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A single dose of cannabidiol reduces blood pressure in healthy volunteers in a randomized crossover study

1 Division of Medical Sciences & Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, United Kingdom.

Garry D. Tan

2 The NIHR Oxford Biomedical Research Centre, Oxford Centre for Diabetes, Endocrinology & Metabolism, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.

Saoirse E. O’Sullivan

1 Division of Medical Sciences & Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, United Kingdom.

1 Division of Medical Sciences & Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, United Kingdom.

2 The NIHR Oxford Biomedical Research Centre, Oxford Centre for Diabetes, Endocrinology & Metabolism, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.

Associated Data

Abstract

BACKGROUND. Cannabidiol (CBD) is a nonpsychoactive phytocannabinoid used in multiple sclerosis and intractable epilepsies. Preclinical studies show CBD has numerous cardiovascular benefits, including a reduced blood pressure (BP) response to stress. The aim of this study was to investigate if CBD reduces BP in humans.

METHODS. Nine healthy male volunteers were given 600 mg of CBD or placebo in a randomized, placebo-controlled, double-blind, crossover study. Cardiovascular parameters were monitored using a finometer and laser Doppler.

CONCLUSIONS. This data shows that acute administration of CBD reduces resting BP and the BP increase to stress in humans, associated with increased HR. These hemodynamic changes should be considered for people taking CBD. Further research is required to establish whether CBD has a role in the treatment of cardiovascular disorders.

Introduction

Epidemiological studies have shown a positive relationship between long-term stress and the development of cardiovascular disease (1). Factors like social isolation, low socioeconomic status, depression, stressful family and work life, and anxiety are associated with an increased risk of the development and accelerated progression of existing cardiovascular disease. Current European guidelines on the prevention of cardiovascular disease have emphasized the importance of tackling these factors (2). Mental stress induces myocardial ischaemia in patients with stable coronary artery disease, and this appears to be mediated by adrenal release of catecholamines (3).

Cannabinoids (CBs) are compounds that bind to CB receptors or are structurally similar to compounds that bind to CB receptors. They include endogenously produced compounds (called endocannabinoids), synthetic compounds and phytocannabinoids obtained from the Cannabis sativa plant. There are over 80 known types of phytocannabinoids, the most widely studied of which is Δ 9 tetrahydrocannabinol (Δ 9 -THC or THC), which is responsible for the psychoactive properties of cannabis (4). The other major phytocannabinoid is cannabidiol (CBD), which does not have psychoactive properties. CBD is currently the focus of much research due to its potential in a number of therapeutic areas, as it has been shown to have antiinflammatory, anticonvulsant, antioxidant, anxiolytic, antinausea, and antipsychotic properties (5). A number of preclinical studies have also shown beneficial effects of CBD in a range of disorders of the cardiovascular system (6). A CBD/THC combination (Sativex/Nabiximols, GW Pharmaceuticals) is licensed for the treatment of spasticity in multiple sclerosis, and CBD alone (Epidiolex, GW Pharmaceuticals) has entered an expanded access program in children with intractable epilepsies (Dravet syndrome and Lennox-Gastaut syndrome). Epidiolex has also received orphan designation status for the treatment of neonatal hypoxia-ischaemic encephalopathy.

CBD has multiple desirable effects on the cardiovascular system. It attenuates high glucose–induced proinflammatory changes in human coronary artery endothelial cells (7) and myocardial dysfunction associated with animal models of diabetes (8), and it preserves endothelial integrity in diabetic retinal microvasculature (9). In vivo administration of CBD before cardiac ischemia and reperfusion also reduces ventricular arrhythmias and infarct size. CBD also causes both acute and time-dependent vasorelaxation in isolated arteries in rats and humans (10–12). There is also evidence from animal studies that CBD modulates the cardiovascular response to stress. Resstel and colleagues (13) showed in rats that i.p. injection of CBD (10 and 20 mg/kg, –30 min) reduced restraint stress–induced cardiovascular response and behavior. Both these effects were blocked by preadministration of WAY100635 (0.1 mg/kg), a 5-hydroxytryptamine 1A (5HT1A) antagonist. These effects appear to be mediated centrally and involve the bed nucleus of the stria terminalis (BNST), a limbic structure that modulates neuroendocrine responses to acute stress (14).

Our recent systematic review showed us that there are no dedicated studies in humans to date, to our knowledge, looking at the effect of CBD on either resting cardiovascular measurement or on the responses to stress, with continuous monitoring of CV parameters (15). Therefore, the aim of the present study was to investigate whether CBD decreases the cardiovascular response to stress after the administration of a single dose of CBD (600 mg) in healthy volunteers, with the hypothesis that blood pressure would be reduced by CBD. Noninvasive cardiovascular measurements were used along with stress tests in the form of mental arithmetic, isometric exercise, and the cold pressor test.

Results

Ten male subjects were recruited, but 1 withdrew for personal reasons. The mean age, weight, and height of the volunteers were 23.7 ± 3.2 years, 77.5 ± 6.4 kg, and 178.6 ± 4.5 cm (mean ± SD).

Effect of CBD on resting cardiovascular parameters.

Changes in resting cardiovascular parameters after a single dose (600 mg) of cannabidiol (CBD) in healthy volunteers (n = 9).

The effects of placebo (closed square) and CBD (open square) on systolic blood pressure (SBP) (A), diastolic blood pressure (DBP) (B), mean arterial blood pressure (MAP) (C), heart rate (HR) (D), stroke volume (SV) (E), cardiac output (CO) (F), ejection time (EJT) (G), total peripheral resistance (TPR) (H), and forearm blood flow (I), measured continuously over 2 hours after drug ingestion, except for forearm blood flow. Forearm blood was measured over a time period of 2 minutes just before the start and in between the stress tests. Dotted line denotes baseline values between the stress tests. Repeated measures 2-way ANOVA; mean ± SEM (*/ + / # P < 0.05, **/ ++ / ## P < 0.01 using Bonferroni’s post-hoc analysis; + and # represent significant change in any parameter over time seen with placebo and CBD, respectively; denotes overall significant difference between 2 treatments).

