Blood pressure medication, things to consider

There are a few types of blood pressure (antihypertensive) medication provided in the UK and globally which include diuretics, beta-blockers, ACE inhibitors, Angiotensin || receptor blockers, calcium channel blockers, alpha blockers alpha-2 receptor agonists and vasodilators. The use of blood pressure medication is rising. A primary care study found that the proportion of patients prescribed antihypertensive drugs rose from 7.8% in 1988 to 21.9% in 2018, indicating a nearly threefold increase over 30 years. This trend aligns with broader patterns in prescription practices; for instance, between 2004 and 2019, the annual number of prescription items dispensed in England and Wales increased by 58.7%, with cardiovascular medications — such as those for blood pressure —accounting for about 30% of all prescriptions.¹

There are a few factors that may have led to this increase, such as an ageing population and better detection of hypertension. We also need to factor in an increase in the guidelines of earlier detection and management.²

Although treating high blood pressure is essential for health, there are a few side effects that can accompany blood pressure medications which include; increased urination, electrolyte imbalances (low potassium, low sodium), dizziness or lightheadedness (especially when standing up), muscle cramps, increased blood sugar or cholesterol levels, dry cough, elevated blood potassium levels (hyperkalemia), rash or taste disturbances, swelling of the face, lips or tongue (angioedema), which is serious and needs urgent care, allergic reactions, swelling (edema) in ankles or feet, headache, flushing, constipation, fatigue or tiredness, cold hands and feet, slow heartbeat (bradycardia), sleep disturbances or vivid dreams, headache and palpitations. 

But what interventions do GPs recommend before the use of antihypertensive medications?

You might get a referral to a dietician or nutritionist if you are very lucky. More than 70% of doctors receive less than 2 hours of nutrition training, leaving them unqualified to give appropriate advice that is tailored to the individual.³

Here is the thing: high blood pressure can be largely caused by diet and lifestyle. That means in many cases, it can also be improved or even reversed, through simple, consistent changes like eating less salt, increasing potassium-rich foods like fruits and vegetables, exercising regularly, managing stress, reducing alcohol and quitting smoking. These interventions not only support healthy blood pressure but also improve overall heart health, often reducing the need for long-term medication.

Dietary interventions proven to reduce high blood pressure

DASH diet (Dietary Approaches to Stop Hypertension)

The DASH diet focuses on fruits, vegetables, whole grains, lean proteins and low-fat dairy, while limiting sodium, saturated fats and added sugars. Clinical trials have demonstrated that following the DASH diet can lead to substantial reductions in both systolic and diastolic blood pressure.⁴

Mediterranean diet

Rich in fruits, vegetables, whole grains, legumes, nuts, olive oil and fish, the Mediterranean diet has been associated with lower blood pressure and a reduced cardiovascular disease risk. Studies suggest that this diet may be particularly effective in populations accustomed to these dietary patterns.⁵

Potassium-rich foods

Increasing intake of potassium can help counteract the effects of sodium and relax blood vessel walls, thereby lowering blood pressure. Foods high in potassium include bananas, oranges, potatoes, spinach and beans.⁶

Nitrate-rich vegetables

Vegetables like beets and leafy greens are high in nitrates, which the body converts into nitric oxide — a compound that helps dilate blood vessels and improve blood flow. Consuming these vegetables has been linked to reductions in blood pressure.⁷

Green tea

Regular consumption of green tea, which is rich in catechins (a type of antioxidant), has been shown to modestly reduce systolic and diastolic blood pressure. Green tea can be a beneficial addition to a heart-healthy diet.⁸

Why prevention is better than cure

While medication can be life-saving, relying solely on prescriptions may create a false sense of security by treating the symptom rather than the root cause. Long-term reliance can also lead to polypharmacy, where people end up on multiple medications with multiple side effects. Prevention through lifestyle change is safer, cheaper and improves overall quality of life.

Best supplements for hypertension

Algae oil

Omega 3 contains both EPA and DHA. There is a higher ratio of DHA to EPA in algae oil vs fish oil, and because of the higher DHA content, is more favourable in lowering blood pressure and heart rate, as well as improving vascular function.⁹

Magnesium

Low magnesium status may play a pathophysiological role in the development of hypertension.¹⁰ Most of the population are deficient in magnesium, and simply dietary and lifestyle changes and magnesium supplementation can improve magnesium levels leading to improved cardiovascular outcomes. An article published in the BMJ concluded that: The evidence in the literature suggests that subclinical magnesium deficiency is rampant and one of the leading causes of chronic diseases including cardiovascular disease and early mortality around the globe and should be considered a public health crisis.¹¹

Homocysteine and B vitamins, what's the deal?

Homocysteine is an amino acid produced during the metabolism of methionine (an essential amino acid found in protein-rich foods). Under normal conditions, homocysteine is broken down with the help of vitamins B6, B12 and folate. Raised homocysteine is associated with; endothelial dysfunction (damage to the inner lining of blood vessels), increased oxidative stress and inflammation, greater risk of blood clots and stiffening of arteries. These changes can impair blood vessel function and increase vascular resistance—contributing to high blood pressure. In some cases, high homocysteine is due to a lack of these B vitamins in the diet. In other cases, its due to the inability of the body to use them effectively, requiring them to be taken in their active forms (methylfolate, methlycobalamin and pyridoxal-5-phosphate). And here's the thing,if you have high blood pressure as a result of high homocysteine levels, it's not just your cardiovascular health that will suffer. High homocysteine is responsible for a lot of life limiting conditions, so treating the cause is a necessity. 

CoenzymeQ10

Coenzyme Q10 (CoQ10) is a vitamin-like compound found in every cell of the body, particularly concentrated in the heart, liver and kidneys. It plays a role in energy production within mitochondria and acts as a powerful antioxidant. Several studies suggest that CoQ10 may help lower blood pressure, particularly in people with hypertension. CoQ10 helps support the production of nitric oxide, which relaxes blood vessels and improves vascular tone, leading to lower vascular resistance. Its antioxidant properties help reduce oxidative damage in blood vessels, which is often elevated in people with high blood pressure. Healthy mitochondria are essential for proper cardiac output and vascular health. CoQ10 may improve the heart's ability to pump efficiently. A meta-analysis of 12 clinical trials found that CoQ10 supplementation significantly reduced systolic blood pressure by up to 17 mm Hg and diastolic pressure by up to 10 mm Hg, without serious side effects.¹²

Vitamin D

Vitamin D helps regulate calcium, which affects vascular smooth muscle contraction, a key factor in blood pressure control. A large meta-analysis showed that low serum vitamin D levels were significantly linked to higher blood pressure and increased risk of hypertension.¹³

Turmeric 

Turmeric, especially its active compound curcumin, has shown promising effects in supporting healthy blood pressure levels, particularly when taken consistently in supplement form or as part of an anti-inflammatory diet. Curcumin may improve endothelial function by increasing nitric oxide (NO) availability, which helps blood vessels relax and widen, lowering blood pressure. A 2019 A systematic review and meta-analysis concluded that curcumin / turmeric supplementation has a favorable on blood pressure when consumed for 12 weeks.¹⁴

Lifestyle

And let's not forget lifestyle. Lifestyle changes for reducing high blood pressure are just as important. Regular exercise, reducing stress, stopping smoking and reducing alcohol are all essential lifestyle changes to go along with dietary changes. 

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