In this article I’ll simply compare the research on the effectiveness of blood pressure medications called ACE-inhibitors, to natural substances, in terms of efficacy. Then I’ll lay out a three-supplement protocol for lowering blood pressure, with specific products that are well-formulated, based on the existing research.
The only abbreviations we have to remember is that SBP stands for systolic blood pressure, which is basically the ‘top’ number in one’s blood pressure, and DBP, which is diastolic blood pressure, or the ‘bottom’ number. The units of measurement for blood pressure are “mm Hg” and we’ll see sometimes they are excluded (but implied).
First, ACE-Inhibitors. According to a Cochraine Review on ACE inhibitors, the average affect is a an 8 point reduction in SBP and a 5 point reduction of DBP, after about 6 weeks of treatment.
Here’s exactly what The Cochrane Review had to say:
We found 92 trials that randomly assigned participants to take either an ACE inhibitor or an inert substance (placebo). These trials evaluated the blood pressure lowering ability of 14 different ACE inhibitors in 12 954 participants. The trials followed participants for approximately 6 weeks (though people are typically expected to take anti-hypertension drugs for the rest of their lives). The blood pressure lowering effect was modest. There was an 8-point reduction in the upper number that signifies the systolic pressure and a 5-point reduction in the lower number that signifies the diastolic pressure. Most of the blood pressure lowering effect (about 70%) can be achieved with the lowest recommended dose of the drugs. No ACE inhibitor drug appears to be any better or worse than others in terms of blood pressure lowering ability.
Most of the trials in this review were funded by companies that make ACE inhibitors and serious adverse effects were not reported by the authors of many of these trials. This could mean that the drug companies are withholding unfavorable findings related to their drugs. Due to incomplete reporting of the number of participants who dropped out of the trials due to adverse drug reactions, as well as the short duration of these trials, this review could not provide a good estimate of the harms associated with this class of drugs. Prescribing the least expensive ACE inhibitor in lower doses will lead to substantial cost savings, and possibly a reduction in dose-related adverse events.
So, the benchmark here is a reduction of 8 points SBP and 5 points DBP, and keep in mind that after reviewing this evidence, Cochrane is recommending for most people, a smaller dose of ACE-inhibitors, which leads to a reduction of 5.6 mm Hg in SBP and 3.5 mm Hg in DBP.
ACE inhibitors work by interfering with your body’s natural ability and desire to create a hormone called angiotensin II. Among other things, Angiotensin II is used by the body to increase Aldosterone production – which is a hormone that is essential for maintaining the proper balance of sodium and potassium in the blood. One might wonder if the body is malfunctioning by producing too much angiotensin II, as if 2 billion years of evolution wasn’t long enough to get things right, or if perhaps the balance of sodium & potassium in the diet should be considered. A pharmaceutical solution to the problem of high blood pressure assumes the former.
The natural substances we’re going to look at don’t work by interfering with the body, they work by supporting the body and what it’s trying to do. Side effects of the substances I’ve listed below may include, but not be limited to: lowering inflammation, improving blood sugar control, balancing cholesterol, improving athletic performance, and preventing DNA damage.
#1 Sesame Lignans
One substance with similar benefits in terms of the magnitude of effect on blood pressure compared to ACE inhibitors, is Sesame Lignans. These are components of sesame seeds, and can be found in supplement form. I’m not sure how many sesame seeds you’d have to eat to get a clinically relevant dose, but it’s probably realistic if you really went for it.
This blood pressure lowering effect was confirmed by a 2017 meta-analysis out of Australia called “Can sesame consumption improve blood pressure? A systematic review and meta-analysis of controlled trials” – they looked at 8 studies with a total of 843 particpants and found a 7.83 mm Hg drop in SBP and a 5.83 mm Hg drop in DBP. The average study duration was 6 weeks, so effects were seen pretty quickly. Dosing was reasonable, though some studies used sesame oil, which I would argue has some negative trade-offs, and therefore I think a supplement here with just the sesame lignan extracts would be best – or eating tons of whole, raw, sesame seeds. The meta-analysis did note that some of the trials were not double-blinded. That said, the results of these studies seem to put Sesame Lignans on-par with ACE inhibitors. There’s a brand of fish oil that contains a decent dose of sesame lignans, along with Olive Leaf extract.
#2 Olive Leaf Extract
Olive leaf extract has also been found quite effective for blood pressure. There was 2011 study with the ridiculous title: “Olive leaf extract, at the dosage regimen of 500 mg twice daily, was similarly effective in lowering systolic and diastolic blood pressures in subjects with stage-1 hypertension as Captopril, given at its effective dose of 12.5-25 mg twice.”
After 8 weeks of treatment both the group taking the olive leaf and the group taking the drug experienced a significant reduction of SBP as well as DBP from baseline; while such reductions were not significantly different between groups – in other words, the results of the Olive Leaf were statistically on-par with the drug. Average SBP reduction from baseline to the end of study were -11.5 and -13.7 mm Hg in Olive and Captopril groups, respectively; and those of DBP were -4.8 and -6.4 mm Hg, respectively. A significant reduction of triglyceride level was observed in Olive group, but not in Captopril group. Note that these numbers seem superior to even higher dose ACE-inhibitors, according to The Cochrane Review.
While the drug seemed slightly more effective with regards to blood pressure, a reduction in triglycerides produced by olive leaf extract is significant in my mind, as this may indicate it’s helpful with blood sugar control as well, and frankly there is some data showing that triglyceride levels are a better predictor of heart health than cholesterol levels, so improving them is important. Patients on the olive leaf extract also saw a statistically significant drop in LDL cholesterol after 8 weeks, while those on the drug Captopril saw a slight increase in LDL. So, at least according to this study, there’s quite a few cardio benefits to be gained from Olive Leaf Extract.
