Could it ever be appropriate for a physician to prescribe slightly higher-than-routine dosing of a well-tolerated blood pressure medication, when other types of BP meds are not tolerated or would be problematical because of interactions with all the other drugs one might be on? I would assume fall risk should be evaluated in conjunction with such a consideration, and that it also might depend on how the particular tolerated BP med actually works in the body.
Dear Dr. Kernisan, you don’t know how thrilled I am to hear back from you!! There seems to be so little kindness these days that I so appreciate your caring response. I have had little success finding information about malignant hypertension. You mentioned following up was a lot of work, but it has been so consuming for me due to my fear, but also trying for a decent quality of life with as few side effects as possible, that my daughter says I need to find something else to do. (I have no other family left)…Besides a very stressful job, and caregiving for my mother who lived to be 97, I have always done volunteer work, so am really ready to get back to being productive…As far as my malignant spikes, I have asked every doctor and no one has an answer as to why it suddenly developed. That is one reason it is so scary. The nephrologist says he guesses it was from years of chronic stress. All the tests (kidney and carotid artery) were negative. I do a ton of research and am so glad to have found your site!! I found you through a link in a Washington Post article by Janice Neumann on August 17 “New Blood Pressure Guidelines Can Cause Problems for the Elderly”… I did not find a way to contact her. I have had no luck finding similar patients but need to learn social media skills. Thank you again so much!!!! I will be a faithful follower from now on!!! Best Regards, Kathy
Developed thousands of years ago in India, Ayurveda is the sister philosophy of yoga, the medication form of it. The therapies and treatments work after the identification of an individual’s Dosha- Vata, Pitta, and Kapha. Dosha imbalance is the foremost reason for any health issues and hypertension is the result of the imbalance of the two doshas- Vata and Pitta.
Your mother’s situation does sound worrisome, as you are describing falls and also some concerns with thinking. Her age of 96 is pretty old, so clinical research studies don’t provide much guidance on what is optimal blood pressure. Unless she has compelling medical reasons to aim for a SBP of 120, most geriatricians would probably reduce her BP meds and try to aim for a SBP in the 130s or 140s. So you may want to ask your mother’s doctor to discuss with you what is a suitable BP goal for her, and whether a reduction in BP meds might be reasonable.
One drink counts as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of spirits. "High levels of alcohol are clearly detrimental," says Obarzanek. "But moderate alcohol is protective of the heart. If you are going to drink, drink moderately." (And if you're trying to keep your weight in check, stick to these low-calorie alcoholic drinks recommended by registered dietitians.)
CoQ10 is a naturally occurring enzyme. It contains antioxidants that are good for maintaining cardiac health. CoQ10 has been shown to decrease blood pressure and reduces the thickening of the heart muscle (hypertrophy). There are no known side effects of CoQ10 since it naturally occurs in the body. According to the Mayo Clinic, for the treatment of hypertension, take 60-360 milligrams daily for 8-12 weeks.

I totally agree with you that we should not rely on medication for high blood pressure. End of the day, high blood pressure is a symptom that our body requires immediate attention. The kidneys work extremely hard to send out the “signal” to us and what we did is to pop a high blood pressure pill to suppress the signal. With this medication, our body has to work even harder to send us another signal. No wonder over the long run people who are suffering from high blood pressure needs an additional pill for deteriorating kidneys. Our body is fully capable of healing itself without us realizing it. I strongly encourage high blood pressure sufferers to listen to this and say goodbye to high blood pressure once and for all:


Our bodies react to tension by releasing stress hormones like cortisol and adrenaline into the blood. These hormones can raise your heart rate and constrict blood vessels, causing your blood pressure to spike. But slow breathing and meditative practices such as qigong, yoga, and tai chi can help keep stress hormones—and your blood pressure—in check, Williams says. (And if you haven't heard, health benefits of meditation include reduced inflammation, natural pain relief, and more.) Start with five minutes in the morning and five minutes at night and build up from there. The breathing exercise above is designed to help you fall asleep fast.
As the body increases production of an enzyme called angiotensin I-converting enzyme, or “ACE”, blood pressure increases. Pharmaceutical drugs called ACE inhibitors work by blocking the formation of this enzyme, but they have multiple side effects. Garlic contains gamma-glutamylcysteine, a natural ACE inhibitor.  This chemical, in combination with the high allicin content, gives garlic its ability to dilate arteries, thereby lowering blood pressure. I usually take one clove of garlic and remove the skin, chew well and swallow. Yes nobody wants to be around me after. You can also buy in pill form.
Common painkillers (so-called non-steroidal anti-inflammatory drugs, NSAID), can increase your blood pressure by inhibiting the production of salt in your kidneys. This includes over-the-counter pills such as Ipren, Ibumetin, Ibuprofen, Diklofenak and Naproxen as well as the prescription drug Celebra. Painkillers with the active substance paracetamol are better for your blood pressure.
If you suddenly find yourself with high blood pressure (hypertension) under the new guidelines from the American Heart Association and the American College of Cardiology, you might be wondering what to do. The guidelines, which were released in November, lowered the definition for high blood pressure to 130/80 from 140/90 millimeters of mercury (mm Hg), meaning more women now meet the criteria for stage 1 hypertension.
Sipping on not one but four cups of tea daily can help control blood pressure. A study presented at the European Society of Hyper tension in Milan found those who avoided coffee and tea consumption all together had the highest rates of blood pressure, pulse pressure, and heart rate. Those who drank tea the most often, between one to four cups a day, had the lowest systolic and diastolic blood pressure readings, as well as the lowest pulse pressure and heart rate. Pinkies up, for your blood pressure’s sake.
If you have hypertension, ask your doctor if OSA could be behind it. (In addition to loud snoring, common symptoms include excessive daytime tiredness and early morning headaches.) Getting your sleep apnea under control could be helpful for improving your blood pressure, says Robert Greenfield, MD, Medical Director of Non-Invasive Cardiology & Cardiac Rehabilitation at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA.

Today's episode of the OPP we feature guest Joe Scola, who is the founder of Wise Ape Tea. They specialize in Adaptogenic teas, which regulate stress for your body. We get into some HEAVY Tea Topics like the weirdest blend of tea, the historic origins of tea, and discuss how adding in CBDs affects tea. Wise Ape also partners with many organizations, and for each tea sale they donate a chunk of the proceeds to these organizations which is awesome! Each tea is partnered with a specific charitable organization so go out there, buy your favorite tea, and contribute to a great cause! Two birds with one stone!

Taking a few moments to concentrate on breathing deeply can be a great help. Meditation and yoga are other great activities to reduce stress. We recommend Yoga Burn, by Zoe Bray Cotton for an amazing at-home yoga workout.  In the long term, creating a routine that including one or more of these stress reduction techniques will be important to keep your blood pressure down in normal levels. [2]

Fish are a great source of lean protein. Fatty fish like mackerel and salmon are high in omega-3 fatty acids, which can lower blood pressure, reduce inflammation, and lower triglycerides. In addition to these fish sources, trout contains vitamin D. Foods rarely contain vitamin D, and this hormone-like vitamin has properties that can lower blood pressure.
Note: The fasting and high blood pressure study described in this article was funded in part by a grant from the National Health Association. It was conducted at the Center for Conservative Therapy in Penngrove, California. The results appeared in the article, “Medically Supervised Water-Only Fasting in the Treatment of Hypertension,” published in June 2001 in the Journal of Manipulative and Physiological Therapeutics.
People who cooked with a blend of the two oils (available at health food stores) saw a drop in blood pressure almost comparable with the decrease that results from taking medication, according to research from the American Heart Association’s Scientific Sessions. Researchers believe the effect is due to the oils’ fatty acids and antioxidants such as sesamin, sesamol, sesamolin, and oryzanol.
Lowering your blood pressure requires more than just cutting back on sodium, Prevention.com reports. You also need to eat foods high in at least two of these three minerals: calcium, magnesium, and potassium. With white beans, you get the jackpot for all three. Just one cup contains 13 percent of the calcium, 30 percent of the magnesium, and 24 percent of the potassium needed for your daily recommended servings. Here are 7 things your doctor isn’t telling you about your blood pressure.
Common painkillers (so-called non-steroidal anti-inflammatory drugs, NSAID), can increase your blood pressure by inhibiting the production of salt in your kidneys. This includes over-the-counter pills such as Ipren, Ibumetin, Ibuprofen, Diklofenak and Naproxen as well as the prescription drug Celebra. Painkillers with the active substance paracetamol are better for your blood pressure.
The calculated difference between the systolic and diastolic pressures is also of interest. If the difference is large (e.g. 170/85), it could be the sign of stiff arteries – often caused by heart disease. This means the blood vessels can’t dilate enough when the heart sends out a pulse, which forces the blood pressure to increase. (The walls can’t expand, so the pressure rises when the heart tries to pump the blood through.)
Did you know high blood pressure affects nearly half of all Americans? When left untreated, it can cause serious problems. High blood pressure (or hypertension) makes the heart work too hard to pump blood around your body. That can increase your risk of other health problems such as heart failure, heart attack or stroke. It can also cause kidney failure and vision issues.