There was a trend toward reduction in total peripheral resistance (TPR, Figure 1H ) with CBD in the latter half of the resting period, and a significant reduction in forearm skin blood flow before the start of the stress tests ( Figure 1I ; P < 0.01).

Effect of CBD on cardiovascular parameters mental stress.

The individual blood pressure responses of healthy volunteers to the stresses are presented in Figure 2 , showing the average baseline systolic or diastolic blood pressure in the 4 minutes preceeding the stress test, the peak response during stress, and the average recovery response in the 4 minutes after the stress test.

Individual systolic and diastolic blood pressure responses to all stress tests after a single dose (600 mg) of cannabidiol (CBD) or placebo in healthy volunteers (n = 9).

Green color coding shows subjectS who had a reduced (compared with placebo) blood pressure response to stress after taking CBD, and red color coding shows an increased blood pressure response to stress after taking CBD.

Mental stress test.

Cardiovascular response to mental stress after a single dose (600 mg) of cannabidiol (CBD) in healthy volunteers (n = 9).

The effects of placebo (closed square) and CBD (open square) on systolic blood pressure (SBP) (A), diastolic blood pressure (DBP) (B), mean arterial blood pressure (MAP) (C), heart rate (HR) (D), stroke volume (SV) (E), cardiac output (CO) (F), ejection time (EJT) (G), total peripheral resistance (TPR) (H), and forearm blood flow (I), measured continuously just before, during, and after mental arithmetic test (dotted line denotes stress test period), except for forearm blood flow. Measurements for forearm blood flow were made over a 2-minute window just before, during, and after the stress test. Repeated measures 2-way ANOVA; mean ± SEM (+ and # denote significant change in a parameter during the stress period seen with placebo and CBD, respectively). + / # P < 0.05, ++ /# # P < 0.01.

Exercise stress test.

Cardiovascular parameters in response to exercise stress after a single dose (600 mg) of cannabidiol (CBD) in healthy volunteers (n = 9).

The effects of placebo (closed square) and CBD (open square) on systolic blood pressure (SBP) (A), diastolic blood pressure (DBP) (B), mean arterial blood pressure (MAP) (C), heart rate (HR) (D), stroke volume (SV) (E), cardiac output (CO) (F), ejection time (EJT) (G), total peripheral resistance (TPR) (H), and forearm blood flow (I), measured continuously just before, during, and after isometric exercise test (dotted line denotes stress test period), except for forearm blood flow. Measurements for forearm blood flow were made over a 2-minute window just before, during, and after the stress test. Repeated measures 2-way ANOVA; mean ± SEM (*/ + / # P < 0.05; **/ ++ / ## P < 0.01; ***/ ### P < 0.001; ****/ #### P < 0.0001 using Bonferroni post-hoc analysis; + and # denote significant change in a parameter during the stress period seen with placebo and CBD respectively).

Cold stress test.

Cardiovascular response to cold stress after a single dose (600 mg) of cannabidiol (CBD) in healthy volunteers (n = 9).

The effects of placebo (closed square) and CBD (open square) on systolic blood pressure (SBP) (A), diastolic blood pressure (DBP) (B), mean arterial blood pressure (MAP) (C), heart rate (HR) (D), stroke volume (SV) (E), cardiac output (CO) (F), ejection time (EJT) (G), total peripheral resistance (TPR) (H), and forearm blood flow (I), measured continuously just before, during, and after cold pressor test (dotted line denotes stress test period), except for forearm blood flow. Measurements for forearm blood flow were made over a 2-minute window just before, during, and after the stress test. Repeated measures 2-way ANOVA; mean ± SEM (*/ + / # P < 0.05, **/ ++ P < 0.01, ***/ +++ P < 0.001, ****P < 0.0001 using Bonferroni post-hoc analysis; + and # denote significant change in a parameter during the stress period seen with placebo and CBD, respectively).

Looking at the individual response to the cold pressor test, 8 of 9 subjects had a lower SBP during the cold stress and in the recovery period after taking CBD ( Figure 2 ). Six of 9 subjects had a lower DBP during the cold pressor, and 7 of 9 subject had a lower DBP in the recovery period after taking CBD ( Figure 2 ).

Discussion

Based on preclinical evidence, the aim of this study was to test the hypothesis that CBD would reduce the cardiovascular response to stress in healthy volunteers. We found that resting blood pressure was lower after subjects had taken CBD and that CBD blunted the blood pressure response to stress, particularly in the pre- and poststress periods. Post-hoc analysis showed an overall trend of lower SBP, MAP, DBP, SV, TPR, forearm skin blood flow, and left ventricular EJT and a higher HR in subjects who had taken CBD. These hemodynamic changes should be considered for people taking CBD and suggest that further research is warranted to establish whether CBD has any role in the treatment of cardiovascular disorders.

We have shown for the first time that to our knowledge that, in humans, acute administration of CBD reduces resting blood pressure, with a lower stroke volume and a higher heart rate. This response may be secondary to the known anxiolytic properties of CBD (16) and may account for the lack of anticipatory rise in blood pressure seen with placebo. These findings are in contrast to previous studies in humans, where CBD at the same dose did not affect baseline cardiovascular parameters (17–19), although changes in the cardiovascular system were not the primary outcome of these studies. In the present study, CV parameters were measured continuously, while in previous studies, monitoring for SBP, DBP, and HR were performed manually at only 1, 2, or 3 hours after drug delivery. Additionally, our subjects were cannabis naive, while the subjects of other studies had used cannabis in the past. Since tolerance may develop to the hemodynamic response to CBs in humans, this may explain the differences between studies.

