Elevated blood pressure, also known as hypertension, affects approximately 1.28 billion adults worldwide and is a significant risk factor for increased mortality. People who develop high blood pressure are more likely to experience health issues like heart attacks, strokes, dementia, kidney disease, and vision problems due to longstanding damage to the blood vessels within those organ systems. Many people are unaware they have high blood pressure until it is too late, which is why increasing awareness and education on lifestyle changes to manage high blood pressure is essential for primary and secondary prevention (1,2).    

Blood pressure is the measurement of pressure against the aorta as the heart contracts (systolic) to force blood into the systemic circulation and relaxes (diastolic) to allow for ventricular filling. Many factors can affect your blood pressure, and values can fluctuate throughout the day, depending on individual circumstances. When high blood pressure becomes sustained and chronic, it can largely influence your health outcomes. Therefore, becoming empowered on how to adapt lifestyle habits to reduce your risk is an essential step in your health.

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High Blood Pressure Signs & Symptoms

High blood pressure is termed “the silent killer” because the pathophysiology often occurs long before an individual develops any signs or symptoms. Measurement of your blood pressure is often the only sign.

It is important to be aware of the presence of other symptoms and how they may be associated with elevations in blood pressure. Here are some signs or symptoms that warrant further assessment, as they may point to other more serious medical conditions in which high blood pressure is present (8,9,10):

• Hypokalemia (lower than average potassium level)
• Chest Pain
• Shortness of Breath
• Palpitations
• Peripheral Edema
• Headaches
• Blurred or impaired vision
• Neurologic Deficits (i.e., garbled speech, numbness or weakness in one extremity)
• Thyroid dysfunction (i.e., Fatigue/Tiredness, weight gain or loss, heat intolerance)
• Snoring

High Blood Pressure Causes

The human body has its own internal regulatory system that works to maintain healthy blood pressure in individuals (5). When this system is disrupted, the blood pressure can become dysregulated and contribute to further health challenges. Genetics, age, race, socioeconomic status, and lifestyle choices are associated with the development of hypertension.

Primary and Secondary Hypertension

There are two categories of hypertension: primary and secondary.

Primary

When there is no known disease-causing the elevation in blood pressure, this is referred to as primary hypertension. Generally, primary hypertension is the result of lifestyle choices (11).

Secondary

Secondary hypertension occurs as a result of a disease or condition. This can include adrenal dysfunction, kidney disease, obstructive sleep apnea, insulin resistance, pregnancy, thyroid disease, immune dysregulation, or medication side effects (12,13,14).

At large, the understanding that high blood pressure is an inflammatory process allows for functional medicine to shine. Finding the root cause etiology through a functional medicine approach will enable patients to implement lifestyle choices as primary and secondary prevention.

Risk Factors for High Blood Pressure

As previously mentioned, there are many risk factors for hypertension (2).  

Age: Given that aging is associated with inflammation, it is not surprising that the prevalence of high blood pressure increases with age. Men are at greater risk of developing high blood pressure compared to women. However, over the age of 60, the rates were similar. Unfortunately, due to the higher levels of metabolic disease, we are now seeing increasing rates in children as young as six years of age.  

Race: Non-Hispanic black men have the highest prevalence of high blood pressure compared to Hispanic and non-Hispanic white adults. Studies are exploring why these disparities occur.

Genetics: Family history increases one's risk of developing high blood pressure. There is much discussion regarding the role of epigenetics and how much impact one's lifestyle and environment contribute to gene activation.  

Stress: Stress can come in many forms, from psychosocial to physiologic. Troubled relationships, poor socioeconomic status, or job burnout are examples of psychosocial stress that can directly affect one's blood pressure. Physiological stress includes insulin resistance, obesity, smoking, excessive alcohol intake, sleep apnea, hormone dysregulation, and toxicity (15,16,17,18).  

Dietary Choices: It has been well documented how dietary choices are associated with blood pressure control. Magnesium, Potassium, and Omega-3 fats are a few nutrients necessary for blood pressure maintenance. These nutritional choices also directly impact the health of the microbiome.

Physical Activity: Individuals who lead sedentary lifestyles are at a significantly higher risk of developing cardiovascular disease, including elevated blood pressure. Exercise has many beneficial mechanisms which allow for the support of healthy blood pressure levels.  

High Cholesterol: Cholesterol plaque and calcium can cause your arteries to become hardened and narrower, which may cause your heart to have to pump harder to push the blood through them. As a result, this increases blood pressure.

Hormone Imbalance: Hormones can directly influence blood pressure regulation. They can become unbalanced for various reasons, most notably from lifestyle choices. Sex hormones can impact endothelial function, potentially affecting blood pressure when imbalanced. Stress hormones, like cortisol, may result in elevated blood pressure due to inflammation and oxidative damage within the cardiovascular system.

How Functional Medicine Practitioners Look for The Root Cause of High Blood Pressure

Traditional lab work can provide great insights into cardiovascular health. A Comprehensive Metabolic Panel, CBC w/ differential & platelets provides information about nutrient levels, the health of blood cells, and the immune system. Fasting Insulin and Hemoglobin A1c are necessary to identify how the body handles glucose and if any insulin resistance is occurring.

