It’s common knowledge that something as simple as stress can raise your blood pressure. But the negative health impacts of high blood pressure are anything but simple. In 2019 alone, high blood pressure contributed to the deaths of more than half a million Americans.1 Plenty of medications are designed to lower blood pressure – but are pharmaceuticals the only option?
To learn more about how Naturopathic Doctors approach high blood pressure, we sat down with Dr. Kasra Pournadeali, ND, FACN, Founder and Director of the Northwest Center for Optimal Health, as well as Dr. Brad Lichtenstein, ND, BCB, BCB-HRV, Founder of The Breath SPACE.
What is High Blood Pressure?
Imagine watering a garden with a blocked hose. Water will travel through the narrowed hose at high pressure. It’s the same in hypertension. When plaque buildup narrows our arteries, blood pressure increases. Over time, this can damage blood vessel walls and organs, contributing to heart issues, clogged arteries, kidney disease, and more.
But what do the two numbers that make up your blood pressure reading mean? The first is systolic (the pressure in your vessels when your heart contracts), and the second is diastolic (the pressure when your heart is at rest between beats).1 The chart below outlines the categories of hypertension according to the American Heart Association and their associated blood pressure readings.
According to the Centre for Disease Control,2 approximately half (47%) of American adults have high blood pressure. The scary part? Only 24% of American adults with high blood pressure have it under control. High blood pressure raises the risk of heart disease and stroke – the two leading causes of death in the United States.
In addition to stress, Pournadeali points to poor diet, hormonal issues, kidney concerns, obesity, and some medications as contributing factors to high blood pressure. “There are also more emerging causes, including inflammation, food allergies, and toxicity from exposures,” adds Pournadeali.
High blood pressure rarely shows up alone. In Pournadeali’s experience, patients with high blood pressure may also have:
● Heart disease
● Retinal disease
● Kidney failure
● Stroke
● Peripheral vascular disease
● Diabetes / Prediabetes
● High cholesterol
Conventional Approaches to High Blood Pressure
Although recommending lifestyle changes like diet, exercise, and stress reduction are part of most conventional guidelines for managing high blood pressure, evidence indicates that patients infrequently get this advice.3 Medications that lower blood pressure are the most common conventional treatment, including drug classes such as ACE inhibitors, diuretics, and calcium-channel blockers.4 “The benefit of using pharmaceuticals is that it helps get things under control and improved quickly,” notes Pournadeali. However, he thinks people overestimate how much these medications can reduce blood pressure. “For every blood pressure medication that you add to somebody’s plan, they may get a 10-point reduction on their blood pressure readings. For somebody 70 points higher than they need to be, they can have four drugs at once and maybe lose 40 points,” explains Pournadeali. “They still won’t reach their goal. Ultimately, there has to be more than just medication. That’s where naturopathic medicine kicks in.”
What High Blood Pressure Patients Can Expect from a Naturopathic Doctor
“The big difference between the conventional and naturopathic approach is meeting the person where their need is – we’re always working to identify ways to make them healthier,” says Pournadeali. “Normalization of blood pressure isn’t just a number goal. It happens as a side effect of the person’s overall health improving.”
At the first visit, Pournadeali takes the time to understand what is really going on with the patient. He takes a detailed patient history, including lifestyle and other potential contributors to high blood pressure. “Do they have hormonal issues or any potential contributors like kidney disease? Do they have stress issues in their life? Are they consuming lots of sugar? Are there genetic, ethnic, or lifestyle factors that may put them at increased risk?”
Based on the patient history, he may run some lab tests, request diagnostic imaging or make a referral to identify any other related health conditions. His next step depends on the unique patient in front of him. “Do they need aggressive therapy with medications? Or perhaps a botanical medicine that would have a pharmacological effect to lower the numbers and keep them in a safe space while we’re working on the long-term goals of lifestyle, diet, and stress management,” explains Pournadeali. “The management of hypertension can be something very aggressive if the person needs it in that first encounter, to something very simple and mindful, like breathing techniques or consuming celery.”