i am currently 63 years old and was on a higher daily dose of zestoretic from about 1992-2010 for 140/90 BP and slowly reduced my need (lower mg) for zestoretic by paying more attention to my health (diet, weight, exercise, etc), eventually (about 2014) i got down to 10mg of lisinopril (no more hctz) about once per week or as needed since i was monitoring BP at home. in late 2016, a new doctor recommended that i stop taking 10mg lisinopril, and my blood pressure was usually low about 100/60 after breakfast or exercise and would go up to about 130/90 in the evening. in 2017, my BP was 150/90 the morning before hernia surgery. anyway, long story short my BP seems to fluctuate a lot during the day, low (100/60) after exercise, low after breakfast, high (130/90) before going to bed. the low BP periods get shorter and shorter so i went back to taking 10mg lisinopril as needed, about once every 2 or 3 weeks and the low BP periods get long again. also my pulse seems to get higher (80) when my BP gets lower 100/60 and my pulse gets lower (70) when my BP gets higher (130/90). anyway, i recently moved so probably need to see another new doctor, but thought i would just let you know what is going on.

Having a bad day can impair our judgment and lead to most of us making not-so-wise lifestyle choices like binge eating, smoking, or drinking. These unhealthy habits done in excess can negatively affect our health, especially our blood pressure. As one in four Americans continue to suffer from the epidemic of high blood pressure, it is imperative for us to effectively avoid and reduce this highly preventable disease associated with heart attack and stroke, aneurysms, cognitive decline, and kidney failure. Fortunately, there are ways to bring down blood pressure without the use of medication.
The causes are most often some combination of clogged “pipes” and excessive salt in the diet. Lifestyle changes, such as appropriate diet and exercise, are among the most effective treatment strategies for high blood pressure. Relaxation, meditation, and otherwise “taking it easy” are not effective solutions, as valuable as such strategies may be for your psychological well-being.
And I am 67 and am on HCTZ25mg (I retain a lot of water) and Losartan 75mg which causes leg cramps but I think I am experiencing angina – not always; it goes away after the initial pain – now I’m worried – yes I could lose weight but do not smoke(17yrs ago) or drink(used to then stopped now for a number of years). What’s are next move. Iam adopted so I can’t look to my Mom for any genetics…Thank you, Laurie

Also focus on eating nitrate and nitrite-rich vegetables (not to be confused with the other types of nitrates and nitrites that are found in processed meats) . Nitrates and nitrates from vegetables help to relax and dilate blood vessels throughout your body and increase blood flow. Although it’s a short-term effect, eating more nitrate-rich vegetables like beets, cabbage, leafy greens, and vegetable juices, can reduce blood pressure for a few hours. Recent studies have also shown that those who drank beetroot juice showed an immediate effect on lowering blood pressure. By eating plant-based foods consistently, you’ll see their regular benefits.

