How Not to Die from High Blood Pressure

High blood pressure is the number-one risk factor for death in the world. In the United States, it affects nearly 78 million people, one in three adults. As we age, our blood pressures get higher and higher, such that by age 60, high blood pressure strikes more than half of us.

Given that it affects most of us when we get older, could high blood pressure be less a disease and more just an inevitable consequence of aging? No. We’ve known since the 1920s that high blood pressure need not occur, which I discuss in my video How Not to Die from High Blood Pressure.

Researchers measured the blood pressures of a thousand people in rural Kenya, where their traditional diet included more whole grains, beans, vegetables, fruit, and dark leafy greens. Though our pressures go up as we age, their pressures actually go down.

With blood pressure, the lower, the better. The 140/90 cut-off you may have heard here or there is arbitrary. Even people who start out with blood pressures under 120/80 appear to benefit from blood pressure reduction. Your doctor would likely give you a gold star if you had a blood pressure of 120/80, but research indicates the ideal blood pressure—blood pressure that wouldn’t get benefit from being any lower—may actually be 110/70.

Is it even possible to get blood pressures as low as 110/70? It’s not just possible—it’s normal for those living healthy enough lives.

Over two years, 1,800 patients were admitted to a rural Kenyan hospital. How many cases of high blood pressure were found? Zero. Wow they must have had low rates of heart disease. No, in fact, they had no rates of heart disease. Not a single case of our number-one killer, arteriosclerosis, was found. Rural China, too. There, people are about 110/70 their entire lives—70-year-olds with the same average blood pressure as 16-year-olds.

Those in Asia and Africa traditionally eat vastly different diets, but they do share a commonality: Both were plant-based day-to-day, with meat eaten only on special occasions. Why do we think it’s the plant-based nature of their diets that was so protective? Because in the Western world, as the American Heart Association has pointed out, the only people getting their blood pressures down that low were those eating strictly plant-based diets, coming in around 110/65.

The largest study to date of people eating plant-based diets studied 89,000 Californians. Non-vegetarians were compared to semi-vegetarians (also called flexitarians, those who eat meat more on a weekly rather than daily basis), pesco-vegetarians (those who eat no meat except fish), lacto-ovo-vegetarians (those who eat no meat at all), and vegans (who eat no meat, eggs, or dairy).

The subjects were Seventh-day Adventists, who all tended to eat lots of fruits and vegetables, exercise, and not smoke, and even the nonvegetarians didn’t eat a lot of meat. So, even compared to a group of relatively healthy meat-eaters, there appeared to be a step-wise drop in hypertension rates as people ate more and more plant-based diets, with vegans having lower rates than lacto-ovo-vegetarians, who had lower rates than pesco-vegetarians, and so on—and the researchers found the same for diabetes and obesity.

So, yes: We can wipe out most of our risk by eating a strictly plant-based diet, but it’s not all-or-nothing. It isn’t black-or-white. Any movement we can make along the spectrum towards healthier eating can accrue significant health benefits.

This can be shown experimentally: Give vegetarians some meat (and pay them enough to eat it), and their blood pressures go up. In another study, meat was removed from people’s diets, and their blood pressures went down—and did so in only seven days. What’s more, this was after the vast majority had reduced or even stopped their blood pressure medications completely. Indeed, the subjects had to stop their medications because once you treat the cause, you can’t be on multiple blood pressure pills with normal blood pressure. Your pressures could fall too low and you could get dizzy, fall, and hurt yourself, so your doctor has to take you off the pills. Lower blood pressures on fewer drugs—that’s the power of plants.

So, does the American Heart Association recommend a no-meat diet? No, it recommends a low-meat diet, known as Dietary Approaches to Stop Hypertension, or the DASH diet. Why wouldn’t the AHA recommend a completely plant-based diet? When the DASH diet was being created, were they just not aware of this landmark research, done by Harvard’s Frank Sacks showing those who eat strictly plant-based average 110/65? No, they were aware. The Chair of the Design Committee that came up with the DASH diet was Frank Sacks.

As he described, the DASH diet was designed explicitly with the number-one goal of capturing “the blood pressure-lowering benefits of a vegetarian diet, yet contain enough animal products to make them palatable” to the general population. They didn’t think the public could handle the truth.

In their defense, just as drugs don’t work unless you actually take them, diets don’t work unless you actually eat them. So, maybe they thought few would eat strictly plant-based, so by soft-peddling the message, by coming up with a kind of compromise diet perhaps on a population scale they felt it would do more good. Fine, but tell that to the thousand American families who lose a loved one every day to high blood pressure.

Maybe it’s time to start telling the American public the truth.


