Of course, weight loss, salt avoidance, whole grains, and exercise are each very useful and important.  Non-medication strategies to lower blood pressure include calcium, magnesium, potassium, and vitamin D, although calcium should be avoided by men over 40 due to its increasing prostate cancer.  Several inexpensive natural supplements have been shown to lower high blood pressure in double-blind studies. Coenzyme Q10, carnitine, melatonin, policosanol, stevioside, and taurine have very few side-effects.  All have been shown to reduce stress on the heart with CoQ10 particularly well researched.  

CoQ10 and carnitine are natural substances the body uses in its mitochondria to help produce energy.  Melatonin is a powerful anti-oxidant produced in the brain at night to aid in the sleep-wake cycle.  Policosanol is a very inexpensive sugarcane wax which lowers bad cholesterol and raises good cholesterol.  Stevioside is a very inexpensive natural sweetener with some very limited evidence of helping high blood pressure.  Taurine is a free amino acid important in many bodily functions. Unfortunately, it is not known whether CoQ10 or stevioside help you live longer, while it has been well proven that ACE inhibitors, diuretics, beta-blockers, and angiotensin receptor blockers each increases longevity in individuals with hypertension.  Melatonin is one of the few substances proven to increase longevity in healthy animals.

Non-Medication Treatment

Balsamodendrom Mukul Helped Hypertensives in Small Study: In a 6-week DB PC study of 57 newly diagnosed hypertensives, those taking Balsamodendron mukul (an extract of the gum of a small tree) 1.5 g/d did better than placebo with levels of systolic blood pressure, diastolic blood pressure, plasma total cholesterol, low-density lipoprotein cholesterol, very low-density lipoprotein cholesterol, triglycerides, free fatty acids, and phospholipid levels were significantly reduced, and high-density lipoprotein cholesterol levels were significantly elevated. Combined therapy with B. mukul and nifedipine was more beneficial than the treatment with B. mukul alone. Single- or double-blind treatment With Balsamodendron mukul and nifedipine in hypertensive patients. Panneerselvam J, et al. Annamalai University, India. J Clin Hypertens (Greenwich). 2005 Jun;7(6):340-5.

Calcium Helps a Little: Bucher, McMaster, 275:1016, JAMA 4/3/96. The authors reviewed 33 trials with Calcium supplements covering 2,412 patients. Systolic decrease only 1.27 mmHg and diastolic 0.24 mmHg. They conclude there is a very small but significant benefit to systolic but not diastolic hypertension and not for normotensives. 

Carnitine Reportedly of Benefit: In a DB PC study of patients with essential hypertension and diabetes mellitus type II, L-carnitine at 2 g twice daily for 45 weeks resulted in extrasystoles, some disorders of A-V conduction and some electrocardiographic signs of ischemia being stopped or diminished and symptoms, chiefly asthenia, significantly improved. No side effects were observed. The benefits of L-carnitine therapy in essential arterial hypertension with diabetes mellitus type II. Digiesi V, Palchetti R, Cantini F., Universita di Firenze. Minerva Med. 1989 Mar;80(3):227-31. The information available to me of this study is sketchy.

CoQ10 Helps HBP in DB: In a DB PC study of 83 men and women, isolated systolic hypertension was treated for 12 weeks at 60 mg twice a day. The average was an excellent 17 mm decrease in BP. Idaho VA. Minor GI discomfort and increase LDH and SGOT has been reported elsewhere. Lower oxidation of LDL cholesterol and can regenerate Vit E. Randomized, double-blind, placebo-controlled trial of coenzyme Q10 in isolated systolic hypertension. Burke BE, Neuenschwander R, Olson RD. South Med J 2001 Nov;94(11):1112-7. 