Uric acid, fibrinogen, and B-type natriuretic peptide are other common inflammatory markers that are associated with hypertension.

The Cardiac Health Panel is a more comprehensive lab test that provides a series of cardiac and lipid biomarkers. This includes markers like apolipoprotein A-1 (apo A1), C-Reactive Protein (hs-CRP), and homocysteine. Elevations in these biomarkers occur when there is systemic inflammation and place an individual at higher risk for cardiovascular disease.  

Hormones

Understanding the balance of hormones related to high blood pressure is vital to work towards root cause resolution. The Dutch Complete is a urine test that, as previously referenced, will provide insight into sex hormones and adrenal health. In addition, organic acid testing is included and will provide methylation and glutathione synthesis markers, necessary for proper detoxification of heavy metals or other toxins that may be present. An essential part of supporting health is understanding methylation patterns and working to ensure detoxification pathways are supported.  

Thyroid function directly impacts cardiovascular health and the management of normal blood pressure. A complete thyroid panel is recommended to understand further the patterns occurring in each individual.

Inflammatory Labs

Inflammation is often at the root of high blood pressure. Based on symptom presentation, there are several tests that may be best to help identify the source.  

• The microbiome's health is an important assessment when pursuing sources of inflammation. The GI Map is a comprehensive stool test that helps identify pathogens and inflammatory markers in the stool. A comprehensive stool test can also help a practitioner detect if the patient is properly breaking down and absorbing vital nutrients needed to maintain homeostasis.
• Micronutrient Testing: Maintaining proper nutrients for optimal blood pressure is essential. If you are worried your patient isn't eating a well-rounded diet or if their comprehensive stool test shows poor digestion, a micronutrient panel can help detect imbalances in their diet.
• While not commonly thought of, an overload of toxins, specifical mercury, is a risk factor for high blood pressure. A comprehensive urine toxin panel will provide markers for heavy metals and environmental toxins to have greater insight into the role of toxicity in hypertension.

Lifestyle Changes to Support Healthy Blood Pressure

Nutrition

Prioritizing proper nutrition is an essential step in lifestyle change to support healthy blood pressure. Food provides fuel and information to each cell. Healthier food choices may facilitate weight management and work to stabilize blood sugars, both of which can help support healthy blood pressure levels. Ensuring plentiful, whole foods that consist of colorful fruits and vegetables is recommended with each meal. This will provide essential vitamins, minerals, antioxidants, and phytonutrients important for cardiovascular health, including boosting nitric oxide, necessary for endothelial health. Moreover, by eating this way, you are supporting the health of your microbiome and reducing inflammation. The Dash and Mediterranean diets provide frameworks for meal planning and have shown to have positive effects on supporting healthy blood pressure.  

Excessive salt intake is associated with increased blood pressure. It is recommended that individuals not exceed 2.3 milligrams of added salt each day. In those who are high risk, these amounts may be less. Many packaged, processed foods contain a high salt content, and it is important to read food labels to monitor intake (19,20).  

Beverage choices can contribute to high blood pressure. Caffeine and alcohol can cause elevations in blood pressure if consumed in excess. Drinks with high sugar content will affect blood sugar and predispose a person to insulin resistance. Prioritizing clean, filtered water is recommended to maintain proper hydration status.

Perhaps a concept that is not well known, the process in which food is prepared can contribute to high blood pressure. Avoid using foods that were prepared using high heat, fried, or blackened. Instead, consider steaming your vegetables to reduce exposure to advanced glycation end products.

Herbs & Supplements

Using herbs and supplements to support healthy blood pressure can be effective in conjunction with dietary changes, especially when blood pressure has not exceeded dangerous levels. They may also be used alongside pharmacologic management to support oxidative stress, underlying deficiencies, detoxification, and cellular metabolism. Supplements and herbs that may be helpful in this instance include co-enzyme Q10, vitamin C, vitamin E, fish oil, garlic, vitamin B6, lipoic acid, magnesium, and zinc (21,22)

Lifestyle

Exercise has a multitude of benefits. Engaging in 30 minutes of moderate-intensity exercise most days of the week may help support healthy blood pressure levels. In addition, any weight management associated with routine exercise can support healthy blood pressure readings.  

Incorporating stress-reducing activities may have a positive effect on blood pressure by helping to shift the body from a sympathetic state to a parasympathetic state, which can help to support healthy blood pressure and facilitate well-being. The importance of breathwork, particularly nose-breathing, has cardiovascular and stress-relieving benefits. Other activities include therapeutic exercises, meditation, journaling, snuggling with a pet or loved one, or time in nature.  

Quit smoking. It is the single most modifiable risk factor for cardiovascular health, including elevated blood pressure, as it contributes to oxidative damage and arterial stiffening.  

Summary

Elevated blood pressure affects a large majority of the population and, if not managed properly, can contribute to a burden of chronic disease.

Fortunately, there are many natural approaches that one can take to assist with supporting healthy blood pressure. The biggest takeaway from this article is one should look for the root cause and focus on healthy lifestyle choices to support and maintain healthy blood pressure levels.