THC, the major psychoactive component of cannabis, is known to cause tachycardia and orthostatic hypotension in humans (20), a hemodynamic response similar to that observed to CBD in the present study. THC is a partial agonist at both CB1 and CB2 receptors (21), and the effects of THC on heart rate are mediated through CB1 receptors (20). CBD does not bind with any great affinity to CB1, but it can interact indirectly by augmenting CB1 receptors’ constitutional activity or endocannabinoid tone, the so called indirect agonism (22). We recently showed that CBD also causes endothelium-dependent vasorelaxation in isolated human mesenteric arteries through CB1 activation (11). Therefore, it is possible that the changes in hemodynamics brought about by CBD are mediated through CB1.

CBD may cause sympathoinhibition (through CB1 or some other mechanism), thereby preventing an increase in blood pressure and cardiac output, causing a compensatory rise in heart rate to maintain cardiac output. Indeed, the changes in SBP preceded any changes in HR. Another possibility is that CBD inhibits cardiac vagal tone, thereby increasing heart rate (despite any potential sympathoinhibition). A recent study in male Sprague-Dawley rats showed that GPR18 activation in the rostral ventrolateral medulla (RVLM) by abnormal CBD (Abn-CBD) resulted in reduced blood pressure and increased heart rate (23) (similar to that observed in the present study). The same study showed that pretreatment with atropine and propranolol fully abrogated the HR response, suggesting a role for the autonomic nervous system. CBD is a weak partial agonist at GPR18 (24).

Effect of CBD on cardiovascular parameters in response to mental stress.

Mental arithmetic has been shown to cause a rise in MAP and muscle sympathetic nerve activity (MSNA) (25) and vasodilatation in forearm skeletal muscle (26). In our study, none of the cardiovascular parameters other than HR, DBP, and SV were affected, suggesting that the level of stress to this test was minimal. This could be because of the added visual stimulus of a computer screen, which would have helped volunteers perform the task. Overall, there was trend for lower SBP, DBP, MAP, SV, TPR, and forearm skin blood flow in subjects who had taken CBD, particularly in the pre– and post–stress test periods. Like resting cardiovascular parameters, these changes may indicate anxiolytic effects of CBD and/or generalized sympathoinhibition.

Effect of CBD on cardiovascular parameters in response to exercise stress.

Isometric exercise produces a pressor response, via sympathoexcitation, originating in the contracting muscle and relayed to the RVLM via the nucleus of solitary tract. The end result is a rise in heart rate and cardiac output and vasoconstriction in nonexercising organs (27–29). There is increased skeletal muscle blood flow in the nonexercising limb, which is sensitive to atropine and propranolol (30). A similar response was seen in our study, where isometric exercise caused a significant rise in SBP, DBP, MAP, and HR and an increase in forearm blood flow, although this was significant in the placebo group only. Subjects who had taken CBD had reduced blood pressure during the exercise stress test, and this was most pronounced in the pre- and posttest period. Before the exercise stress, HR was higher and SV lower in volunteers when they had taken CBD, and this trend continued throughout exercise stress and in the poststress period. There was also a significant reduction in EJT with CBD, which represents a reciprocal change to increased HR. The rise in cutaneous blood flow was only seen with placebo and not with CBD, possibly suggesting reduced β2 adrenergic–mediated vasodilatation, which could be a result of general sympathoinhibition or a specific effect at the β2 adrenoceptors. The tissue distribution of β2 adrenoceptors and CB1 receptors overlaps in many tissues, including in the cardiovascular system (31). At the cellular level, a complex physical and functional interaction between these 2 receptors has been demonstrated; there is evidence of cointernalization of β2 adrenoceptors with CB1 receptors, leading to desensitisation of β2 adrenoceptors (31).

Effect of CBD on cardiovascular parameters in response to cold stress.

Cold stress causes intense sympathoexcitation, producing a tachycardic and pressor response, and an increase in MSNA (32, 33). The pressor response is due to an initial rise in CO, in response to increased HR and a later increase in MSNA, causing vasoconstriction. Both MAP and TPR show a linear correlation with MSNA during cold stress (34). In our study, cold stress produced a pressor response in both groups, but, interestingly, while SBP and MAP continued to rise with placebo throughout the test period, the pressor response to cold was blunted in subjects who had taken CBD, and SBP and MAP were significantly lower. In keeping with this, TPR was lower with CBD than placebo, suggesting a possible inhibition of sympathetic outflow. This could also be due to analgesic properties of CBD (35), reducing cold stress and therefore minimizing the sympathetic response (also explaining why the cold pressor test was affected more by CBD than the exercise test). In the animal study of Resstel and colleagues (13), the authors suggested that the modulation of cardiovascular response was most likely secondary to attenuation of emotional response to stress. However, given our findings that CBD produced similar changes in cardiovascular parameters — though to a variable degree — during rest and stress, this may indicate that CBD also has direct cardiovascular effects.

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Safety and tolerance.

CBD was well tolerated, and there were no adverse events on the day of stress tests. None of the subjects reported any adverse events over the following week.

Conclusion.

Our data show that a single dose of CBD reduces resting blood pressure and the blood pressure response to stress, particularly cold stress, and especially in the post-test periods. This may reflect the anxiolytic and analgesic effects of CBD, as well as any potential direct cardiovascular effects. CBD also affected cardiac parameters but without affecting cardiac output. Giving the increasing use of CBD as a medicinal product, these hemodynamic changes should be considered for people taking CBD. Further research is also required to establish whether CBD has any role in the treatment of cardiovascular disorders such as a hypertension.

Methods

Study design.

The study was a randomized, crossover design with each subject given CBD (BN: K12067A) or placebo (both gifts from GW Pharmaceuticals) in a capsule in a double-blind fashion, with a minimum time interval of at least 48 hours (range 3–16 days), taking place at the Division of Medical Sciences, School of Medicine, Royal Derby Hospital. Allocation was decided by a coin toss, and block randomization was employed by S.E. O’Sullivan, who assigned participants. K.A. Jadoon carried out all study visits, and data analysis was blinded.