The first time someone visits NutritionFacts.org can be overwhelming. With videos on more than 2,000 health topics, where do you even begin? Imagine stumbling onto the site not knowing what to expect and the new video-of-the-day is about how a particular spice can be effective in treating a particular form of arthritis. It would be easy to miss the forest for the trees, which is precisely why I created a series of overview videos that are essentially taken straight from my live, hour-long 2016 presentation How Not to Die: Preventing, Arresting, and Reversing Our Top 15 Killers.

The other videos in this overview series are:

Inspired to learn more about the role diet may play in preventing and treating high blood pressure? Check out these other popular videos on the topic:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Salt Is Put to the Test

From a medical journal editor:

“Like any group with vested interests, the food industry resists regulation. Faced with a growing scientific consensus that salt increases blood pressure…major food manufacturers have adopted desperate measures to try to stop governments from recommending salt reduction. Rather than reformulate their products, manufacturers have lobbied governments, refused to cooperate with expert working parties, encouraged misinformation campaigns, and tried to discredit the evidence.”

After all, salt is the main source of flavor in processed foods. Of course, they could improve flavor by adding real ingredients, but making a pop-tart with actual strawberries would be more expensive and cut into profits.

The evidence they’re trying to discredit includes double-blind, randomized trials dating back decades. When you take people with high blood pressure and put them on a sodium-restricted diet, their blood pressure drops. Then, if you keep them on the low-salt diet and add a placebo, nothing happens. But, if you instead secretly give them salt in the form of a time-release sodium pill, their blood pressure goes back up. And, the more sodium you secretly give them, the higher their blood pressure climbs. You can see these trials in my video The Evidence That Salt Raises Blood Pressure.

Even just a single meal can do it. If you take people with normal blood pressure and give them a bowl of soup containing the amount of salt a regular meal might contain, their blood pressure goes up over the next three hours compared to those who had the same soup with no added salt. Why, though? High blood pressure appears to be our body’s way to push the excess salt out of our system.

Dozens of such studies have been done, showing that if we reduce our salt intake, we can reduce our blood pressure, and the greater the reduction, the greater the benefit. The so-called DASH diet, which I covered in my video How to Treat High Blood Pressure with Diet, is commonly used to capture the blood pressure benefits of a more plant-based diet, but how do we know the benefits have anything to do with eating less salt instead of just from eating more fruits and vegetables? Because it was put to the test. Sure, eating more healthfully lowers blood pressure no matter how much salt we eat, but, even if we stick to the same diet, lowering salt helps independently of other dietary improvements.

You can do this on a community level with two matched villages that both start out about the same. In one such study, on average, blood pressures in the control village went up or stayed the same. But, in the village where they were able to cut down on salt intake, blood pressures went down.

If we don’t cut down chronic high salt intake can lead to a gradual increase in blood pressure throughout life, as shown in the famous Intersalt study. Fifty-two centers from 32 countries participated, with hundreds of participants each, and four of those centers were in populations that ate so little salt they actually complied with the American Heart Association guidelines for salt reduction, something less than 1 percent of Americans achieve. In a population where everyone made the cut off, not a single case of high blood pressure was found. What’s more, the older folks had the same blood pressure as the teenagers.

This is why including such populations is so important. If you just look at the 48 centers in the industrialized Western world, there does not appear to be any relationship between rising blood pressure with age and how much sodium people are getting every day. Now, the salt industry looks at this and says, “Aha! I told you so! There isn’t any relationship between salt and increasing blood pressures as you get older.” But maybe that’s because they’re all getting too much salt.

In the Intersalt study, they were all way over the American Heart Association recommendation for salt intake. You can imagine a similar result if this was instead lung cancer rates versus packs of cigarettes smoked every year. Whether you smoked 150 packs a year or 200 packs a year, it might not make much of a difference. To see a relationship between smoking and cancer, you’d have to compare smokers to those who rarely light up. And, indeed, if you add in those low-salt populations who get little or no high blood pressure as they get older, you end up with a highly statistically significant relationship between increasing sodium and increasing blood pressure—but only if you include people that actually comply with the salt guidelines.

As with so many lifestyle interventions, they only work if you actually do it.


This is part of my extended dive into the manufactured controversy about the health effects of sodium. Check out:

Will cutting back on salt make everything tastes like cardboard? Don’t worry! Check out Changing Our Taste Buds.

For more on the DASH diet, check out How to Treat High Blood Pressure with Diet.

Interested in more on the blood pressures of those on plant-based, salt-shaker-free diets? See:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

What to Eat to Cure High Blood Pressure

High blood pressure ranks as the number-one risk factor for death and disability in the world. In my video, How to Prevent High Blood Pressure with Diet, I showed how a plant-based diet may prevent high blood pressure. But what do we do if we already have it? That’s the topic of How to Treat High Blood Pressure with Diet

The American Heart Association (AHA), the American College of Cardiology (ACC, and the Centers for Disease Control and Prevention (CDC) recommend lifestyle modification as the first-line treatment. If that doesn’t work, patients may be prescribed a thiazide diuretic (commonly known as a water pill) before getting even more meds until their blood pressure is forced down. Commonly, people will end up on three drugs, though researchers are experimenting with four at a time. Some patients even end up on five different meds.