Some naturopathic doctors may prescribe herbs and supplements proven to reduce blood pressure, including omega-3 fish oils, b-vitamins, magnesium, CoQ10, Resveratrol, hawthorn, garlic, dandelion, motherwort, and passionflower.3 Spending time in nature may be recommended,5 and many NDs also take heart rate variability (HRV) into account. Research shows that variation in HRV (the space between heartbeats) is associated with lower blood pressure.6 Lifestyle changes that effectively lower blood pressure include increased physical activity, weight loss, limited alcohol consumption, relaxation techniques of yoga, acupuncture, tai chi, mindfulness-based stress-reduction program, and transcendental meditation.7
When their blood pressure drops, Pournadeali gets just as excited as his patients. “There’s nothing as satisfying as someone suffering from medication side effects (like cramps, constipation, fatigue, headaches or gout) and being able to eliminate the need for those medications through lifestyle changes or therapeutic nutrition,” says Pournedeali. “It does work, and people get really excited. That’s why I like my job because I get to walk people through that space and observe them realizing those great improvements.”
Pournadeali finds that his patients experience a significant shift in how they think about health, recognizing the interconnectedness of all systems in the body. “It’s a real paradigm shift to have somebody understand the fast food they eat is causing inflammation, which leads to decreased vascular compliance and increases their blood pressure. Or that the wheat that they’re sensitive to is doing the same thing.”
How Safety Impacts High Blood Pressure
After teaching at Bastyr University for over 25 years, Lichtenstein’s private practice now focuses on teaching patients how to breathe, orient to the world differently and address safety. “I tell all my patients that I do not treat hypertension, PTSD, or anxiety. I talk to people about how their nervous system is regulated,” explains Lichtenstein. “The nervous system is the master regulator of the world.”
Taking a broad approach to safety, Lichtenstein points to personal life stressors such as financial, job, and food insecurity and larger social and political concerns such as climate change and war. People who grew up in unsafe environments may become hyper-vigilant, constantly scanning their surroundings for danger.
Evolution designed our fight or flight response to give us a burst of energy to escape predators and other life-threatening situations. Today, we rarely need to run for our lives. But let’s say you open an email from your boss. Your heart may beat faster, and your breathing becomes shallow. As far as the body is concerned, opening that email is just as dangerous as being chased by a tiger.
The fight or flight response is a natural and essential process. However, it’s supposed to be temporary, lasting just long enough for us to escape danger. Today’s environment of chronic stress means that we are constantly overstimulating the sympathetic nervous system. We must move from fight or flight mode to ‘rest and digest’ mode, allowing the parasympathetic nervous system to help us recover.
“What drives up our heart rate and blood pressure is lack of settling in the moment,” explains Lichtenstein. “If I’m constantly hyper-vigilant, I’m not breathing properly. I’m decreasing parasympathetic tone, increasing sympathetic tone, and I’m going to increase my heart rate and blood pressure.”
Taking a page from the research of cognitive neuroscientists such as Lisa Feldman Barrett, Lichtenstein believes that all emotions are predictive constructions. And these constructions can have a big impact on high blood pressure. When an event happens, our body doesn’t categorize it as good or bad stress – it tries to estimate the energy needed to deal with it. If that energy estimate is high, we brace ourselves by releasing the stress hormone cortisol, keeping us in fight or flight mode.
Lichtenstein finds that many of his patients unconsciously predict that they are unsafe. He works with them to reframe safety in their bodies and minds using their breath as a guide. Of the many high blood pressure patients he worked with at the Bastyr Center for Natural Health, every central hypertension patient lowered their blood pressure by practicing breathwork. “If we don’t slow our breathing rate down significantly throughout the day, we’re going to keep having high blood pressure,” explains Lichtenstein. “This goes back to safety. What does almost everyone with high blood pressure do when they don’t feel safe? They hold their breath. After the first week of working with me, patients all say, ‘I didn’t realize how much I hold my breath throughout my day!’”