Developed thousands of years ago in India, Ayurveda is the sister philosophy of yoga, the medication form of it. The therapies and treatments work after the identification of an individual’s Dosha- Vata, Pitta, and Kapha. Dosha imbalance is the foremost reason for any health issues and hypertension is the result of the imbalance of the two doshas- Vata and Pitta.

Scientists have long debated the effects of caffeine on blood pressure. But an analysis of 34 studies seems to have delivered a verdict. On average, consuming 200 to 300 mg caffeine (the amount found in one or two cups of coffee) raises systolic blood pressure by 8 mmHg and diastolic blood pressure by 6 mmHg. And the effects can last for up to three hours. (For reference, 8 ounces of drip coffee contain 100-125 mg of caffeine; the same amount of tea, 50 mg; an equal quantity of cola, about 40 mg.)


Eating nutritious foods that are packed full of vitamins and antioxidants is a great way of lowering your blood pressure and keeping it down for good. Raw vegetables and fresh fruits are vital to a healthy diet and play a key part in controlling your blood pressure. Spinach, tomatoes and garlic are all good choices for keeping blood pressure down. [1]
7. Cut down on sodium intake: Processed and packaged food needs to go out of your kitchen, if you want healthy levels of blood pressure. This is because processed food is loaded with added preservatives to increase their shelf life. Also, prepare your food with lesser salt as high intake of salt is linked to risks of high blood pressure and stroke.
Omega-3 fatty acids, such as those found in fish oil supplements, offer a wide variety of health benefits, including the ability to reduce blood pressure by reducing LDL (or “bad”) cholesterol. It is possible to consume enough Omega-3 fatty acids simply by adding more fatty fish to your diet, but it’s much easier to take it in supplement form. The best forms of Omega-3 oil are krill and calamari oils.
According to the American College of Cardiology and the American Heart Association, the goal of blood pressure treatment is to attain a blood pressure reading that's less than 130/80 mmHg systolic and less than 80mmHg diastolic. In general, if you have hypertension, it is likely that you will need to be treated for the duration of your life to maintain this target blood pressure. 
3. Implement strategies to lower inflammation. Several cross-sectional and longitudinal studies connect high blood pressure with chronic inflammation, a driving force for nearly every disease on the planet. Lowering inflammation starts with what you put on your fork. Focus on anti-inflammatory foods like wild-caught seafood (rich in omega-3 fatty acids), freshly ground flax and chia seeds, spices like turmeric, and plenty of colorful plant foods. Good sleep, stress management, exercise, and the right nutrients can also help lower inflammation.

Consider once again the analogy of the garden hose. If you turn on the water “harder,” there is more pressure in the hose. Excessive salt in the diet can result in excessive fluid volume in the blood, which results in elevated blood pressure. This cause, too, is reversible, as a plant-based diet of whole, natural foods, devoid of added salt, is naturally low in sodium chloride.


Blood pressure is written as two numbers, such as 112/78 mm Hg. The top, systolic, number is the pressure when the heart beats. The bottom, diastolic, number is the pressure when the heart rests between beats. Normal blood pressure is below 120/80 mm Hg. If you’re an adult and your systolic pressure is 120 to 139, or your diastolic pressure is 80 to 89 (or both), you have pre-hypertension. High blood pressure is a pressure of 140 systolic or higher and/or 90 diastolic or higher that stays high over time.
2) Cayenne pepper. Arguably one of the fastest foods to lower blood pressure, cayenne pepper is a powerful vasodilator, which means it helps expand blood vessels and improve blood flow. This effect naturally lowers blood pressure levels by increasing the rate at which blood flows throughout the circulatory system, which in turn takes some of the pressure off arterial walls.
While making these changes may not mean you can immediately go off your blood pressure medications or never have to take them, they will improve your overall health and reduce your risk for developing other diseases, including diabetes and possibly even cancer. Making healthy lifestyle changes can reduce your risk of stroke, heart attack or kidney damage, and reduce the likelihood that your dose of blood pressure medication will need to be increased in the future.

