- George Wang, MD, PhD
Can high blood pressure be "cured"? Hopes and caveats
Hypertension, or high blood pressure, is one of the most common reasons for which people seek medical care. It is notoriously associated with a slew of adverse health outcomes over the long-term, including enlargement of the heart, heart failure, stroke, and chronic kidney disease, which in turn are associated with higher mortality rates. That is why none of us should take hypertension lightly.
The word "cure" is rarely used to describe the outcome of a patient treated for chronic diseases such as hypertension, diabetes, heart disease, autoimmune disease, or cancer. To be able to cure something requires us to know the root cause of what we are trying to cure. (And even when we have "cured" a disease, we might not have "healed" the person. This is a topic for another day, but to truly heal, we must understand the factors and choices that led to the occurrence of the disease in the first place. Otherwise, additional health problems will arise eventually.)
What causes hypertension? The majority of cases of hypertension are called "primary hypertension" or "essential hypertension," which means that there is not a blatantly obvious cause that we can clearly identify and fix. In contrast, secondary hypertension results from a cause or mechanism that doctors can identify and fix, or try to fix, but these secondary causes of hypertension are relatively uncommon. (Examples of secondary causes of hypertension include kidney disease, sleep apnea syndrome, pheochromocytoma, and coarctation of the aorta.) Use of certain medications such as oral contraceptives, antidepressants, steroids, and over-the-counter NSAIDS (ibuprofen, Advil, Motrin, etc.) and decongestants (phenylephrine, pseudoephedrine, Sudafed, etc.) can also cause secondary hypertension.
So how can we hope to "cure" hypertension if we cannot clearly identify a cause, or causes? While there is not a clear-cut cause in primary or essential hypertension, which account for the majority of cases, there are a number of risk factors that are known to be strongly associated with it. These risk factors traditionally include age, obesity, family history, high-sodium diet, physical inactivity, and excessive alcohol use. Additional considerations from the functional medicine perspective include chronic stress, mercury, and other heavy metals.
Most clinical guidelines recommend using lifestyle changes as the first step in treating hypertension. However, as most veteran users of the health care system have come to realize, and most health care practitioners have experienced through years of practice: Most doctors eventually end up prescribing medications for the majority of their hypertensive patients. More than occasionally, additional medications are eventually added to the regimen, in an attempt to adequately control the blood pressure. And in most cases, these patients will remain on antihypertensive medications for decades, if not for the remainder of their lives.
Is taking one or more blood pressure-lowering drugs on a chronic basis the inevitable fate of any person diagnosed with hypertension?
The answer is, "No": not from the perspective of integrative medicine and functional medicine (colloquially, "holistic medicine"). When the root causes are addressed, the right food plan is selected, and the right lifestyle choices are made and actively kept, hypertension can be very effectively treated and controlled, often without having to rely on long-term use of medications. Of course, there are situations where medication use is prudent and necessary, and no one should ever try to discontinue or taper blood pressure-lowering medications on their own without the guidance and oversight of a physician or licensed practitioner. (That would be dangerous.)
In my experience treating patients with hypertension using food as medicine and lifestyle medicine, many people are able to achieve normal blood pressure levels without the use of any medications. Beyond the basic recommendations such as quitting smoking and avoiding a sedentary lifestyle, perhaps the most important part of the treatment is choosing the right food plan. This does not simply mean eating less sodium.
Eating whole foods, rather than processed or refined foods, and eating plants, rather than animal-derived foods, are important ingredients in the recipe for achieving optimal control of blood pressure and maintaining blood-vessel health. In other words: Enjoy a whole-food, plant-predominant food plan. Simply eating plants is not the whole equation; for example, one can eat excessive amounts of plant-derived processed foods and be unhealthy.
Eliminating sugar and refined carbohydrates is a critical part of the plan, but often the most challenging. Having a well-balanced nutritional plan that includes a diverse spectrum of phytonutrients, macronutrients, vitamins, and minerals from whole, real foods is the foundation to kindle our body's own ability to heal itself, including achieving optimal blood pressures. Stress management and mindfulness practice are equally important in this regard.
High blood pressure often finds itself in the company of other chronic diseases, such as diabetes and high cholesterol levels, in the same person. The elegance, and the effectiveness, of a holistic medicine approach using food as medicine in the treatment of hypertension is that these co-morbid diseases are often concomitantly well treated or reversed as well.
Now the caveats: When done properly and comprehensively, using food as medicine and lifestyle medicine can be very powerful in treating or reversing hypertension. However, if you are already taking blood pressure-lowering medications, your blood pressure must be carefully monitored frequently as you change your diet and lifestyle, under the supervision of your primary care physician. As your body starts to heal itself and your blood pressure normalizes naturally through your dietary and lifestyle changes, the additional effects from antihypertensive medications may further lower your blood pressure. If your blood pressure is lowered excessively, you may have symptoms such as lightheadedness, fatigue, sleepiness, nausea, and clammy skin. Follow up with your physician more frequently during this period of time in order to ensure that your medication dosages are properly adjusted or tapered off based on your blood pressure levels.
In addition, while achieving optimal blood pressure levels can lower the risks for adverse long-term clinical outcomes mentioned above, how that optimal blood pressure is achieved can potentially matter. For example, in a randomized trial of almost 3,000 people with type 2 diabetes, those who received intensive blood pressure control through medications, compared with those who received less intensive blood pressure control, had a greater shrinkage in their brain volume after 40 months (1). So in this trial, more intensive blood pressure lowering was associated with a worse outcome. However, this does not mean that hypertension should be better left untreated. Rather, it just means that when it comes to blood pressure control, lowering the blood pressure too aggressively and excessively as a result of medications, rather than using natural means such as dietary and lifestyle changes, may not lead to the intended health benefits. Each person is different, and each case is different. Always consult your physician in the management of hypertension.
Finally, when you decide to make fundamental and health-promoting changes to your diet--bravo on taking the first step!--it is important to do so with proper guidance, such as from a nutritionist or a clinician well versed in using food as medicine, so that adequacy and balance in macronutrients and micronutrients (such as vitamin B12) can be maintained.
In summary, for long-term health, it is important to treat hypertension and maintain optimal blood pressure levels. While blood pressure-lowering medications can have a role, integrative and functional medicine (holistic medicine) emphasizes finding the root causes of hypertension and addressing them. These root causes are often related to dietary and lifestyle choices and environmental factors. When implemented properly, fundamentally, and comprehensively, using food as medicine and making lifestyle changes can often result in remarkable, optimal control of blood pressures without having to resort to long-term use of medications.
1. Williamson, J.D., et al., Cognitive function and brain structure in persons with type 2 diabetes mellitus after intensive lowering of blood pressure and lipid levels: a randomized clinical trial. JAMA Intern Med, 2014. 174(3): p. 324-33.