CoQ10 Helps HBP in DB: In a 59 patient DB PC 8-week study of 60 mg twice a day, CoQ10 lowered systolic and diastolic BP in hypertensive patients already on meds. It also raised HDL "good cholesterol," and vitamins A, C, and E. It lowered glucose, fasting and 2 hour insulin and triglycerides. Effect of hydrosoluble coenzyme Q10 on blood pressures and insulin resistance in hypertensive patients with coronary artery disease. Singh RB, Niaz MA, Rastogi SS, Shukla PK, Thakur AS. India. J Hum Hypertens 1999 Mar;13(3):203-8.; Also, Digiesi V, Cantini F, Brodbeck B. Effect of coenzyme Q10 on essential arterial hypertension. Curr Ther Res 1990;47:841–5; Digiesi V, Cantini F, Oradei A, et al. Coenzyme Q10 in essential hypertension. Molec Aspects Med 1994;15 Suppl:s257–63.

CoQ10 Helps After Heart Attack in DB: In a DB PC study of 144 patients started on CoQ10 at 120 mg/day within 3 days of a heart attack, there were large decreases in angina (10% vs. 28%), total arrhythmias (10% vs. 25%), poor left ventricular function (8% vs. 22%) and total cardiac events (15% vs. 31%) over next 28 days. Lipid peroxidases, malondialdehyde, and diene conjugates, all indicators of oxidative stress, were lower with Q10. Vitamins A, C, E, and beta-carotene were all higher with Q10. Singh, Moradabad, Cardiovasc Drug Ther 9/98;12:347

CoQ10 Helps HBP: In a 109 patient open study, 51% were able to eliminate 1 to 3 BP medications. The average dose used was 225 mg/day given with goal blood level over 2 microg/ml. Only 1 patient dropped out. Treatment of essential hypertension with coenzyme Q10. Several patients with improved left ventricular function. Langsjoen P, Langsjoen P, Willis R, Folkers K. U Tx. Mol Aspects Med 1994;15 Suppl:s165-75; The same authors report treating 424 patients with 75-600 mg/day (aver. 242) depending on whether they were improving. One patient had transient nausea, the only side-effect noted. Usefulness of coenzyme Q10 in clinical cardiology: a long-term study. 58% improved heart functioning on NYHA scale. Langsjoen H, Langsjoen P, Langsjoen P, Willis R, Folkers K.: Please Note: Open trials are markedly inferior to DB studies. Fortunately, other researchers have done such studies and the benefits were documented. 

Exercise: 60-90 Minutes Lowers HBP a Lot: Kazuko Ishikawa-Takata, Japan's National Institute of Health and Nutrition tested 207 men and women who had high blood pressure but were otherwise healthy. None exercised regularly. Divided into 5 groups. 60-90 minutes/week gave 12 mmHg systolic & 8 mmHg diastolic lowering and more exercise without added benefit. JAMA 8/30/03

Fiber Helps Lower BP: In a meta-analysis of 25 randomized studies, dietary fiber intake was associated with a significant -1.65 mmHg reduction in diastolic BP (DBP) and a non-significant -1.15 mmHg reduction in systolic BP (SBP). A significant reduction in both SBP and DBP was observed in trials conducted among patients with hypertension (SBP -5.95 mmHg; DBP -4.20 mmHg) and in trials with a duration of intervention >/= 8 weeks (SBP -3.12 mmHg; DBP -2.57 mmHg).

Garlic Oil, Hawthorn, Valerian root, Reishi mushrooms, Celery Promoted for HBP: Energy Times 2/99, a typical free health food store magazine, was promoting the above for hypertension.  I can unable to find any human research. A University of Chicago study of butyl phthalide from celery found it decreased BP in rats.  I small human report claimed the same effect, but it was just a small observational report, not a scientific study of any type.

Hibiscus Helped Blood Pressure: In a 4-week DB PC study of 193 adults with hypertension stage I or II, hibiscus s. with 250 mg of total anthocyanins per dose vs. 10 mg of lisinopril found hibiscus decreasing blood pressure from 146/98 to 130/86 mmHg (11.58/12.21%, p < 0.05) without side-effects. ACE plasmatic activity was inhibited by HsHMP from 44 to 30 Units (Us; p = 0.0001). A randomized, double-blind, lisinopril-controlled clinical trial. Herrera-Arellano A, et al. Instituto Mexicano del Seguro Social, Argentina, Mexico. . Planta Med 2007 Jan;73(1):6-12.