Let’s look at another study. In 2016 a double blind crossover trial was published in the European Journal of Nutrition. These crossover trials are very good because they eliminate individual variability, and are considered the gold standard – better than a simple double-blind placebo controlled trial. This 2016 trial involved 60 pre-hypertensive males consuming olive leaf extract, or placebo, for 6 weeks, before doing a 4-week washout and then another 6-weeks with whatever treatment they were not receiving previously (ie, people taking placebo switched to olive leaf, people taking olive leaf switched to placebo; all blinded).
When analyzing the data, researchers found statistically significant benefits of olive leaf extract over 6 weeks lowering SBP by 3.95 mmHg and DBP by 3.00 mm Hg, while placebo controls experienced no such benefit. Total cholesterol, LDL cholesterol and Triglycerides were also all significantly lower after 6 weeks of olive leaf extract, again with placebo seeing no such benefit. Remember, these were not patients with clinical high blood pressure, they had borderline high blood pressure, so I wouldn’t expect to see the same magnitude of effect as we saw in some of the previous trials. It’s just more confirmation that Olive Leaf extract actually works.
And apparently I am not the only one aware of this research. The brand Life Extension has put together an Omega-3 supplement that has both Sesame Lignans and Olive Leaf Extract. They haven’t disclosed as much, but it would seem this product is designed for treating hypertension. My recommendation would be four capsules per day, to get hopefully clinically significant doses of these substances. They call their product “super omega-3” and it can be found here.
I have no association with Life Extension, though I confess I do often buy their products, in particular I like their two-per day multivitamin. Although there are not studies showing Omega-3s or fish oil has a positive effect specifically on hypertension, there was a 2010 study showing that “Omega-3 fatty acid consumption is inversely associated with incidence of hypertension” – in other words, people who consumer less Omega-3 are prone to hypertension, while those who consume more Omega-3 have statistically less hypertension. Even though we don’t have direct supplementation trials showing fish oil affects blood pressure, the evidence that fish oil is generally helpful for systemic inflammation and cardiovascular disease is robust in my opinion.
#3 Pomegranate
This will be short and sweet. If you want to read more about the benefits of pomegranate on the cardiovascular system, check out my post on the subject here. It’s a very impressive little fruit, with well-known and well-studied benefits for cardiovascular health.
With all the studies on pomegranate for cardiovascular health, a group in 2016 published a meta-analysis to summarize all the data. They found pomegranate elicited a 5 mm Hg drop in SBP, and a 2mm Hg drop in DBP, so closer to the low-dose of ACE-inhibitor recommended by Cochrane. This was consuming about 250 ml per day for about 12 weeks.
#4 Vitamin D
You may know by know that I’m in love with Vitamin D. This won’t come close to the other two in terms of treating hypertension, but it’s important to keep your levels high when dealing with high blood pressure. There are meta-analysis involving Vitamin D showing that:
- Vitamin D levels are inversely associated with blood pressure (ie, higher your vitamin D status the lower your blood pressure tends to be)
- Vitamin D supplementation lowers Systolic Blood Pressure (but not DBP)
- Spending time outdoors lowers blood pressure
Causes of High Blood Pressure
There are various meta-analysis on the causes of high blood pressure, and there’s no real question; they mostly point to one cause of high blood pressure and that cause is high blood sugar.
For example:
- Sugar-sweetened beverages were associated with a modest risk of developing hypertension in 6 cohorts. from 2015
- The present meta-analysis suggested that a higher consumption of Sugar Sweetened Beverages was associated with a higher risk of hypertension and Coronary Heart Disease. from 2015
- Children and adolescents with high intakes of carbonated beverages could be at increased risk of MetS, abdominal obesity, and hypertension. from 2014
- Higher sugar-sweetened beverage consumption is associated with higher serum uric acid levels and systolic blood pressure in US adolescents. from 2009
- Sugar-sweetened beverages intake is associated with blood pressure and sympathetic nervous system activation in children. from 2018
- These results support previous findings indicating a significant positive association between sugar-sweetened beverage consumption and hypertension. from 2019
- Guidelines should focus more on reducing sugar rather than salt for the prevention and treatment of hypertension and its consequences. from 2016
- This systematic review shows that the consumption of sugar-sweetened beverages is associated with higher blood pressure. from 2014
- Fructose has been strongly linked with hypertension, hyperuricemia and inflammation in experimental models and humans. from 2011
- High doses of fructose raise the BP and cause the features of metabolic syndrome. from 2010
- Higher sugar-sweetened beverage consumption is associated with higher serum uric acid levels and systolic blood pressure in US adolescents. from 2009
I’ll do a full post on what raises blood sugar in the future, but let’s just say that in addition to the obvious one, grains and dairy are big culprits. Infographic courtesy of Dr Jockers. He knows what’s up.
Supplements:
Not too complicated here. Start with these three supplements and track your blood pressure. After 12 weeks, everything else being equal, you should see some good improvements.
Life Extension Super Omega-3’s – 4 per day
Nature’s Way Standardized Pomegranate – 2 per day
Now Foods liquid D3 & MK-7 – 1000 IU Vitamin D / day / 25 lbs body weight
Pomegranate juice is a good alternative to the pills, but considering the sugar in it, I’d consider it a treat or dessert – take some indulgence out of your diet to make room for the juice!
There are also lots of lifestyle changes that can really help with blood pressure. Exercise, yoga, meditation are all excellent, but I think to treat the root cause you’ll need to be making conscious eating choices. My article on cholesterol talks about the importance of avoiding the industrial seed oils that are in virtually everything, and choosing foods that don’t spike blood sugar will also have a big impact.
