is nicknamed the “silent killer”.
Better understanding of blood pressure measurement
Blood pressure is made up of systolic and diastolic pressures, which are measured in millimeters of mercury, or mmHg.
- Systolic pressure is the blood pressure when the heart contracts and pushes blood through the arteries. It ensures a supply of blood everywhere in the body;
- Diastolic pressure is the pressure that continues to be exerted on the arteries between each contraction. At this time, the heart relaxes and regains its volume, allowing the heart chambers to fill with blood. This pressure tends to increase with age, but past the age of 60, it gradually decreases due to the weakening of the body’s blood vessels.
So, when we talk about the pressure of 120/80, 120 corresponds to the systolic pressure, and 80 to the diastolic pressure.
Prevalence of high blood pressure
According to the World Health Organization, 30% of men and 50% of women between the ages of 65 and 75 suffer from high blood pressure.
Its frequency increases with age, but nowadays it affects younger and younger populations. According to Hypertension Canada, more than 9 out of 10 Canadians will develop hypertension if they do not change their lifestyle.
If the situation does not improve, it is estimated that in 2025, the number of hypertensives in the world will have reached 1.56 billion individuals, an increase in the prevalence of 60% 75 .
Types of high blood pressure and their causes
Primary (or “essential”) hypertension accounts for approximately 90% of cases. It is caused by a multitude of factors whose effects accumulate over the years.
The main ones are related to age, heredity (especially for men), and lifestyle. Thus, obesity, physical inactivity, smoking, alcohol abuse, and stress contribute to high blood pressure.
Secondary hypertension can result from another health problem, such as a kidney or endocrine problem or a birth defect of the aorta.
It can also come from the frequent use of certain medications, for example, anti-inflammatories, which create water and salt retention, bronchodilators, which have a stimulating effect on the heart and nasal decongestants, because of the ephedrine they contain (a substance whose effect resembles that of adrenaline secreted in stressful situations).
It can also come from the consumption of illegal drugs, such as cocaine and amphetamines.
Secondary hypertension appears more suddenly and blood pressure is often higher.
This type of hypertension most often appears gradually from the age of 50, but can also occur before this age.
High salt intake is also associated with elevated blood pressure. However, according to a survey conducted by Statistics Canada, more than 85% of men and 60% of women have a salt or sodium intake that exceeds the recommended upper limit of 2,300 mg per day 1 . See the complete table of the maximum tolerated sodium intake.
How to diagnose high blood pressure?
Before establishing a diagnosis of high blood pressure, the doctor measures the blood pressure several times, during successive visits. Indeed, it can vary during the day depending on the activities and vary from time to time.
It is quite common that, under the effect of stress or nervousness, tension rises significantly when a patient enters the doctor’s office, and that his tension drops when he leaves. This is referred to as the “white coat syndrome”.
To avoid this type of reaction, the doctor can suggest that the patient measure his blood pressure himself, at home, using a tensiometer.
The doctor may also prescribe the patient an ambulatory blood pressure monitor (ABPM). The MAPA is a compact device that records blood pressure measurements at specific times over a 24-hour period.
Once the reliable values have been obtained, the doctor can make a diagnosis: a person whose pressure is equal to or greater than 140/90 has high blood pressure. Note that people with diabetes or kidney disease should ideally maintain a blood pressure that does not exceed 130/80.
The following table of blood pressure levels shows the standards in force in North America and England 3 . They set normal blood pressure at 120/80 or less, and optimal blood pressure at 115/75.
This classification applies to adults who are not taking medication for high blood pressure and who do not have diabetes or kidney disease 2 .
|Blood pressure level||Systolic pressure measurement||Diastolic pressure measurement|
|Optimal||115 mmHg||ET||75 mmHg|
|Normal||less than 120 mmHg||ET||less than 80 mmHg|
– Light stadium
– Moderate stage
– Advanced stage
180 mmHg et plus
110 mmHg et plus
High blood pressure is usually asymptomatic, that is, it does not cause any symptoms.
However, very high (moderate or advanced stage) and sustained blood pressure can cause the following symptoms: discover them in this sheet.
High Blood Pressure Symptoms
- Headaches accompanied by fatigue (these headaches are often localized in the neck and occur very early in the morning);
- dizziness or ringing in the ears;
- heart palpitation;
- confusion or drowsiness;
- numbness or tingling in the feet and hands.
Do you know who is at risk and what risk factors are for high blood pressure?