Hibiscus Helped Blood Pressure: In a 1-month DB study of 75 hypertensives ages 30-80, an infusion prepared with 10 g of dry calyx from H. sabdariffa on 0.51 water (9.6 mg anthocyanins content), daily before breakfast, or captopril 25 mg twice a day, H. sabdariffa decreased systolic BP from 139 to 123mm Hg and diastolic BP from 90 to 79mm Hg, very similar to captopril. A natriuretic effect was observed with hibiscus. No side-effects were noted. Effectiveness and tolerability of a standardized extract from Hibiscus sabdariffa in patients with mild to moderate hypertension: a controlled and randomized clinical trial. Herrera-Arellano A, Flores-Romero S, et al. Morelos, Mexico. Phytomedicine. 2004 Jul;11(5):375-82

Magnesium Helps a Little in DBs: A meta-analysis of 20 studies found that magnesium lowered diastolic and systolic by only 1 mmHg but higher doses (e.g. 40 mmol/d vs. 10 mmol/d) had considerably larger effect although more research is needed on this. The effect of magnesium supplementation on blood pressure: a meta-analysis of randomized clinical trials. Jee SH, Miller ER 3rd, Guallar E, Singh VK, Appel LJ, Klag MJ. Korea. Am J Hypertens. 2002 Aug;15(8):691-6.  Many studies in PubMed suggest that magnesium helps in many ways.  I recommend and personally take 250 mg twice a day.

Melatonin: Supplement Lowering Effect at Night in Diabetic Teens: Melatonin 5 mg taken at bedtime increases the nocturnal drop of diastolic blood pressure (BP) in adolescents with type 1 diabetes. In an open-label trial of 10 mg melatonin for 7 days with 9 normotensive adolescents with type 1 diabetes, and 8 healthy teens, for diabetic teens systolic BP decreased 4.4 mmHg and diastolic 2.2 mmHg, but no change for controls. Blood pressure-lowering effect of melatonin in type 1 diabetes. Cavallo A, Daniels SR, et al. University of Cincinnati. J Pineal Res. 2004 May;36(4):262-6

Melatonin: Nighttime BP Reduced in Hypertensives by Supplement: Patients with essential hypertension have disturbed autonomic cardiovascular regulation and circadian pacemaker function. The biological clock is involved in autonomic cardiovascular regulation. In a 3-week DB PC crossover study of 16 men with untreated essential hypertension, those taking melatonin 2.5 mg/night had reduced systolic and diastolic blood pressure during sleep by 6 and 4 mm Hg, respectively. The treatment did not affect heart rate. A single dose of melatonin had no effect on blood pressure or sleep. Improvements in blood pressure and sleep were statistically unrelated. Daily nighttime melatonin reduces blood pressure in male patients with essential hypertension. Scheer FA, Van Montfrans GA, et al. Netherlands Institute for Brain Research, Amsterdam. Hypertension. 2004 Feb;43(2):192-7. 

Potassium Helps in Those Not Restricting Sodium: JAMA 5/28/97 277:1624 Whelton. This review of 33 DB PC studies totaling 2609 patients with potassium supplements found that potassium decreased systolic blood pressure by 3.11 mmHg and diastolic 1.97 mmHg.  It helps those with high sodium intake especially. Whelton says supplements do not help normotensives. Article used by Energy Times to promote taking supplements as was published in Hypertension ’98;31:131-8 which Energy Times claims reported lowering BP for 300 women with potassium supplement. But the actual article found potassium only of benefit for those with low intake and that calcium and magnesium supplement did not of benefit individuals despite low intake, a fact left out by Energy Times. Fruits, nuts, vegetables, cereals, and dairy are high in potassium.