During an initial visit, subjects were familiarized with the stress tests and with noninvasive cardiovascular (CVS) monitoring, and an electrocardiogram (ECG) was done to rule out any preexisting cardiac conditions. Subjects were advised to fast overnight, to avoid beverages containing caffeine or alcohol, and to avoid strenuous exercise for 24 hours before each of the 2 study visits. Two hours after CBD/placebo was administered, subjects performed various stress tests (36). Noninvasive cardiovascular monitoring using Finometer and laser Doppler flowmetry was carried out during the 2 hours to assess changes in baseline parameters and during the stress test periods.

Visit days.

Upon arrival, subjects were rested for 10–15 minutes, and their baseline blood pressure and heart rate were recorded using a digital blood pressure (BP) monitor. Participants were given a standardized breakfast, and 15 minutes later, they were given either oral CBD (600 mg) or placebo in a double-blind fashion. This is a dose known to cause anxiolytic effects in humans and is comparable with what is used clinically (19, 37–39). Study medication consisted of capsules containing either 100 mg of CBD or excipients, which were a gift from GW Pharmaceuticals. There was no difference between the 2 formulations in color, taste, or smell.

Two hours afterward, subjects were asked to perform the stress tests (36). Timing of the tests was chosen to coincide with peak plasma levels for CBD (18). All the experiments were performed in a sitting position under ambient temperature conditions. Maximum voluntary contraction for the isometric hand grip test was assessed for each subject prior to administering study medication.

After administration of CBD or placebo, subjects remained seated, either doing nothing, reading, or using a computer. During this time, subjects were connected to a calibrated Finometer (Finapres Medical Systems), which uses a finger-clamp method to detect beat-to-beat changes in digital arterial diameter using an infrared photoplethysmograph (40). The Finometer gives a continuous signal of beat-to-beat changes in blood pressure and blood flow, and it uses this signal to derive other parameters, including systolic, diastolic, and mean blood pressure; interbeat interval; heart rate and left ventricular ejection time; stroke volume; cardiac output; and systemic peripheral resistance. Baseline cardiovascular data was recorded for 2 hours following administration of CBD or placebo. Forearm blood flow was measured using a calibrated laser Doppler flowmeter (Perimed) (41). For each recording, 5 images of microcirculation were taken, over an area 19 mm × 19 mm, using the upper third of the left forearm under high resolution. After 2 hours, subjects underwent the cardiovascular stress tests in the following order: mental arithmetic, isometric exercise, and cold pressor test.

The mental arithmetic test consisted of calculating a sum every 2 second for 2 minutes. Subjects were seated in front of a computer screen, and a PowerPoint presentation delivered a slide with a simple mathematical sum of a 3-digit number minus a smaller number (e.g., 317 – 9, 212 – 11, 185 – 7) every 2 seconds; the subject had to give the answer verbally. In the isometric exercise stress test, using a dynamometer, handgrip was maintained at 30% of maximum voluntary contraction (MVC) for 2 min. For the cold pressor test, subjects immersed their left foot (up to ankle) in ice slush (temperature 4°C–6°C) for 2 minutes. Cardiovascular parameters were measured continuously using the Finometer, while skin blood flow measurements were taken just before, during, and 5 minutes after each test. Each stress test lasted for 2 minutes, and there was a recovery period of at least 10 minutes.

Statistics.

Data were analyzed using repeated measures ANOVA to determine the effect of treatment and time on different variables using GraphPad PRISM version 6.02. Level of significance was set at α = 0.05 and values presented as mean ± SEM. Sidak’s post-hoc test was used to see treatment affect at various time points. Data were not unblinded until after statistical analysis.

Study approval.

Ten healthy young male volunteers, mean age 24 years (range 19–29), with no underlying cardiovascular or metabolic disorders, were recruited for this study, which was approved by the University of Nottingham Faculty of Medicine Ethics Committee (study reference E18102012). Written informed consent was obtained according to the Declaration of Helsinki. Exclusion criteria included any significant cardiovascular or metabolic disorder or use of any medication. All the volunteers were nonsmokers and had taken no prescribed or over-the-counter medication within a week prior to randomization. No volunteers had ever used cannabis.

Author contributions

KAJ helped with study design, researched data, wrote the manuscript, and reviewed/edited the manuscript. GDT reviewed/edited the manuscript. SEO was involved in study design and reviewed/edited the manuscript.

Supplementary Material

Acknowledgments

GT is supported by the NIHR Oxford Biomedical Research Centre Programme. The views expressed are those of the author and not necessarily those of the NHS, the NIHR, or the Department of Health.

Footnotes

Conflict of interest: GW Pharma supplied the cannabidiol (CBD) and placebo but did not fund the study.

Reference information:JCI Insight. 2017;2(11):e93760. https://doi.org/10.1172/jci.insight.93760.

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How to Treat Hypertension Naturally

Being told you have high blood pressure can be enough to make it soar even higher. Especially if you’re then told that you need to relax or de-stress in order to lower it. That’s a recipe for heightened anxiety, if ever I heard one! It reminds me of time when I had insomnia and got myself more and more worked up the nearer bedtime arrived. It seems the more you ‘try’ to get to sleep, the more it eludes you. Likewise, the more you ‘try’ to relax, the harder it gets.

So while a continuous state of high blood pressure (hypertension) is potentially dangerous – due to the strain it imposes on the heart, blood vessels and kidneys – some basic information can help reduce some of the fear of this condition.

What is high blood pressure (Hypertension) ?

High blood pressure, often referred to as hypertension, is very common. The NHS estimate that one third of adults in the UK have this condition. It develops when blood flows through your arteries at higher-than-normal pressures. Blood pressure is made up of two numbers: systolic and diastolic. Systolic pressure (the first number) occurs as blood pumps out of the heart and is circulated around the body. Diastolic pressure (the second number) is created as the heart rests between heart beats.

Blood pressure is measured in millimetres of mercury (mmHg) and the current ‘normal’ blood pressure is 120/80 mm Hg. However, this figure has changed over time. Traditionally, doctors used to gauge a healthy systolic BP level as 100 plus your age. So if you’re 55, an acceptable reading would have been 155 mmHg. In the February 2018 edition of ‘What Doctors Don’t Tell You’ magazine, the authors said that back in the 1980s, hypertension was diagnosed with a reading of 160/100 mm Hg. So what might have been ‘normal’ then, would be classed as hypertension today.

If your numbers are consistently high, this can begin to put strain on the heart and blood vessels, plus the brain, kidneys and eyes.

I’ve had one high reading, does this mean I’m doomed?

First things first, it is perfectly normal for the blood pressure to fluctuate throughout the day. It’s usually at its highest in the morning. So having just one reading is a snapshot in time, and its not wise to jump to conclusions. It’s important to know whether you’ve done anything in the hour before taking the reading that could elevate the figures, such as drinking caffeine or smoking. It’s even suggested that just drinking water can raise blood pressure for a while! There is also a phenomenon called ‘white coat hypertension’ in which blood pressure can increase just through the stress of having it taken by your doctor! In this instance the systolic measurement (the top number) can raise by as much as 30mmHg.

Then there is the position you are in when taking a reading. Professor William B. White, is Chief of the Division of Hypertension and Clinical Pharmacology in the Calhoun Cardiology Center at the University of Connecticut School of Medicine. He says “The patient’s position is critical—patients must be sitting in a chair with their back supported and feet on the floor. Having your BP taken while seated on the edge of an exam table, with your legs dangling and no back support, can create substantial errors, making BP appear higher than it actually is.”

Ideally, you’d take your own blood pressure readings at home, several times a day and note the average. Before taking it, be sitting, calmly for five to ten minutes. You want the cuff around your upper left arm just above the elbow, and your arm resting comfortably on the arm of the chair or a table. And remember Prof White’s advice to have your feet on the floor.

What causes high blood pressure?

It’s not unusual for blood pressure to increase during exertion or emotional stress, and in a healthy body it will return to normal quite quickly.

However, for some people, the blood pressure stays high and it can be for a number of reasons, including genetic disposition, sedentary lifestyle, poor diet and stress. So reducing high blood pressure requires attention to many aspects of your lifestyle such as reducing stress, eating healthily, maintaining a healthy weight, increasing physical activity and reducing smoking and alcohol use.

How will my Dr treat high blood pressure?

Your Dr will suggest lifestyle changes along with medication, depending on your reading and risk factors. Current treatment, as outlined from the NHS is:

  • if your blood pressure is consistently above 140/90mmHg (or 135/85mmHg at home), but your risk of other problems is low – you’ll be advised to make some changes to your lifestyle
  • if your blood pressure is consistently above 140/90mmHg (or 135/85mmHg at home) and your risk of other problems is high – you’ll be offered medicine to lower your blood pressure, in addition to lifestyle changes
  • if your blood pressure is consistently above 160/100mmHg – you’ll be offered medicine to lower your blood pressure, in addition to lifestyle changes

Let’s dig deeper into some of the lifestyle changes you could try:

Here are some natural ways to reduce blood pressure

Acupressure

Acupressure is an ancient healing art which uses the fingers, thumbs or knuckles to press key points on the surface of the skin, which stimulates the body’s natural self-curative abilities. If you’ve ever used sea sickness bands on your wrists, then you’ve experienced the power of acupuncture. The NHS recommend the use of acupressure for reducing morning sickness.

In his book “Acupressure: How to cure common ailments the natural way”, author Michael Reed Gach recommends three potent points for hypertension:

GB20 – Just below the base of the skull, in the hollows on both sides. Use your thumbs to gradually push up and underneath your skull as you slowly tilt your head backwards. Breathe deeply and hold for one or two minutes until you feel a regular, even pulse on both sides.

B62 – In the first indentation, directly below the outer anklebone. This hollow is one third the distance from the outer anklebone to the bottom of the heel.

K6 – Directly below the inside of the anklebone in a slight indentation.

Use your thumbs to hold the K6 points on the inside of each ankle in an indentation directly below the inner ankle bone. Position your fingertips directly across from your phone to press B62, which is located directly below the outer anklebone. Hold these points for one minute as you breathe deeply.

You can practice holding these points twice a day. However, take professional advice if you are pregnant, as some acupressure points can stimulate contractions.

Aromatherapy

Massage with one or more of the essential oils known to decrease blood pressure can be calming, soothing, and deeply relaxing.

Long term studies in a London teaching hospital have shown that massage effectively reduces high blood pressure, and that this effect persists for a long time. The most important oils for use in these circumstances our lavender, marjoram, and Ylang Ylang, says aromatherapist Patricia Davis. In her book ‘Aromatherapy an A-Z’ Davis says “All these oils are pleasing and enjoyable to use in massage oils, and also as bath oils for use between treatments. You can also use chamomile, bergamot, neroli, rose and frankincense because these are sedative, antidepressant and uplifting oils.”

In her book “The fragrant pharmacy”, Valerie Ann Worwood, suggests a synergistic blend of marjoram, lavender and geranium to be used in a bath. She also recommends giving yourself a daily massage with diluted essential oils – always moving in the direction of the heart – with marjoram, geranium and hyssop.

In studies, inhaling bergamot, lavender and ylang ylang essential oils once a day for four weeks, was shown to lower both blood pressure and cortisol levels.

In another study, lavender, ylang ylang, marjoram and neroli were shown to decrease daytime blood pressure.

Beetroot

Although I’ll talk about more foods later, I wanted to give beetroot a section of its own. The humble beetroot – commonly associated with being a peasant food – comes up trumps when it comes to lowering blood pressure.