People at risk for high blood pressure
- People over 55 years old. Blood pressure tends to increase from this age;
- in young adults, the percentage of hypertensives is higher in men than in women. Among people aged 55 to 64, the percentage is roughly the same for both sexes. Among people over 64, the percentage is higher among women;
- African Americans;
- people with a family history of early hypertension;
- people with certain medical conditions, such as diabetes, sleep apnea, or kidney disease.
Risk factors for high blood pressure
- General obesity, abdominal obesity, and overweight 76 ;
- a diet high in salt and fat and low in potassium;
- excessive alcohol consumption;
- physical inactivity;
- the stress ;
- regular consumption of black licorice or black licorice products, such as non-alcoholic pastis.
Why is it important to prevent high blood pressure? And, therefore, how do detect it and do prevention to reduce the risk of developing hypertension?
Consult this detailed sheet for more information.
Prevention of high blood pressure
- Because the risk of cardiovascular disorders doubles each time the systolic pressure increases by 20 mmHg and the diastolic pressure increases by 10 mmHg;
- because controlling blood pressure reduces the risk of stroke by 35% to 40%, and also reduces the risk of kidney problems, predominantly vascular dementia and vision problems;
- finally, most people who adopt healthy lifestyles will never develop high blood pressure, unless they have a hereditary component or secondary hypertension.
Your blood pressure should be measured once a year by a family doctor (at the time of your periodic medical examination).
Basic preventive measures
Maintain a healthy weight
Ideally, by combining regular physical exercise with good eating habits.
To be active
The practice of moderate-intensity physical activity, for at least 20 minutes, 4 to 7 times a week, is recommended to prevent and treat cardiovascular disorders.
In a study of more than 6,000 men aged 35 to 60, those who walked 11 to 20 minutes a day reduced their risk of high blood pressure by 12% compared to those who didn’t. had not worked 6 .
Even better, those who walked more than 20 minutes a day reduced their risk by 30%.
Pay attention to signs of chronic stress
The relationship between stress and hypertension is complex. Everything indicates, however, that the adrenaline secreted in stressful situations raises blood pressure due to its vasoconstrictor effect.
When stress becomes chronic, it damages the arteries and the heart over time. It is important to understand the origin of stress in order to better control it.
Eat very salty foods in moderation
Maintaining a good balance between the consumption of sodium (contained in salt) and that of potassium (found in fruits and vegetables) is important to keep blood pressure within normal limits.
A sodium-to-potassium ratio of 1:5 would be ideal for maintaining good blood pressure. However, the average American diet contains twice as much sodium as potassium 8 .
It is advisable to limit sodium intake to a maximum of 2,300 mg per day7. The latest recommendations from the Canadian Hypertension Education Program even advise a dietary sodium intake of 1,500 mg per day for adults aged 50 or younger, and 1,300 mg per day for people aged 51 to 70. , and 1,200 mg per day if the age is over 70 years.
A good way to reduce your sodium intake is to avoid all prepared meals, deli meats, sauces, chips, fast meals, and certain canned foods – including soups which are often very salty.
You should also be sure to eat foods rich in potassium. Cantaloupe, baked potato with skin, winter squash, bananas, and cooked spinach are excellent sources.
Consume 2 to 3 fish meals per week
The omega-3s they contain provide cardiovascular protection, according to numerous studies (see the Fish oils sheet). Choose oily fish, such as herring, mackerel, salmon, sardines, and trout.
Consume plenty of fruits and vegetables
For their beneficial contribution to dietary fiber, antioxidants, and potassium.
Limit your fat intake
To maintain good cardiovascular health.
Moderate your alcohol consumption
We recommend a maximum of 2 drinks per day (2 beers or 2 glasses of wine) for men and 1 drink per day for women. Some will benefit from abstaining from alcohol completely.
There is no treatment that can permanently cure high blood pressure.
The purpose of the treatment is to artificially lower the blood pressure to prevent possible damage to the organs (heart, brain, kidneys, eyes).
When these organs are already affected, the treatment of high blood pressure becomes even more important. In people with diabetes, treatment goals are higher because the risk of complications is increased.
High blood pressure treatments
In cases of mild hypertension, adopting healthier lifestyle habits may be enough to normalize the tension.
In the event of moderate or advanced hypertension, the adaptation of lifestyle habits remains essential, which will make it possible to reduce the consumption of drugs. In any case, a comprehensive approach has an even greater effect on blood pressure than taking medication alone.
Several types of medication, obtained by prescription, can provide adequate control of high blood pressure. The majority of patients require 2 or more medications to achieve blood pressure targets. Here are the most commonly used:
- diuretics. They promote the elimination of excess water and salt through urine. There are several types, which have different modes of action;
- beta-blockers. They reduce the heart rate and the force of ejection of blood by the heart;
- calcium channel blockers. They cause dilation of the arteries and reduce cardiac effort;
- angiotensin-converting enzyme inhibitors. They also have a dilating effect on the arteries, by countering the production of a hormone (angiotensin);
- angiotensin receptor blockers (also called sartans). Like the previous class of drugs, they prevent angiotensin from constricting blood vessels, but by a different mechanism of action.
If treatment with a combination of several of these drugs fails, the doctor may prescribe other drugs, such as alpha-blockers, alpha-beta blockers, vasodilators, and centrally acting agents.
Remark. Certain over-the-counter medications, such as nonsteroidal anti-inflammatory drugs, can raise blood pressure in people with high blood pressure. Always seek advice from your doctor or pharmacist before taking any medicine.
For more practical advice, see our special high blood pressure diet.
It is possible to lower your blood pressure by applying the following tips:
- eat lots of fruits and vegetables;
- limiting salt intake: studies indicate that 30% of hypertensives (especially those who react easily to sodium) can control their blood pressure by reducing their salt intake 11 . If necessary, for cooking or seasoning, replace table salt, sea salt, or fleur de sel with potassium salt;
- moderate alcohol and caffeine consumption (a maximum of 4 cups of coffee per day);
- increase your intake of omega-3s of marine origin, especially found in mackerel, salmon, trout, herring, and cod;
- eat garlic: although its virtues have not been rigorously proven, several doctors recommend garlic for its vasodilating properties (see Complementary Approaches).
The DASH Diet
In the United States, the National Institutes of Health (NIH) advocates the DASH diet (Dietary Approaches to Stop Hypertension).
This diet is specially designed to treat high blood pressure. It is similar to the Mediterranean diet. Research has shown its effectiveness and, in the case of mild high blood pressure, it can even replace the usual medications.
Regular monitoring of this diet reduces systolic blood pressure from 8 mmHg to 14 mmHg, and diastolic blood pressure from 2 mmHg to 5.5 mmHg 9 .
In this diet, the emphasis is on fruits and vegetables, whole grains, nuts, fish, poultry, and low-fat dairy products. The consumption of red meats, sugar, fat (and more particularly saturated fat), and salt is reduced 2.
The 2000 kcal DASH DIET
|Recommended servings per day||Examples of portions|
|Whole grain cereal products 7 to 8||5 ml or 1 tbsp. |
oil or margarine;
5 ml or 1 tbsp.
15 ml or 1 tbsp.
tablespoons of reduced-fat mayonnaise;
15 ml or 1 tbsp.
tbsp plain vinaigrette;
30 ml or 2 tbsp.
|Vegetables 4 to 5||250 ml of lettuce or other leafy vegetables;|
125 ml or 1/2 cup of vegetables;
180 ml or 3/4 cup of vegetable juice.
|Fruit 4 to 5||1 medium fruit;|
125 ml or 1/2 cup of fresh, frozen, or canned fruit;
180 ml or 3/4 cup fruit juice;
60 ml or 1/4 cup of dried fruit.
|Low-fat dairy products 2 to 3||250 ml or 1 cup skimmed or 1% milk;|
180 ml or 3/4 cup skimmed yogurt;
50 g or 1 1/2 ounces of partly skimmed or skimmed cheese.
|Meat, poultry, and fish 2 or less||90 g or 3 ounces of lean meat, poultry, fish, or seafood|
|Fat 2 to 3||5 ml or 1 tbsp. |
oil or margarine;
5 ml or 1 tbsp.
15 ml or 1 tbsp.
tablespoons reduced-fat mayonnaise;
15 ml or 1 tbsp.
tbsp plain vinaigrette;
30 ml or 2 tbsp.
|Legumes, nuts, and seeds 4 to 5 per week||125 ml or 1/2 cup of cooked legumes;|
80 ml or 1/3 cup walnuts;
30 ml or 2 tbsp.
tablespoons of sunflower seeds.
|Snacks and sweets 5 per week||1 medium fruit;|
250 ml or 1 cup of fruit yogurt;
125 ml or ½ cup of frozen yogurt;
200 ml or 3/4 cup pretzels;
125 ml or ½ cup fruit gelatin;
15 ml or 1 tbsp.
tablespoon of maple syrup, sugar or jam;
3 hard candies.