Potassium Supplement Lowered Blood Pressure: 6 week DB PC 59 healthy adults took 24 mmol (roughly 1000 mg or 1/4 teaspoon of "No Salt") slow-release KCl per day. Systolic decreased 7 mmHg and diastolic 6 mmHg, similar to the impact of a blood pressure medicine. Epidemiological and clinical trials suggest an inverse relationship between dietary K intake and blood pressure (BP). Author says 24 mmol = 5 servings of fruits or vegetables in potassium content. King’s College London. The effect of low-dose potassium supplementation on blood pressure in apparently healthy volunteers. Naismith DJ, Braschi A. Br J Nutr. 2003 Jul;90(1):53-60; Potassium chloride helped salt-sensitive Dahl rats. J Hypertens. 2003 Dec;21(12):2305-13

Potassium Supplement Lowered in Beijing: 150 patients with borderline to mild HBP (systolic 130-160, diastolic 80-94) DB PC 12 week 60 mmol potassium (about 2500 mg or 3/4 teaspoon of "No Salt"). Systolic BP dropped 5 mmHg and diastolic 1mmHg. Effect of potassium supplementation on blood pressure in Chinese: a randomized, placebo-controlled trial. Gu D, He J, Wu X, Duan X, Whelton PK. J Hypertens. 2001 Jul;19(7):1325-31

Potassium Supplement Lowered Blood Pressure in Kenya: 84 patients with mild HBP in a DB study of potassium 60 mmol or bendrofluazide (a diuretic) for 28 weeks found that both groups showed a major decrease in BP with diastolic dropping 108 to 88 with potassium. No side-effects or biochemical changes occurred from potassium, but the diuretic caused 8 cases of hyperuricemia, 4 hyperglycemia, and 3 hypokalemia. Potassium supplementation versus bendrofluazide in mildly to moderately hypertensive Kenyans. Obel AO, Koech DK. J Cardiovasc Pharmacol. 1991 Mar;17(3):504-7.

Potassium Lowers Stroke: A Harvard study with 8 years of follow-up of men taking potassium supplements during first 2 years found 69% fewer strokes. Men with highest potassium intake (4.3 g supplement or 9 servings of fruits and vegetables) had 38% fewer strokes than lowest intake (2.4 g or 4 servings).

Potassium Baking Powder OK; "No Salt" and Orange Juice Cheapest Sources; Potassium Capsules a Waste: Potassium is high in most natural foods including almost all fruits, vegetables, beans, peas, etc. It is low in refined flour and absent from sugar and oils. The cheapest way to add potassium to the diet is to buy a large shaker of "No Salt" and use up to a teaspoon a day.  Over-the-counter potassium capsules are five times more expensive.  At Walmart, 250 potassium 99 mg. capsules costs $4 (25,000 mg). Many people would need 15-30 a day!  At my local health food store, just 100 capsules cost an incredible $4-8. Potassium baking powder at another health food store costs $4.50 for the equivalent of 400 capsules (29,160mg) and works fine as a healthy baking powder.  We use it whenever we need baking powder. OJ has 4500 mg of potassium in a 1/2 gal, or 560 mg/cup.  While this is more expensive that Walmart potassium capsules, orange juice is a low cost food with many other nutritional values and tastes two cups a day tastes a lot better than 11 capsules of potassium. Studies using potassium supplements use 60-120 Meq/day or 4500 mg-9000 mg./day (1 mEq=75 mg). Micro-K 10 Extencaps have 750 mg. potassium. The usual dietary intake of potassium for an adult is 50-100 mEq/day or 3500-7000 mg./day. Excessive levels are rare if a person has normal kidney function. However, in chronic renal failure, systemic acidosis, acute dehydration, extensive burns, adrenal insufficiency or with a potassium sparing diuretic medication such as spironolactone, triamterene, or amiloride, there is a danger of overdosage.