Well, it sounds like you started with one BP med in the angiotensin II receptor blocker (ARB) class, and then your doctor switched you to another drug in that same class. These drugs do affect potassium, which can affect muscle function but otherwise, I haven’t heard of them being particularly associated with joint pain, and I didn’t see much mention of this when I looked just now in my clinical reference (Uptodate.com).

Loading up on potassium-rich fruits and vegetables is an important part of any blood pressure-lowering program, says Linda Van Horn, PhD, RD, a professor of preventive medicine at Northwestern University Feinberg School of Medicine. Potassium encourages the kidneys to excrete more sodium through urination, and that sodium excretion can help lower blood pressure.
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Certain groups of people—the elderly, African Americans, and those with a family history of high blood pressure—are more likely than others to have blood pressure that's particularly salt-sensitive. But because there's no way to tell whether any one individual is at risk, everyone should consume less sodium, says Eva Obarzanek, PhD, a research nutritionist at the National Heart, Lung, and Blood Institute.
Kiwis are another fruit that positively impacts blood pressure. Some researchers studied how the fruit fares compared to apples. They found that eating three kiwis a day over eight weeks reduced blood pressure in people with slightly high blood pressure more so than eating one apple per day during the same time. A daily serving of kiwi was also found to reduce blood pressure in people with only mildly elevated levels. Kiwis are also an excellent source of vitamin C which can also also improve blood pressure. 
Reduce the stress in your life. Long-term stress can lead to high blood pressure. There are small lifestyle changes you can make to both combat stress and to manage the effects of it in healthy ways. Exercise, eating a healthy diet, limiting alcohol and caffeine intake, practicing yoga, meditation, or deep breathing, meditating, praying, journaling, laughing, listening to music, spending time with family and friends, and playing with animals can all help reduce your stress and lower blood pressure. Learn about more tips for reducing stress.
The calculated difference between the systolic and diastolic pressures is also of interest. If the difference is large (e.g. 170/85), it could be the sign of stiff arteries – often caused by heart disease. This means the blood vessels can’t dilate enough when the heart sends out a pulse, which forces the blood pressure to increase. (The walls can’t expand, so the pressure rises when the heart tries to pump the blood through.)
Editor’s Note: Considerable controversy exists about whether fat or cholesterol are, per se, drivers of atherosclerosis. They are implicated in some studies, while others indicate that quality of fat, and placement in a wider dietary pattern, may be more significant to ultimate impact. What seems clear, however, is that a diet high in animal products, sugar, and processed foods is often a recipe for high blood pressure and heart disease.

If you’re feeling overwhelmed about how to make changes to your diet or if you’re trying to lose weight, you may want to consider working with a registered dietitian-nutritionist (RDN). Some people work with an RDN if they have a health condition like type 2 diabetes. In fact, high blood pressure is a risk factor for type 2 diabetes. This is partly because they share similar modifiable risk factors, like being overweight or obese, following an unhealthy diet, and having a lack of physical activity.
The heartening news is that most people can effectively control their blood pressure without the need for medications by following a healthy lifestyle like the Pritikin Program.  “Those who still need medications usually require a lower dose and/or fewer drugs, thereby reducing their risk of suffering adverse side effects from the medications,” states Dr. Fruge.
It goes without saying that when you don’t sleep well, you don’t feel well, and your body just doesn’t work well. In fact, research has shown for decades that a strong link between insomnia and hypertension exists. Reevaluating your daytime decisions or nighttime routines leading up to bedtime can help you find what works best for you in getting a good night’s rest.
In addition to these methods being effective, other lifestyle changes and diet adjustments may also be useful in lower blood pressure. One study explains that losing weight can have a significant positive impact on patients that have been diagnosed with hypertension. Even small reductions in bodyweight amongst those individuals who are both obese and hypertensive can yield life-saving benefits. Dietary changes can also help. In particular, the patient should aim to lower their daily intake of sodium, which causes an elevation in blood pressure. The patient should also focus on obtaining more calcium, potassium and other minerals that are useful in balancing blood pressure levels. Fiber, fruits and a lot of vegetables should also be an essential part of the patient’s daily diet.
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