Cost-Effective Strategies to Reduce High Blood Pressure
There are many strategies to reduce high blood pressure that are effective at home and won’t break the bank. “It doesn’t cost to practice a breathing technique, to not eat sugary foods, or to find foods that don’t have a ton of salt,” advises Pournadeali. “The act of taking a bath can lower blood pressure by changing the stress levels and chemicals in our bodies.”
Although you can purchase biofeedback devices that help you slow your breathing rate, Lichtenstein notes that plenty of free ‘breath pacer’ apps are available. “It’s not about taking deep breaths. It’s about slowing the breath rate down. Doing that on your own, you’ll see a change in your blood pressure.”
He offers the following mind-body tips for people with high blood pressure:
● Observe your posture and breathing. How does it differ when you feel safe vs. unsafe? Is the breathing up in the chest, or is it in the belly?
● Learn to let the abdomen muscles release so that the breath is not up in the chest. Allow it to soften and deepen. Learn to breathe slower.
● Make your exhale longer than your inhale to get into ‘rest and digest’ mode.
● Using an app can help pace your breath and avoid getting lightheaded or dizzy by over-breathing.
● Learn how to sit in a comfortable, upright position. Soften your muscles, relax the intonation of your voice, and focus on breathing.
Value of Treating The Root Cause in Hypertension
When it comes to getting to the root causes of illness, Pournadeali considers high blood pressure more of a symptom than a disease. “The goal with high blood pressure, and with any condition that I treat, is about improving the health of the person and having signs of ill health (like high blood pressure, high cholesterol, joint stiffness, and fatigue), lessen by improving overall health.”
For Pournadeali, it’s not all about the numbers. “If you can address the cause of the numbers, then you don’t have to see me for that six-month refill of herbal treatment or pharmaceuticals,” says Pournadeali. “Learn how to reduce inflammation, control stress, and improve the parasympathetic response in your body on your own with the tools that I can provide if those happen to be the causes.”
After working with the nervous system, Lichtenstein’s patients notice improvements in high blood pressure and beyond. “Patients notice that they’re sleeping better because they are no longer laying in bed ruminating about things; they have built that skill,” says Lichtenstein. “A lot of their other diseases improve as well because now they’re more cognizant of the connection between how they orient and nervous system effects. And the nervous system is spilling out into all these different conditions.”
Do You Really Have High Blood Pressure?
When it comes to the body-wide impact of high blood pressure, Pournadeali is used to his patients having lightbulb moments. Yet, there is one issue that regularly floors his patients. Not all high blood pressure diagnoses are accurate- and it has to do with how blood pressure is taken.
“True resting blood pressure means the body has reached a state of rest, where their blood pressure has stabilized,” explains Pournedeali. “And so, every blood pressure that we read in-office is not a true resting blood pressure.”
Picture it: You walk into a doctor’s office, are seated for a while, and speak with the assistant before or during the blood pressure reading. According to Pournadeali, that’s not what the research on high blood pressure treatment is based on. “The only way to get to that resting blood pressure is to continue accessing our readings until the person has reached a steady state, and the systolic and diastolic numbers are within five points of each other on successive readings.”
This need for a true resting state also means that patients may not be taking accurate blood pressure readings at home. When he brings this up with patients, and they start taking their blood pressure differently, some are in for a shock. Suddenly, they don’t have high blood pressure! What really riles Pournadeali up is that an incorrect reading could lead to a dangerous prescription. “Treating people for hypertension when they have a random high blood pressure reading is outside of what we’re supposed to be doing as physicians,” exclaims Pournadeali. “It’s not about treating the number that’s elevated. It’s about making sure that it’s actually the proper diagnosis.”
Some patients become anxious simply by being in a doctor’s office. When they sit down to get a blood pressure reading, their temporary anxiety may skew the results. Not only is this an incorrect diagnosis – it’s a lost healing opportunity. “Is the proper treatment of that person a diuretic or calcium channel blocker drug that changes the physiology?” asks Pournadeali. “Or is there something that that person needs to control anxiety in a stressful situation? Do they need to exercise or practice yoga or do breathing techniques? It’s a high-stress environment for those select people.”
