​High blood pressure is the most important risk factor in predicting heart disease. The reason is simple—blood pressure is not merely a risk factor; it is also a direct marker of blood vessel function and the health of your whole cardiovascular system.

Blood pressure is typically recorded as two numbers, written as a ratio like this: 118/78. The higher top number is the systolic blood pressure, measuring the pressure in the arteries when the heart beats (when the heart muscle contracts). The lower bottom number is the diastolic blood pressure, measuring the pressure in the arteries between heartbeats (when the heart muscle is resting between beats and refilling with blood). Your blood pressure rises with each heartbeat and falls when your heart relaxes between beats.

While BP can change from minute to minute with changes in position, exercise, stress or sleep, it should normally be less than 120/80 mm Hg (less than 120 systolic AND less than 80 diastolic) for an adult age 20 or over.

Blood pressure over 120/80 is elevated. And if you have elevated blood pressure that means that your arteries are sick and that you are likely growing arterial plaque and decreasing blood flow.

What Are Elevated Blood Pressure and Hypertension?
Blood pressure of more than 120/80 is called elevated blood pressure, which is abnormal and puts you at elevated risk for heart attacks, strokes, and sudden death.

Generally speaking, if the systolic number is high that is a sign that your arteries are stiff and your blood pressure jumps with each beat. If the diastolic number is high, that suggests that the heart is stiff and your blood pressure doesn’t drop normally.

Hypertension occurs once your blood pressure is greater than 140/90 mm Hg, and this leads to a strong likelihood of advanced arterial thickening. If the 140/90 level persists during the course of a few doctor’s consultations, the standard treatment is to start a blood pressure medication.

And despite that medications can lower blood pressure and help to decrease your future risk for a heart attack or stroke, they can have numerous side effects, including:

• Dizziness
• Depression
• Decreased energy
• Erectile dysfunction
• Wheezing
• Decreased exercise performance
• Decreased libido
• And a variety of more serious side effects as well.

My goal is to help you have normal blood pressure, without needing medication. I don’t think of blood pressure medications as being bad per se, and for some people they may be essential, but they often have many unpleasant side effects, and my hope is that you won’t need them if you follow the six easy-to-follow steps noted below. If you are taking medications to lower your blood pressure, please do not stop them on your own without talking to your own medical provider.

What Causes Hypertension?
There are four lifestyle choices that can cause hypertension.

• First, if you are inactive or not aerobically fit, your arterial walls will become weak and stiff because you are not exercising them enough.
• Second, if your diet does not include a daily portion of leafy green vegetables, you will lack vitamin K. Without it, your arteries will also become calcified and stiff.
• Third, if you don’t eat enough vegetables, fruits, beans, and nuts, you will not get sufficient potassium or magnesium—minerals that are essential for your blood vessels to dilate and keep blood pressure normal.
• Fourth, prolonged, unmanaged stress can also increase your blood pressure. The key is proactively taking daily steps to help manage your stress.
• All of these lifestyle factors contribute to your risk for cardiovascular disease.

Salt consumption is another dietary lifestyle risk factor that can create a spike in blood pressure. However, genetic testing shows that this doesn’t hold true for everyone. One-third of us experience a big jump in blood pressure with high salt intake, another third of us have a fairly mild increase, and in the remaining third, there is hardly any relationship between salt intake and blood pressure. However, salt intake plays a critical role for people with heart failure, which is partly why salt intake receives so much attention.

After decades of coaching patients, most of my patients taking hypertension drugs have been able to stop them and maintain a normal blood pressure, but keep in mind that this requires long-term changes in diet, activity, nutrient intake, and proactive stress management. There is no magic bullet apart from comprehensive lifestyle changes. And if you are taking these medications currently, I always insist that you work with your medical provider before you make lifestyle changes to avoid overtreating your blood pressure and having low blood pressure that can result in dizziness, dangerous loss of consciousness, and falls.

Six Steps to Improve Blood Pressure Control without Taking Medications
Below are six steps that are as effective as adding a medication, without those side effects, and they are pretty easy to implement, too:

Step 1: Eat five cups of vegetables and fruits and two ounces of nuts daily
Vegetables, fruits, and nuts provide nutrients such as potassium, magnesium, vitamin K, vitamin C, flavonoids, and an array of other compounds that make your arteries dilate.  Everyone should eat at least five cups (which is ten servings) of produce plus two ounces (two handfuls) of nuts every day, and the more colorful the produce the better. Ideally include one cup of cooked greens with your vegetable intake every day as green leafy vegetables are loaded with vitamin K, fiber, and folate which are essential for good heart health. It is amazing that doing something so simple is as effective as taking a drug.

Step 2: Exercise for 30 minutes daily
No doubt about it, exercise is great for blood pressure control. Dance, walk, bicycle, or go to the gym and find something that makes you sweat. Any activity that raises your heart rate will improve your blood vessel function and will improve your blood pressure control. If you have risk factors for heart disease, always talk to your medical provider before changing your activity level.

Step 3: Lose 10 pounds
I won’t say weight loss is easy, but it is super effective at lowering blood pressure (BP). For people who are overweight (which is two-thirds of Americans) losing just 10 pounds and keeping it off is as effective in controlling BP as taking a BP drug.

Step 4: Spend 10 minutes meditating daily
Daily meditation truly helps blood pressure control. If you are not good at meditating, then try using an app like, which gives you feedback and makes meditating easier. Studies show that for many people adding meditation or using HeartMath for just 10 minutes per day is as effective as using blood pressure medication.

Step 5: Specific probiotic supplement species have been shown to improve blood pressure control.
Recent studies have shown that having the right probiotic species in your gut will improve blood pressure control, and taking the right probiotic species is similarly effective to taking a blood pressure medication. Whether you get these probiotic species from food (such as yogurt or kefir) or get them from taking a capsule is up to you and both can be effective with the right species and the right dosages for the proper time.

The following species when used as a supplement have been shown to be effective at improving blood pressure control:

• Lactobacillus plantarum,
• Lactobacillus reuteri,
• Streptococcus thermophilus,
• Lactobacillus acidophillus

Studies have shown that several factors make using a probiotic supplement more successful:

1. Use species that are proven to work.
2. Combining 2 to 3 or more species is better than only taking a probiotic with 1 species.
3. Total dosage should be at least 10 billion microbes and up to 25 billion every day. Keep in mind that one cup of yogurt provides about 5 billion microbes and that a single probiotic capsule can provide 20-50 billion microbes daily.
4. Take a probiotic daily for at least 2-3 months. Treating for less time may not be adequate to modify the gut flora.

Step 6: Yes, limit salt intake, but more important is to limit your sugar!
For people with hypertension, decreasing salt intake from a typical American sodium intake of 3,800 mg per day to 2,500 mg per day lowers the top blood pressure reading (systolic) about 5 mm of Hg points, and the lower blood pressure reading (diastolic) 2.5. Yet for the average American with elevated blood pressure, the typical benefit from cutting your salt intake is only a 2 point reduction.

On the other hand, new research suggests that sugar has a bigger impact on blood pressure than salt. The challenge in making this distinction is that most processed foods are often loaded with both.

A study published in Open Heart by Drs.  DiNicolantonio and Lucan compare the effect of sugar and salt on blood pressure levels. (DiNicolantonio JJ, Lucan SC. Open Heart 2014;1:3000167)

Their findings show that:

• Eating more sugar increases systolic blood pressure 6.9 mm Hg points and diastolic blood pressure 5.6 mm Hg in the short term, and 7.6/6.1 mm Hg if followed for more than 8 weeks.
• Drinking a 24-ounce soft drink daily can increase blood pressure by 15 systolic and 9 diastolic points and raise heart rate by 9 beats per minute.
• People who consume 25% more calories from sugar (which is easy to do) have a 300% increase in death rate due to cardiovascular disease.
• A high-fructose (sugar) diet for just 2 weeks increases blood pressure 7 mm Hg systolic and 5 diastolic, but also raises pulse rate, triglycerides, fasting insulin and is associated with fatty liver.
• The good news is there is no harm noted from eating more fruit, so don’t fret over having an apple, a peach, or a cup of berries. Do avoid fruit juice and dried fruit.

For the best results, combine as many of these six steps together for the best results. These tools (with help from your medical provider) will help most people with elevated and high blood pressure to bring their blood pressure levels back to normal.

I wish you the best of health!

Steven Masley, MD, FAHA, FACN, CNS