Drinking 250ml of beetroot juice each day could significantly lower the blood pressure of people with high blood pressure, according to research funded by the British Heart Foundation. Volunteers, who took part in the study, were found to have blood pressure levels back in the ‘normal’ range by the end of the study. This effect is caused by an active ingredient present in beetroot, called nitrate. This chemical is also available in foods such as spinach, kale, cabbage, broccoli, lettuce and watercress.

When we eat beetroot, bacteria that live in the mouth turn the nitrate in the beetroot into nitrite and this in turn is thought to get changed into nitric oxide which causes the blood vessels to dilate – lowering our blood pressure. In this experiment by Dr Chris Van Tullken, results showed that beetroot significantly lowered blood pressure.

Why not start your day with a juice such as beetroot, carrot (or cabbage), apple and ginger?

Breathing mindfully

Breathing is such a simple thing, yet many of us overlook the importance of good breathing. If you watch a baby or an animal such as a cat or dog, you’ll notice that when they breathe, their chests are relatively still, while their abdomen rises and falls. Most adults are shallow breathers, taking fast breaths into their chests.

By consciously focusing on your breath, you can quickly lower both heart rate and blood pressure.

The American Journal of Cardiology found that short-term voluntary slow breathing can lower blood pressure and heart rate. This study shows that slow breathing, at around six breaths per minute, helps to lower blood pressure. Aim to build up to 15 minutes a day for the best benefit. And as you’ll discover later, doing your breathing with the backdrop of relaxing music can have even more benefits to you. An easy way to check if you are breathing correctly, is to put one hand on your chest and the other on your abdomen. As you breathe, you want the hand on your chest to stay relatively still, while the one over your abdomen rises and falls smoothly.

CBD oil

CBD oil is getting a lot of attention at the moment and has been shown to reduce stress, anxiety and improve sleep. Research is limited on hypertension, but there were promising results shown in a study done on people with healthy blood pressure. When subjected to a stress test, participants were given a single dose of CBD oil, which was shown to lower blood pressure.

The NHS suggest basic guidelines, such as reducing the amount of salt you eat to less than a teaspoonful, or 6gms. They also recommend increasing fruits, vegetables along with plenty of fibre from wholegrain rice, bread and pasta.

However, not all salt is created equal. In this study done on rats, researchers learned that a healthy intake of sea salt may actually be beneficial in treating hypertension. They concluded it is likely that the major beneficial effect of sea salt is associated with the mineral content of the sea salt that is known to be anti-hypertensive such as potassium, calcium and magnesium. Research still needs to be done on humans.

Harvard Health list a more comprehensive eating plan, including a sample weekly shopping list.

I’m a great believer in using ‘food as medicine, and we’ve already mentioned beetroot, but there are other foods that can help lower blood pressure too:

Bananas and their peels: Banana peels have a long history of use in folk and traditional medicine for use in treating blood pressure, due to their potassium content and ability to relax the blood vessels.

Berries: The beautiful hues of red, purple and blue in berries is due to anthocyanins (ACNs). These anthocyanins have numerous health benefits. In this synopsis of 66 trials, a consistent number of studies documented a significant blood-pressure-lowering activity related to ACNs and ACN-rich berry consumption, suggesting that an effect indeed exists.

Citrus fruit: A 5-month study involving 101 Japanese women combined daily ingestion of lemons with walking which significantly lowered blood pressure.

In this study, grapefruit juice was shown to reduce blood pressure in both healthy patients and those exhibiting hypertension.

Oily fish: Oily fish such as salmon and mackerel are rich in omega 3 oils, which this source says “A higher Omega-3 Index is associated with statistically significant, clinically relevant lower [blood pressure]… Diets rich in [omega 3 fatty acids] may be a strategy for primary prevention of hypertension.”

Pumpkin seeds: Pumpkin seeds are a great food to snack on throughout the day. They are one of the best natural sources of magnesium, a mineral that’s important for keeping blood pressure in check. In one study, women taking 3gms pumpkin seed oil every day for three weeks, showed that their systolic blood pressure decreased significantly.

Raisins: This research was funded through the California Raisin Marketing Board, so make of it what you will, but they found that three handfuls of raisins a day for 12 weeks reduced high blood pressure. This could be because they are high in potassium. (And you’d need to watch your sugar levels if you were eating that many raisins per day.)

Spinach: Like beetroot which we mentioned earlier, spinach is rich in nitrates. It also contains potassium, magnesium and calcium – all of which are required, in balance, for healthy blood pressure. This study gave participants spinach soup, every day for a week. They found that dietary nitrate from spinach may have the potential to help manage elevated blood pressure.

EFT is an amazing tool I use with most of my clients. While it looks weird and sounds weird, there have been over 100 scientific studies done on the positive effects of EFT on many physical and mental health symptoms including anxiety, depression, phobias, cravings and addictions, PTSD and physical pain. It can also be used to improve athletic performance.

There are several accounts of people using EFT to treat high blood pressure successfully, including this German Dr, who discovered that many cases of hypertension are linked to emotional issues which can revealed by looking for stressful events in the clients life when the hypertension started. There are links to other blood pressure case histories on this page, one of which shows that following five rounds of tapping, one patient reduced her blood pressure from 149/95 to 119/84. This was later confirmed by her physician.

Exercise

Exercise is an important factor in a healthy blood pressure, especially with our sedentary lifestyles. And walking is one of the easiest exercises to do and requires no special equipment. Aim for brisk walking, at least 30 minutes a day, at least 5 days a week. If you’re short on time, vigorous activity, like jogging, gives you the same benefit in 20 minutes, 3 to 4 days a week.