Policosanol Reported to Decrease Serious Vascular Effects in High Cholesterol Diabetics in 2-Year Study: In a 2-year DB PC study of 239 Type 2 diabetics with high cholesterol, those on policosanol 5 mg/day lowered LDL-C (29.5 %), TC (21.9 %), TG (16.9 %) and raised HDL-C (12.4 %). No significant changes occurred with placebo. The frequency of serious adverse events (SAE), mostly vascular, in policosanol patients (6/119, 5.0 %) was much lower than in placebo (26/120, 43.3 %). Five patients, all placebo, died during the study, four due to myocardial infarction. No drug-related impairment of safety indicators, particularly on glycemic control, was observed. A reduction of systolic and diastolic blood pressure was observed with policosanol. Long- term effects of policosanol on older patients with Type 2 diabetes. Mas R, Castano G, Fernandez J, Gamez RR, Illnait J, Fernandez L, Lopez E, Mesa M, Alvarez E, Mendoza S, Cuba. Asia Pac J Clin Nutr. 2004;13(Suppl):S101 

Quercetin supplemented diet did not prevent cardiovascular complications in spontaneously hypertensive rats. Carlstrom J, et al. J Nutr 2007 Mar;137(3):628-33. University of Utah

Quercetin Helped Salt-Sensitive Rats: Both quercetin and verapamil had similar antihypertensive effects in mineralocorticoid hypertension, but only quercetin improved endothelial dependent aortic dilatation.

Sesame Oil Powerful Lowering Effect on HBP: 328 people with hypertension on nifedipine 10-30 mg/d. were treated with 35 grams (a little more than 2 tablespoons) of sesame oil a day for 60 days as their sole cooking oil. It lowered their blood pressure levels from 166 mm Hg systolic to 134 mm Hg and from 101 mm Hg diastolic to 84.6 mm Hg. Nifedipine was able to be decreased from 22 to 7 mg/d. Meeting of the Inter-American Society of Hypertension. 3/10/03 Yahoo.

Stevioside Sweetener Helps Hypertension: Stevioside is an extract from the leaf of a plant native to Paraguay. It is used as a sweetener in Brazil and Japan. A two year 174-patient DB PC study of Taiwanese with mild high blood pressure found stevioside 500 mg (1/2 teaspoon) 3 times a day lowered systolic BP from 150 to 140 and diastolic from 95 to 89. Side-effects were the same in both groups. Quality of Life was better with stevioside. The percentages developing left ventricular hypertrophy of the heart were 6% for stevioside and 24% for placebo. Taiwan Univ. Efficacy and tolerability of oral stevioside in patients with mild essential hypertension: A two-year, randomized, placebo-controlled study. Hsieh MH, Chan P, Sue YM, Liu JC, Liang TH, Huang TY, Tomlinson B, Chow MS, Kao PF, Chen YJ. Clin Ther. 2003 Nov;25(11):2797-808; 

    Steviol's hypotensive mechanism may be due to inhibition of the Ca(2+) influx. Pharmacology. 2003 Jan;67(1):14-20. While calcium channel blockers, like nifedipine (Procardia), also inhibit calcium influx, there must be important differences, because steviosides has virtually no side-effects while calcium channel blocker cause frequent dizziness, flushing, peripheral edema, muscle cramps and other side-effects. A more recent study suggests that a selective relaxation of the potassium channel by isosteviol allows intracellular calcium to escape. The results indicate that a decrease of [Ca (2+)]i in A7r5 cells by isosteviol is mainly mediated by the selective opening of potassium (ATP) channel or/and calcium-activated potassium (SK (Ca)) channel channel. Alteration in the potassium voltage-gated (Kv) channels also plays a critical role in the inhibitory action of isosteviol. Planta Med. 2004 Feb;70(2):108-12