Cardiovascular exercises (brisk walking, running, cycling, dancing, swimming) are recommended. It is suggested to do at least 20 minutes a day, but any physical exercise, even less intense, is beneficial. In the long term, regular physical exercise can reduce systolic blood pressure by 4 mmHg to 9 mmHg, even without weight loss 9 .
However, be careful with exercises that require lifting weights (at the gym, for example). They become contraindicated when blood pressure is high.
In any case, it is best to seek the advice of your doctor before starting an exercise program.
Consult our file Being active: the new way of life! See also our Fitness series.
If you are overweight, losing weight is the most effective way to reduce blood pressure. On average, losing 2 ½ kilos (5 pounds) results in a drop in systolic pressure of 5 mmHg and diastolic of 2.5 mmHg.
Stress, impatience, and hostility play an important role in the onset of hypertension. Some experts estimate that stress can cause blood pressure to fluctuate by 10%. Many doctors recommend approaches such as meditation, relaxation, or yoga. Practiced regularly (at least 2 or 3 times a week), these can give good results.
People with hypertension can expect to reduce their systolic pressure by 10 mmHg and their diastolic pressure by 5 mmHg 12 , for example.
Along with these practices, the unnecessary hassle will be avoided. It is therefore a question of learning how to reduce stress factors related to lifestyle: better manage your time, determine your priorities, etc.
See also on this subject the section Complementary approaches.
In order to ensure better follow-up and to help the doctor adjust the treatment, it is recommended to measure your blood pressure once or twice a week using a tensiometer. To do this, you can get a device that you will first have checked in a clinic to ensure its accuracy.
At each reading, note the values obtained and share them with your doctor at the next visit. Once the voltage has stabilized, it can be measured less frequently.
The opinion of Dr. Jacques Allard
“High blood pressure is nicknamed the ‘silent killer and this is not a gratuitous statement! It is a major risk factor for life-threatening or very disabling diseases, such as heart attack myocardium, or stroke.
High blood pressure, even when it is very high, most often goes unnoticed because it causes no symptoms.
My first piece of advice is: to have your blood pressure taken regularly when possible or take advantage of opportunities to take it yourself when devices are available in some public places, such as pharmacies.
My second piece of advice concerns treatment. Of course, changing lifestyle habits (exercise, maintaining a healthy weight, quitting smoking, etc.) is essential.
However, if your doctor has to prescribe medication, make sure you take it regularly, and above all don’t stop taking it without his advice! As hypertension is asymptomatic, many patients mistakenly believe they are cured, stop their medication, and run unnecessary risks!”
In addition to medical treatments, it is possible to implement complementary approaches to treat high blood pressure.
Discover them in this sheet.
Complementary approaches are effective in cases of high blood pressure
Remark. Certain supplements and herbs may be effective for high blood pressure. However, self-treatment without consulting a healthcare professional is not recommended. A medical follow-up is required to assess the risks and adjust the medication accordingly, if necessary.
The body of evidence demonstrates that fish oil supplements modestly reduce systolic (by approximately 3.5 mmHg) and diastolic (by approximately 2.5 mmHg) pressures in patients with high blood pressure.
Fish oils, a good source of omega-3 fatty acids, also have a protective effect on the cardiovascular system in several ways. They positively affect blood lipid levels, vascular function, heart rate, platelet function, inflammation, etc.
Dosage: to moderately reduce blood pressure, it is advisable to consume 900 mg of EPA/DHA per day either by taking a fish oil supplement or eating oily fish every day, or combining the two contributions.
See our Fish Oils sheet for more information.
Taken in oral form, this antioxidant has been shown to be effective in several clinical trials as an adjuvant treatment for hypertension. In 3 double-blind, placebo-controlled trials (217 subjects in all), researchers found that coenzyme Q10 (a total of 120 mg to 200 mg daily in 2 doses) lowered blood pressure and reduced the dosage of conventional hypotensive medication 42-46 .
Dosage: The dosages used in studies on hypertensive subjects have varied from 60 mg to 100 mg, twice a day.
Derived from traditional Chinese medicine, Qi Gong practiced regularly aims to strengthen and soften the musculoskeletal structure, optimize all the functions of the body, and even ensure longevity.
A systematic review identified 12 randomized clinical trials, including a total of more than 1,000 participants15. The results suggest that regular Qigong practice may have positive effects on lowering blood pressure.