Data in this small study shows that aerobic exercise leads to a significant reduction of blood pressure – this occurred after 8-12 weeks of walking on a treadmill three times a week. Strength training can also help, as this study reveals. Another study shows that walking on a treadmill for 30 minutes each morning lowers blood pressure; it also highlights the importance of getting up regularly, if your lifestyle requires you to sit a lot (hello computer workers…)

Essentially any exercise that you stick to and enjoy should bring benefits – use a bike, go for a swim, take an aerobics class or pick up a skipping rope. Your commitment to what you are doing is more important than what you actually do.

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If you sit for several hours a day, try to take 5- to 10-minute breaks each hour to stretch and move. Set a reminder on your phone for this if you need to.

Herbs

Berberine is a naturally occurring compound found in many plants. It’s been used for hundreds of years in Chinese medicine to treat various ailments including reducing blood sugar levels, lowering cholesterol as well as helping people to lose weight. In this clinical trial – due to finish in May 2022 – researchers are investigating whether berberine hydrochloride tablets will have a positive effect on hypertension. In this study, promising results were found when using berberine on diabetic rats.

Hawthorn berry shows promising results in research too. In this study, volunteers took either 600 mg magnesium or 500 mg hawthorn berry extract daily for 10 weeks. They also set up groups taking both supplements or a placebo. At the end of the ten weeks, there was significant reduction in diastolic blood pressure for those taking hawthorn berry compared to the other groups. What’s interesting, is they also had lower anxiety scores. When you consider that stress can be a big component of hypertension, hawthorn berry could be a useful herbal remedy.

Another study was done on patients with diabetes, as well as high blood pressure. Patients with type 2 diabetes were randomly given either 1200 mg hawthorn extract or a placebo for 16 weeks. At the end of the research, patients who had been taking hawthorn extract had significant difference in mean diastolic blood pressure reductions. See the study here.

Isometric Hand grip exercises

I find this study very exciting, because it’s a fun thing to do. And when you’re feeling stressed, it’s important to bring fun into your life. For the study, participants used a handgrip tool at 30% of their maximum voluntary contraction for 3 minutes, then rested for 5 minutes and repeated this five times. This exercise was repeated three times a week for 10 weeks. They concluded that Isometric Hand Grip exercise training might be a simple, effective, inexpensive and non-pharmacological method in lowering blood pressure.

In another study, the Journal of the American Heart Association found similar results when participants performed 3 sessions per week, for 8 weeks, of unilateral handgrip exercises, consisting of 4 sets of isometric contractions for 2 minutes at 30% of maximum voluntary contraction and a 4‐minute interval between sets. You can read that in full, here.

Here’s a short YouTube on how to do the exercise:

If isometric exercises feel achievable to you, but you don’t have a hand grip tool, then there are other things you can do such as doing thigh squeezes while you’re sitting at your desk or watching TV, holding the plank bridge or squeezing a ball in your hand. This brilliant article talks you through half a dozen easy and fun exercises. The authors cite that in a handful of studies, people with normal blood pressure who did three 15 to 20 minutes sessions of isometric exercises every week for 10 weeks experienced more than a 10-point plunge in their systolic blood pressure. And their diastolic pressure fell almost 7 points. Not bad for not lifting a finger!

They continue by saying that in the research, the three weekly sessions included doing multiple 2-minute rounds of isometric exercises like those, with 1 to 3 minute rests in between.

Meditation, mindfulness and relaxation

Stress can be a major contributor to hypertension, so it’s important to reduce stress as much as possible. How you do that is an individual choice, but tools like mindfulness based stress reduction (MBSR) and other relaxation techniques can help. You can find some simple audio files to listen to on the EppCymru site. Breathing techniques where the out-breath is twice the length of the in-breath can help you to relax. If you have a pet, you’ll know they are fantastic for releasing tension, so go and stroke your cat or dog! And don’t forget laughter, watch some funny videos on YouTube, call up a friend who shares your sense of humour or join a yoga laughter group.

Music

Have you noticed how music can change your mood? Well it can lower your blood pressure too! In this small study, participants who listened to classical, Celtic or Indian (raga) music for just 30 minutes a day for one month had significant reductions in their blood pressure. This study found that listening specifically to Mozart or Strauss had similar effects on hypertension.

Supplements

Taking good quality supplements can help support healthy blood pressure. For example:

Calcium is low in some hypertension patients. To ensure good uptake of calcium, you need vitamin D3 and K2 as well.

COQ10 A suggested daily dose of 150mg COQ10 may help lower blood pressure

EFAs We’ve already talked about EFAs in relation to oily fish.

Magnesium around 200-600mgs per day can help reduce blood pressure

Potassium helps regulate blood pressure, so consider taking a supplement and / or adding potassium-rich foods into your diet, such as bananas or raisins; which we’ve already mentioned.

Probiotics. It’s becoming more and more apparent that good health begins in the gut. In Hypertension journal, it was found that probiotic consumption over a couple of months may improve blood pressure. You could also include kefir in your diet, which has been shown to lower blood pressure in rats.

Weight

Keeping your weight at healthy levels can help reduce blood pressure. In fact, your blood pressure rises as your body weight rises, because your heart has to work harder to pump the blood around your body. Find out if you have a healthy BMI with this online calculator.

Tai Chi, Qi Gong and Yoga

While scientific evidence is limited, proponents of tai chi, qi gong and yoga believe these forms of exercise can relieve tension, help relaxation, aid sleep and improve a sense of well-being.

Yoga is an exercise-related and posture-related technique that involves gentle stretching, breath control and meditation. Here are several yoga poses reported to be beneficial for treating hypertension. While studies are limited, there is evidence that yoga can have a ‘moderate’ effect on lowering blood pressure. However, yoga has so many more benefits, that it felt right to include it here.

Both Qi Gong and Tai Chi use slow movements, postures and stretches, based on a Chinese martial art, used to enhance mental and physical health. When done regularly, both might enhance cardiovascular function and improve well-being by helping relaxation.

As mindful breathing, reduction of stress and increased exercise can help lower blood pressure, it’s worth taking a class in one of these disciplines to see how it might benefit you.