Pournadeali recalls a senior patient he saw just a few weeks ago. His Primary Care Physician was not managing his care well, and he had been on blood pressure medication for over a decade. Due to age, his body was no longer tolerating the medication. He ended up in the emergency room with low sodium brought on by the medications – a condition that could have ended his life.
Fortunately, the ER doctors immediately stopped the medications, and the patient is continuing to work with Pournadeali to find better alternatives. “These medicines require a prescription because there is inherent danger in them. As much as we can do to reduce our reliance on them, the better we are,” Pournadeali points out. “It is not the naturopathic profession. It is the medical profession, the American Heart Association, the American College of Cardiology, there are guidelines that state specifically that the way to prevent atherosclerotic disease is to promote a healthy lifestyle throughout life. Those are things we should all be practicing. I’m happy to say that as a naturopathic doctor, that’s exactly what I do.”
High Blood Pressure Takeaways
● Common root causes of high blood pressure include poor diet, hormone, and kidney issues.
● High blood pressure can raise the risk of stroke, heart disease, and other chronic conditions.
● Blood pressure-lowering medication is not the only treatment option.
● Naturopathic recommendations for high blood pressure may include herbs, supplements, stress reduction strategies, as well as dietary and exercise recommendations.
Are you ready to get to the root causes of hypertension with the support of a naturopathic doctor? Use our Find an ND search tool to find a naturopathic doctor in your area.
Dr. Kasra Pournadeali, ND, FACN, is the Founder and Director of the Northwest Center for Optimal Health in Marysville, Washington. He has been elected President of the Washington Association of Naturopathic Physicians and the American Association of Naturopathic Physicians. He speaks and writes locally and nationally, has published hundreds of articles, and has made over 1,000 television and radio appearances. He is co-host of KSER’s Sound Living with the Doctors on FM 90.7 and at kser.org, Thursdays at 4:00 p.m. P.T.
Dr. Brad Lichtenstein, ND, BCB, BCB-HRV is the Founder of the Breath SPACE in Lake Forest Park, Washington, and taught at Bastyr University for over 25 years. His chapters on mind-body medicine have been published in the Advanced Clinical Textbook of Naturopathic Medicine (2020) and in Integrative Men’s Health (2014), and his articles have appeared in several publications and journals. He regularly speaks on stress reduction, mind-body approaches to healing trauma, and end-of-life issues.
References
1. Understanding Blood Pressure Readings | American Heart Association. Accessed June 26, 2023. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings
2. Facts About Hypertension | cdc.gov. Centers for Disease Control and Prevention. Published May 15, 2023. Accessed June 26, 2023. https://www.cdc.gov/bloodpressure/facts.htm
3. Bradley R, Kozura E, Kaltunas J, Oberg EB, Probstfield J, Fitzpatrick AL. Observed Changes in Risk during Naturopathic Treatment of Hypertension. Evidence-Based Complementary and Alternative Medicine. 2011;2011:enep219. doi:10.1093/ecam/nep219
4. Types of Blood Pressure Medications | American Heart Association. Accessed June 26, 2023. https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/types-of-blood-pressure-medications
5. Yau KKY, Loke AY. Effects of forest bathing on pre-hypertensive and hypertensive adults: a review of the literature. Environmental Health and Preventive Medicine. 2020;25(1):23. doi:10.1186/s12199-020-00856-7
6. Bolin LP, Saul AD, Bethune Scroggs LL, Horne C. A pilot study investigating the relationship between heart rate variability and blood pressure in young adults at risk for cardiovascular disease. Clinical Hypertension. 2022;28(1):2. doi:10.1186/s40885-021-00185-z
7. Verma N, Rastogi S, Chia YC, et al. Non-pharmacological management of hypertension. The Journal of Clinical Hypertension. 2021;23(7):1275-1283. doi:10.1111/jch.14236