According to 2 other summaries of studies, the practice of Qi Gong (associated with medication) reduces the risk of stroke, reduces the dose of medication required for blood pressure control, and also reduces mortality 16,17 . It seems that Qi Gong works by reducing stress and stabilizing the activity of the sympathetic nervous system.
Dark chocolate and cocoa (Theobroma cacao)
A 15-year study of 470 elderly men showed a strong correlation between cocoa consumption (rich in polyphenols) and low blood pressure.
A few clinical trials and a meta-analysis published in 2010 confirmed that consuming dark chocolate for 2 to 18 weeks reduced systolic pressure by 4.5 mmHg and diastolic pressure by 2.5 mmHg67.
Dosage: Some doctors recommend that people with high blood pressure consume 10 g to 30 g of dark chocolate each day.
Several clinical trials have shown that tai chi helps reduce blood pressure in people with hypertension18,19.
Several reviews and meta-analyses 68,69 suggest that tai chi may be effective as an adjunct to antihypertensive medications. However, the quality of the trials and the number of participants remain low.
This deep relaxation technique close to self-hypnosis uses suggestion and concentration to eliminate the stress of all kinds that the body accumulates.
A few studies 20-24 indicate that autogenic training may, alone or in conjunction with conventional treatments, help reduce blood pressure. However, the authors point out that biases in the methodology make it difficult to interpret the results.
Other relaxation techniques, such as deep breathing, can also be effective.
This intervention technique allows the patient to visualize the information emitted by the body (brain waves, blood pressure, body temperature, etc.) on an electronic device, in order to then be able to react and “educate” themselves to reach a state nerve and muscle relaxation.
A meta-analysis reports convincing results obtained by biofeedback14. However, 2 new meta-analyses published later conclude that the lack of quality studies prevents concluding the effectiveness of biofeedback.
Biofeedback is usually done as part of behavioral therapy or physical therapy rehabilitation. However, in Quebec, biofeedback practitioners are rare. In French-speaking Europe, the technique is also marginal. To find out more, consult our Biofeedback sheet.
Some trials suggest that an extract of stevia, a shrub from South America, may help reduce blood pressure in the long term (1 year to 2 years) 70-73 .
A few small studies 25-27 indicate that acupuncture lowers blood pressure. However, according to a review of the scientific literature 28 including 20 trials, the contradictory results and the poor quality of the studies do not make it possible to clearly establish the effectiveness of this technique.
Ail (Allium sativum)
The World Health Organization indicates that garlic may be useful for moderate hypertension. Several clinical trials show that garlic can indeed help in this regard 60-62 .
However, according to the authors of a meta-analysis, the majority of these studies report a statistically insignificant effect and their methodology is of poor quality 63 .
In the course of numerous studies, the existence of a link, still poorly understood, has been noted between high blood pressure and poor calcium metabolism, which is manifested in particular by poor retention of this mineral.
Researchers believe that dietary calcium may help maintain normal blood pressure and thus protect the cardiovascular system. The diet designed to curb hypertension (DASH) is also rich in calcium.
In terms of supplementation, the clinical efficacy of calcium has not been established. According to 2 meta-analyses, taking calcium supplements would lead to only a very modest reduction in blood pressure 48,49 . It could still be that an additional calcium intake benefits people whose diet is deficient in this mineral.
The effect of vitamin C on hypertension is of interest to researchers, but so far the findings of studies are inconsistent 51-54 .
A few clinical trials indicate that the daily practice of yoga is an effective tool in lowering blood pressure in people with hypertension29-34, although its effect is less than that of medication.
Note that we have identified a study in the scientific literature that concludes that yoga and stress management exercises are ineffective in controlling blood pressure 35 .
Note on potassium supplements
Clinical trials indicate that in the event of hypertension, the contribution of potassium in the form of supplements leads to a slight reduction (of about 3 mmHg) in blood pressure.
Given the risks associated with taking potassium supplements, doctors and naturopaths recommend taking potassium from food instead. Fruits and vegetables are good sources.
See the Potassium fact sheet for more information.
Note on Magnesium Supplements
In North America, medical authorities recommend a dietary intake high in magnesium to prevent and treat hypertension 57 , in particular by adopting the DASH diet. This diet is also high in potassium, calcium, and fiber.
Moreover, the results of a meta-analysis of 20 clinical trials indicate that magnesium supplementation can lower blood pressure very slightly 58 . But this supplementation alone is not a clinically relevant treatment 59 .
When do you say you have hypertension? What are the foods to avoid? Are there any natural treatments?