It can be terrifying to be diagnosed with hypertension, but it’s important to recognise that things can be done, if you address certain lifestyle factors, such as weight, exercise, diet and stress levels. If you are suffering from the stress caused by, or contributing to, high blood pressure, then contact me. I help stressed, overwhelmed, anxious people transform their lives so they feel happy, healthy and energised.

The Pulse: Cardiologist Micah Eimer On High Blood Pressure, ‘White Coat Syndrome’ And More

Commissions we earn from partner links on this page do not affect our opinions or evaluations. Our editorial content is based on thorough research and guidance from the Forbes Health Advisory Board.

Dr. Micah J. Eimer is an experienced general cardiologist in the division of cardiology at Northwestern University Medical School. He is also the medical director for the Evanston/Glenview/Deerfield Outpatient Centers for Northwestern Medicine.

In addition to being a Forbes Health Advisory Board member, Dr. Eimer is a cardiology consultant for Northwestern Athletics and co-director of the Sports Cardiology Program at Northwestern University Medical School.

In a conversation with Forbes Health, Dr. Eimer shares his thoughts on high blood pressure, common heart health myths, Apple’s new technology aimed at measuring blood pressure levels and more.

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High blood pressure is often referred to as the “silent killer.” But are there any signs I can watch for?

It’s true that most people don’t feel high blood pressure, but there are a few exceptions.

When blood pressure is very elevated, patients may complain of headache, visual changes, shortness of breath or chest discomfort. Long-term high blood pressure, though, may eventually manifest as organ damage—for example, a stroke or heart attack. If the high blood pressure has done damage to the heart or kidneys over the years, patients may also present with fluid retention, which appears as swelling in the legs.

On the flip side, are there any signs of low blood pressure I can watch for?

Patients with low blood pressure, regardless of the cause, typically feel lightheaded or dizzy and occasionally may pass out. This tends to be worse when standing up quickly from bed or getting out of a chair.

The vast majority of low blood pressure is due to overtreatment of high blood pressure. Occasionally, young thin women will have symptoms of organic low blood pressure. In addition, there are rare endocrine and neurologic disorders that can cause low blood pressure.

My blood pressure is always high when I get it checked at the doctor, but when I check it by myself at home with a blood pressure monitor, it’s normal. What’s that about?

This is a very common problem often referred to as “white coat syndrome” [a temporary, fight-or-flight-induced spike in blood pressure]. For this reason, I don’t typically make treatment decisions based on office blood pressure. All patients with high blood pressure should have an automatic blood pressure machine for checking blood pressure at home. Even at home, the results can seem variable at times. My advice to patients is to check the blood pressure three times in five minutes at home and record only the third value.

Are there any foods I can eat to lower my blood pressure?

The DASH diet looked at this exact question and found that a diet low in sodium and high in potassium is as effective as a blood pressure medication for lowering blood pressure. (Interested in learning more about the DASH diet? Read our guide here).

Apple is reportedly planning on adding a feature to its new smartwatch that measures blood pressure, and everyone seems really excited. Is this an effective way for me to measure and monitor my blood pressure? I’ve heard blood pressure wristbands aren’t recommended , so is this just hype?

One of the biggest obstacles to treating high blood pressure well is getting enough data outside the office. There are some exciting technological innovations on the horizon that may change the way blood pressure is measured and thus managed. Treating a patient’s blood pressure based on one reading at an annual physical is far from ideal. In fact, there are some patients in whom the act of checking blood pressure with a traditional sphygmomanometer raises their blood pressure.

Novel technologies may allow us to track blood pressure throughout the day without the patient sensing it. This technology is different from currently available wrist cuffs, which inflate and are prone to being less accurate, in my experience. This could provide data about nocturnal blood pressure, an area that is not well understood but thought to be important in health. Of course, this new technology has to be validated against the standard of care in a wide range of outpatients to be accepted.

What is one heart health myth you’ve heard that you can’t stand?

It’s the difference between “I don’t have the disease” and “I am well treated for the disease.” A treated disease is not the same thing as not having the disease—which is not to de-emphasize the importance of good control of these conditions, but rather to remind patients that treated diseases are still associated with excess risk compared to patients who do not have the disease. It gets to the fundamentals of prevention and healthy lifestyle and avoiding the false sense of security from medication.

When explaining this distinction, I make two levels in the air with my hands as an illustration—the lower hand is the risk of having a heart attack with normal blood pressure, the higher hand is the risk of having a heart attack with uncontrolled high blood pressure and in the middle is the risk of having a heart attack with treated high blood pressure.

Aside from managing my blood pressure levels, are there any other health metrics I should be focusing on to avoid heart disease and boost my heart health in the new year?

Exercise, exercise and exercise. If patients seem overwhelmed with what to eat and how to lose weight, I usually say just start with exercise. Thirty minutes three to five days per week is ideal, but if the patient is not doing any exercise, then start with five to 10 minutes of walking per day. When a patient exercises, they naturally eat better and often lose weight without really trying. Also, at any weight, patients who exercise are at a lower risk of heart attack. So just start there.

I’m on blood pressure medication. Will I need to be on it forever? Is there anything I can do to try and get off?

It depends. Start by looking at your parents. If your parents were diagnosed with high blood pressure in their 20s and 30s with a reasonable lifestyle, then chances are you’ve arrived at high blood pressure genetically, which is very difficult to treat without medication.

If that’s not your family history and you can make improvements in lifestyle—like losing weight, exercising and avoiding sodium—then chances are you can reduce or possibly eliminate medication depending on how successful you are with the lifestyle changes. One often overlooked but very treatable and common cause of high blood is sleep apnea. Patients who have their sleep apnea diagnosed and treated can, in some cases, reduce or eliminate blood pressure medication.

The Pulse is for informational purposes only and should not substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health providers with any questions about a medical condition.

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