Stevioside Helps Hypertension: In an earlier DB PC study of 106 Chinese hypertensives, 250 mg (1/4 teaspoon) 3 times a day was effective throughout the one year study and lowered the average systolic from 166 to 152 and the diastolic from 104 to 90. No side-effects were noted and it had no impact on blood biochemistry or glucose. A double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension. Chan P, Tomlinson B, Chen YJ, Liu JC, Hsieh MH, Cheng JT. Br J Clin Pharmacol. 2000 Sep;50(3):215-20.  Ed: 250 mg of pure stevioside is enough to sweeten 4-8 cups of tea.  I found taking the 1/4 teaspoon dose of powdered stevioside easily tolerated if immediately followed by food and drink. At the best price I could find to get this dosage, it would cost just $0.08 per day. Several generic medicines, e.g. the ACE inhibitors captopril (Capoten) or enalaprilat (Vasotec), the diuretic hydrochlorothiazide, and some beta-blockers, for high blood pressure cost only 2-10 cents a day wholesale, but the pharmacy fee would make them more expensive than stevioside.  Stevioside, if used in place of an artificial sweetener, is less expensive than any currently on the market in the U.S.  Coenzyme Q10 is better researched than stevioside and costs 30-60 cents per day for 100-120 mg once a day dose. CoQ 10 is also a very good supplement for the heart.  Both can be used together.

Taurine Lowered BP in Small, Brief Human Study: In 19 borderline high blood pressure young patients treated in a DB PC trial for just 7 days with taurine 6 g/d, systolic blood pressure decreased 9.0 vs. 2.7 mmHg and diastolic decreased 4.1 vs. 2.7. Taurine lowered epinepherine but not norepinepherine. Effects of increased adrenomedullary activity and taurine in young patients with borderline hypertension. Fujita T, Ando K, Noda H, Ito Y, Sato Y. Circulation. 1987 Mar;75(3):525-32 

Taurine Helps Salt-Induced Hypertensive Mice: Hagiwara K, et al, Tohoku University, Sendai, Japan. J Cardiovasc Pharmacol. 2003 Jan;41 Suppl 1:S127-31.

Taurine: Helped in Rat Studies:  In a review, the authors notes that in several rat models of hypertension taurine has helped high blood pressure, among other cardiovascular problems, i.e., the spontaneously hypertensive rat, the DOCA-salt rat, the Dahl-S rat, the renovascular hypertensive rat, the hyperinsulinemic rat and the ethanol-treated rat. Militante JD, Texas Tech. Amino Acids. 2002;23(4):381-93  

Vitamin C Might Help: Taddei, U Pisa, Circ ’98;97:2222-9 = very small study of 14 HBP and 14 healthy given Vit C and in HBP pt, impaired endothelial vasodilation improved by Cit C and support hypothesis that nitric oxide inactivation by oxygen free radicals contributes to endothelial dysfunction in HBP. This article was used by Energy Times 2/99 to promote taking Vit C for HBP; U Freiburg. Circ ’97;96:1513-9

Vitamin D and Sunlight May Help Prevent: The prevalence of hypertension in a population increases with distance north or south of the equator.  Ultraviolet light may contribute to geographic and racial blood pressure differences. Rostand SG. Hypertension 1997;30:150–6. Hypertension becomes less severe in subjects whose 25(OH)D concentrations are increased to >100 nmol/L through ultraviolet exposure^. Krause R, Buhring M, Hopfenmuller W, Holick MF, Sharma AM. Ultraviolet B and blood pressure. Lancet 1998;352:709–10.

Vitamin D Suppresses Renin and Hypertension: Vitamin D is a potent endocrine suppressor of renin biosynthesis. Mice lacking the Vitamin D receptor have elevated production of renin and angiotensin II, leading to hypertension, cardiac hypertrophy and increased water intake. These abnormalities can be prevented by treatment with an ACE inhibitor or AT(1) receptor antagonist. Vitamin D repression of renin expression is independent of calcium metabolism, the volume- and salt-sensing mechanisms and the Ang II feedback regulation. In normal mice, Vitamin D-deficiency stimulates renin expression, whereas injection of 1,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)] reduces renin synthesis. In cell cultures, 1,25(OH)(2)D(3) directly suppresses renin gene transcription by a VDR-dependent mechanism. Vitamin D: a negative endocrine regulator of the renin-angiotensin system and blood pressure. Li YC, Qiao G, Uskokovic M, Xiang W, Zheng W, Kong J. University of Chicago. J Steroid Biochem Mol Biol. 2004 May;89-90(1-5):387-92

Thomas E. Radecki, M.D., J.D.

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