What’s wrong with skipping the lifestyle modification step and jumping straight to the drugs? Because drugs don’t treat the underlying cause of high blood pressure yet can cause side effects. Less than half of patients stick with even the first-line drugs, perhaps due to such adverse effects as erectile dysfunction, fatigue, and muscle cramps.

What are the recommended lifestyle changes? The AHA, ACC, and CDC recommend controlling one’s weight, salt, and alcohol intake, engaging in regular exercise, and adopting a DASH eating plan.

The DASH diet has been described as a lactovegetarian diet, but it’s not. It emphasizes fruits, vegetables, and low-fat dairy, but only a reduction in meat consumption. Why not even more plant-based? We’ve known for decades that animal products are significantly associated with blood pressure. In fact, if we take vegetarians and give them meat (and pay them enough to eat it!), we can watch their blood pressures go right up.

I’ve talked about the benefits to getting blood pressure down as low as 110 over 70. But who can get that low? Populations centering their diets around whole plant foods. Rural Chinese have been recorded with blood pressures averaging around 110 over 70 their whole lives. They eat plant-based day-to-day, with meat only eaten on special occasions.

How do we know it’s the plant-based nature of their diets that was so protective, though?

Because in the Western world, as the American Heart Association has pointed out, the only folks getting down that low on average were those eating strictly plant-based diets, coming in at about 110 over 65.

So were the creators of the DASH diet just not aware of this landmark research done by Harvard’s Frank Sacks? No, they were aware. The Chair of the Design Committee that came up with the DASH diet was Dr. Sacks himself. In fact, the DASH diet was explicitly designed with the number-one goal of capturing the blood pressure-lowering benefits of a vegetarian diet, yet including enough animal products to make it “palatable” to the general public.

You can see what they were thinking. Just like drugs never work—unless you actually take them. Diets never work—unless you actually eat them. So what’s the point of telling people to eat strictly plant-based if few people will do it? So by soft-peddling the truth and coming up with some kind of compromise diet, the on a population scale maybe you’d do more. Ok, but tell that to the thousand U.S. families a day that lose a loved one to high blood pressure. Maybe it’s time to start telling the American public the truth.

Sacks himself found that the more dairy the lactovegetarians ate, the higher their blood pressures. But they had to make the diet acceptable. Research has since shown that it’s the added plant foods—not the changes in oil, sweets, or dairy—that appears to the critical component of the DASH diet. So why not eat a diet composed entirely of plant foods?

A recent meta-analysis showed vegetarian diets are good, but strictly plant-based diets may be better. In general, vegetarian diets provide protection against cardiovascular diseases, some cancers, and even death. But completely plant-based diets seem to offer additional protection against obesity, hypertension, type-2 diabetes, and heart disease mortality. Based on a study of more than 89,000 people, those eating meat-free diets appear to cut their risk of high blood pressure in half. But those eating meat-free, egg-free, and dairy-free may have 75% lower risk.

What if we’re already eating a whole food, plant-based diet, no processed foods, no table salt, yet still not hitting 110 over 70? Here are some foods recently found to offer additional protection: Just a few tablespoons of ground flaxseeds a day was 2 to 3 times more potent than instituting an aerobic endurance exercise program and induced one of the most powerful, antihypertensive effects ever achieved by a diet-related intervention. Watermelon also appears to be extraordinary, but you’d have to eat around 2 pounds a day. Sounds like my kind of medicine, but it’s hard to get year-round (at least in my neck of the woods). Red wine may help, but only if the alcohol has been taken out. Raw vegetables or cooked? The answer is both, though raw may work better. Beans, split peas, chickpeas, and lentils may also help a bit.

Kiwifruits don’t seem to work at all, even though the study was funded by a kiwifruit company. Maybe they should have taken direction from the California Raisin Marketing Board, which came out with a study showing raisins can reduce blood pressure, but only, apparently, compared to fudge cookies, Cheez-Its, and Chips Ahoy.


The DASH diet is one of the best studied, and it consistently ranks as US News & World Report’s #1 diet. It’s one of the few diets that medical students are taught about in medical school. I was so fascinated to learn of its origins as a compromise between practicality and efficacy.

I’ve talked about the patronizing attitude many doctors have that patients can’t handle the truth in:

What would hearing the truth from your physician sound like? See Fully Consensual Heart Disease Treatment and The Actual Benefit of Diet vs. Drugs.

For more on what plants can do for high blood pressure, see:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: