High Blood Pressure (Hypertension) (Holistic)
About This Condition
- Watch what you eat
Choose a diet low in cholesterol and animal fat, and high in produce, whole grains, legumes, and low-fat dairy, with some nuts and seeds.
- Get more soy
Add 10 grams of soy protein or 16 ounces soy milk twice daily into your diet to help lower blood pressure.
- Boost heart health with supplemental garlic
600 to 900 mg a day of a standardized garlic extract can improve heart and blood vessel health, and also has a mild blood pressure–lowering effect.
- Try CoQ10
Taking 100 mg a day of this powerful antioxidant may have a significant impact on your blood pressure after one to several months.
- Sidestep salt
Avoid using too much table salt, limit salty fast foods, and read labels to find low-sodium foods (less than 140 mg per serving) in your grocery store.
- Take minerals
Supplements of calcium (800 to 1,500 mg a day) and magnesium (350 to 500 mg a day) may be helpful.
- Sidestep salt
Avoid using too much table salt, limit salty fast foods, and read labels to find low-sodium foods (less than 140 mg per serving) in your grocery store.
- Watch what you eat
Choose a diet low in cholesterol and animal fat, and high in produce, whole grains, legumes, and low-fat dairy, with some nuts and seeds.
- Maintain a healthy weight
Lose excess weight and keep it off with a long-term program of healthier eating and regular aerobic exercise for 30 to 60 minutes per day, four or more days per week.
- Go vegetarian
Vegetarians have lower blood pressure than meat eaters, partly because of the mineral potassium in fruits and vegetables, which helps blood pressure.
- Limit alcohol
Keep daily alcohol intake to two drinks or less per day, and fewer than 9 drinks per week for women to help prevent hypertension.
About This Condition
Approximately 90% of people with high blood pressure have “essential” or “idiopathic” hypertension, for which the cause is poorly understood. The terms “hypertension” and “high blood pressure” as used here refer only to this most common form and not to pregnancy-induced hypertension or hypertension clearly linked to a known cause, such as Cushing’s syndrome, pheochromocytoma, or kidney disease. Hypertension must always be evaluated by a healthcare professional. Extremely high blood pressure (malignant hypertension) or rapidly worsening hypertension (accelerated hypertension) almost always requires treatment with conventional medicine. People with mild to moderate high blood pressure should work with a doctor before attempting to use the information contained here, as blood pressure requires monitoring and in some cases the use of blood pressure-lowering drugs.
As with conventional drugs, the use of natural substances sometimes controls blood pressure if taken consistently but does not lead to a cure for high blood pressure. Thus, someone whose blood pressure is successfully reduced by weight loss, avoidance of salt, and increased intake of fruits and vegetables would need to maintain these changes permanently in order to retain control of blood pressure. Left untreated, hypertension significantly increases the risk of stroke and heart disease.
Essential hypertension is usually without symptoms until complications develop. The symptoms of complications depend on the organs involved.
Healthy Lifestyle Tips
Smoking is particularly injurious for people with hypertension.1 The combination of hypertension and smoking greatly increases the risk of heart disease–related sickness and death. All people with high blood pressure need to quit smoking.
Consumption of more than about three alcoholic beverages per day appears to increase blood pressure.2 Whether one or two drinks per day meaningfully increases blood pressure remains unclear.
Daily exercise can lower blood pressure significantly.3 A 12-week program of Chinese T’ai Chi was reported to be almost as effective as aerobic exercise in lowering blood pressure.4 Progressive resistance exercise (e.g., weight lifting) also appears to help reduce blood pressure.5 At the same time, blood pressure has been known to increase significantly during the act of lifting heavy weights; for this reason, people with sharply elevated blood pressure, especially those with cardiovascular disease, should approach heavy strenuous resistance exercise with caution. In general, people over 40 years of age should consult with their doctors before starting any exercise regimen.
Most people with high blood pressure are overweight. Weight loss lowers blood pressure significantly in those who are both overweight and hypertensive.6 In fact, reducing body weight by as little as ten pounds can lead to a significant reduction in blood pressure.7 Weight loss appears to have a stronger blood pressure-lowering effect than dietary salt restriction.8
A specific chiropractic adjustment has been shown to produce a sustained reduction in blood pressure that was equivalent to that produced by two blood pressure-lowering medications.9
Anxiety in men (but not women) has been linked to development of hypertension.10 Several research groups have also shown a relationship between job strain and high blood pressure in men.11, 12, 13 Some researchers have tied blood pressure specifically to suppressed aggression.14
Although some kind of relationship between stress and high blood pressure appears to exist, the effects of treatment for stress remain controversial. An analysis of 26 trials reported that reductions in blood pressure caused by biofeedback or meditation were no greater than those seen with placebo.15 Though some stress management interventions have not been helpful in reducing blood pressure,16, 17 those trials that have reported promising effects have used combinations of yoga, biofeedback, and/or meditation.18, 19, 20 Some doctors continue to recommend a variety of stress-reducing measures, sometimes tailoring them to the needs and preferences of the person seeking help.
Preliminary laboratory studies in animals21 and humans22, 23, 24 suggest that acupuncture may help regulate blood pressure. Most,25, 26, 27, 28, 29, 30 but not all,31 preliminary trials also suggest that acupuncture may be an effective way to lower blood pressure. Whether blood pressure goes back up after acupuncture is discontinued remains an unsettled question.
Auricular (ear) acupressure has been reported to be an effective treatment for hypertension,32, 33, 34 though in one case the improvement was not significantly better than use of traditional herbal medicines.35
Spinal manipulation may lower blood pressure (at least temporarily) in healthy people, according to most preliminary36, 37, 38 and controlled39 trials. However, some research suggests the effect is no better than the blood pressure-lowering effect of sham (“fake”) manipulation.40 In hypertensive people, temporary decreases in blood pressure have also been reported after spinal manipulation.41, 42, 43 However, most,44, 45, 46 but not all,47 trials suggest that manipulation produces only short-term decreases in blood pressure in hypertensive people.
The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.
|Add some fiber|
Several studies have shown that adding around 7 grams of fiber per day to the diet reduces blood pressure, although other studies have not shown a benefit.
Several double-blind trials have shown that adding 6.5–7 grams of fiber per day to the diet for several months leads to reductions in blood pressure. However, other trials have not found fiber helpful in reducing blood pressure. The reason for these discrepant findings is not clear.
|Fry with good oils|
Frying with more stable oils (such as olive oil) does not appear to increase high blood pressure risk, unlike cooking with unstable oils such as sunflower, corn, canola, and flaxseed.
Reusing vegetable oils for frying, especially oils with high concentrations of unsaturated fatty acids (such as sunflower or safflower oil) has been associated with an increased risk of high blood pressure. Presumably, this increased risk is due to some of the degradation products (such as lipid peroxides or polymers) that result from the excessive heating of these oils. Frying with more stable oils, such as olive oil, is not associated with an increased risk of high blood pressure.
Some doctors recommend that people with high blood pressure eat less sugar, as it has been reported to increase blood pressure in short-term trials.
Sugar has been reported to increase blood pressure in animals and humans in short-term trials. Though the real importance of this experimental effect remains unclear, some doctors recommend that people with high blood pressure cut back on their intake of sugar.
|Try a vegetarian diet|
Vegetarians have lower blood pressure than meat eaters, partly because fruits and vegetables contain potassium—a known blood pressure–lowering mineral.
Vegetarians have lower blood pressure than do people who eat meat. This occurs partly because fruits and vegetables contain potassium—a known blood pressure-lowering mineral. The best way to supplement potassium is with fruit, which contains more of the mineral than do potassium supplements. However, fruit contains so much potassium that people taking “potassium-sparing”diuretics can consume too much potassium simply by eating several pieces of fruit per day. Therefore, people taking potassium-sparing diuretics should consult the prescribing doctor before increasing fruit intake. In the Dietary Approaches to Stop Hypertension (DASH) trial, increasing intake of fruits and vegetables (and therefore fiber) and reducing cholesterol and dairy fat led to large reductions in blood pressure (in medical terms, 11.4 systolic and 5.5 diastolic) in just eight weeks. Even though it did not employ a vegetarian diet itself, the outcome of the DASH trial supports the usefulness of vegetarian diets because diets employed by DASH researchers were related to what many vegetarians eat. The DASH trial also showed that blood pressure can be significantly reduced in hypertensive people (most dramatically in African Americans) with diet alone, without weight loss or even restriction of salt. Nonetheless, restricting salt while consuming the DASH diet has lowered blood pressure even more effectively than the use of the DASH diet alone.
|Try some tomato|
In one study, supplementing with a tomato extract significantly lowered blood pressure in people with hypertension.
In a double-blind trial, supplementation with a tomato extract significantly lowered both systolic and diastolic blood pressure, compared with a placebo, in people with hypertension. The amount of extract used was 250 mg per day (providing 15 mg per day of lycopene plus other carotenoids) for eight weeks.
|Cut back on coffee|
In some studies, coffee drinking has led to small increases in blood pressure. Many doctors tell people with high blood pressure to avoid caffeinated products.
Right after consuming caffeine from coffee or tea, blood pressure increases briefly. In trials lasting almost two months on average, coffee drinking has led to small increases in blood pressure. The effects of long-term avoidance of caffeine (from coffee, tea, chocolate, cola drinks, and some medications) on blood pressure remain unclear. A few reports have even claimed that long-term coffee drinkers tend to have lower blood pressure than those who avoid coffee. Despite the lack of clarity in published research, many doctors tell people with high blood pressure to avoid consumption of caffeine.
Avoid using too much table salt, limit salty fast foods, and read labels to find low-sodium foods in your grocery store.
Primitive societies exposed to very little salt suffer from little or no hypertension. Salt (sodium chloride) intake has also been definitively linked to hypertension in western societies.Reducing salt intake in the diet lowers blood pressure in most people. The more salt is restricted, the greater the blood pressure-lowering effect. Individual studies sometimes come to differing conclusions about the relationship between salt intake and blood pressure, in part because blood pressure-lowering effects of salt restriction vary from person to person, and small to moderate reductions in salt intake often have minimal effects on blood pressure—particularly in young people and in those who do not have hypertension. Nonetheless, dramatic reductions in salt intake are generally effective for many people with hypertension.
With the prevalence of salted processed and restaurant food, simply avoiding the salt shaker no longer leads to large decreases in salt intake for most people. Totally eliminating salt is more effective, but is quite difficult to achieve. Moreover, while an overview of the research found “There is no evidence that sodium reduction presents any safety hazards,” reports of short-term paradoxical increases in blood pressure in response to salt restriction have occasionally appeared. Therefore, people wishing to use salt reduction to lower their blood pressure should consult with a doctor.
|Try a hypoallergenic diet|
In one study, people with migraines who also had high blood pressure experienced a significant drop in blood pressure when put on a hypoallergenic diet.
Food allergy was reported to contribute to high blood pressure in a study of people who had migraine headaches. In that report, all 15 people who also had high blood pressure experienced a significant drop in blood pressure when put on a hypoallergenic diet. People who suffer migraine headaches and have hypertension should discuss the issue of allergy diagnosis and elimination with a doctor.
Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by some in the medical community, and whether studies have found them to be effective for other people.
For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.
3 StarsReliable and relatively consistent scientific data showing a substantial health benefit.
2 StarsContradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1 StarFor an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.
140–300 mg per day
Extracts of green, unroasted coffee that are high in chlorogenic acids might help lower high blood pressure.
Coffee beans contain chlorogenic acids, biologically active polyphenols that appear to have blood pressure–lowering and other positive health effects. Since roasting coffee beans may degrade their chlorogenic acids, extracts of green unroasted coffee beans have been investigated for their potential to lower high blood pressure and improve metabolic disturbances. A meta-analysis of results from nine clinical trials indicates green coffee bean extract in doses lower than 400 mg per day can reduce high blood pressure.
2 grams of combined EPA and DHA daily
EPA and DHA, the omega-3 fatty acids found in fish oil, have been shown to lower blood pressure.
EPA and DHA, the long-chain polyunsaturated omega-3 fatty acids found in fish oil, have been shown to improve blood vessel function and lower blood pressure. Although a large observational study that followed 12,279 men for an average of 15.8 years found no relationship between omega-3 fatty acid intake and risk of high blood pressure, multiple studies have noted higher blood levels of these fatty acids, and especially DHA, are associated with reduced incidence of hypertension. Furthermore, a meta-analysis of 70 randomized controlled trials found supplementing with at least 2 grams of EPA plus DHA per day significantly reduces systolic and diastolic blood pressure, and the effect is stronger in those with hypertension.
600 to 1,200 mg of garlic extract daily
Taking garlic may improve heart and blood vessel health and lower high blood pressure.
Garlic supplements, in doses ranging from 600–1,200 mg per day, have consistently been shown in randomized controlled trials to lower high blood pressure to a degree that is comparable to anti-hypertensive medications. One randomized controlled trial that included 88 participants with high blood pressure found treatment with 1,200 mg of aged garlic extract daily for 12 weeks reduced systolic blood pressure by an average of 5 mmHg. The trial identified a subgroup of 29 responders to garlic therapy whose blood pressure dropped by more than 3%; in this subgroup, systolic blood pressure was reduced by an average of 11.5 mmHg and diastolic blood pressure by 6.3 mmHg. Another trial found garlic extract lowered blood pressure in hypertensive patients with severe coronary artery disease: the trial included 56 participants with severe coronary artery disease who were given 800 mg of garlic extract per day or placebo for three months. Although the effect of garlic on blood pressure was not significant overall, in the 18 participants with baseline hypertension, garlic lowered blood pressure significantly more than placebo. Furthermore, garlic extract has been found to reduce arterial stiffness, improve blood glucose control, lower high cholesterol levels, decrease blood clot risk, and improve gut microbial balance, and may reduce the risks of heart attack and stroke.
Fresh garlic may also help lower high blood pressure: In an open trial, 40 participants with metabolic syndrome were given raw crushed garlic in an amount based on body weight (100 mg per kg body weight twice daily). After four weeks, blood pressures were reduced, and other markers of metabolic health, including waist circumference, triglyceride levels, fasting glucose levels, and cholesterol levels were improved. A six-year observational study found those who eat the largest amount of allium vegetables such as garlic and onion were less likely to develop high blood pressure, chronic kidney disease, and cardiovascular events.
Grape Seed Extract
100–400 mg per day
Grape seed extract may lower blood pressure in people with pre-hypertension and mild hypertension, especially in those with other metabolic disturbances.
Grape seeds contain polyphenolic compounds called proanthocyanidins that have powerful antioxidant properties. Grape seed extract has been found in clinical trials to improve blood vessel elasticity and reduce high blood pressure in those with pre-hypertension and mild hypertension. A meta-analysis of 16 randomized controlled trials with a combined total of 810 participants found grape seed extract can reduce high blood pressure, and the effect was stronger in younger individuals and those with metabolic disturbances like obesity.
750 mg of hibiscus extract per day; or 1 tsp (1 to 2 grams) dried flowers brewed as tea, taken two to three times per day
Clinical trials have shown that Hibiscus sabdariffa, as tea or tablet, can lower high blood pressure and some trials suggest hibiscus tea may be as potent as certain blood pressure medications.
The hibiscus family of flowering plants consists of a number of related species, the most studied of which is Hibiscus sabdariffa. Hibiscus flowers may be best known for their vitamin C content and their antioxidant and anti-inflammatory effects, and multiple studies indicate hibiscus may be helpful in improving all aspects of metabolic syndrome, including high blood pressure.
Several clinical trials have shown that hibiscus can lower blood pressure. A meta-analysis of five randomized controlled trials with a total of 390 participants found Hibiscus sabdariffa lowered high blood pressure, and was more effective in those with mild blood pressure elevation. In one trial that included 125 hypertensive subjects, 320 mg of Hibiscus sabdariffa twice daily worked as well as ramipril (an anti-hypertensive drug in the ACE inhibitor family) at reducing diastolic pressure, and while it also reduced systolic pressure, this reduction was not as great as with ramapril. Hibiscus sabdariffa was also found to be as effective as the blood pressure-lowering drugs captopril and lisinopril (other ACE inhibitors) and more effective than hydrochlorthiazide (a diuretic used to treat hypertension) in randomized controlled comparison trials in people with high blood pressure.
350 to 500 mg daily
Taking magnesium is effective for lowering blood pressure and has a greater impact in those with higher baseline blood pressure.
Chronic inadequate intake of magnesium increases arterial stiffness and raises the risk of high blood pressure, as well as a range of cardiovascular, metabolic, and neurological disorders. It is estimated 64% of men and 67% of women in the US have insufficient intake of magnesium. Observational evidence shows higher dietary magnesium intake and blood magnesium levels are correlated with lower risk of high blood pressure. Multiple randomized controlled trials show that magnesium supplements can reduce high blood pressure. A meta-analysis that included data from 34 randomized controlled trials with a total of 2,028 participants with normal or high blood pressure found supplementing with 300 mg of magnesium or more daily for two months or longer modestly decreased blood pressure. Overall, magnesium led to an average decrease in systolic blood pressure of 2.00 mmHg and an average decrease in diastolic blood pressure of 1.78 mmHg. A meta-analysis of eleven randomized controlled trials with a total of 543 participants, all of whom had chronic metabolic disorders (insulin resistance, pre-diabetes, type 2 diabetes, or coronary artery disease), found magnesium supplementation at doses of 365–450 mg per day lowered systolic and diastolic blood pressures. Another meta-analysis included findings from seven trials in which a total of participants were receiving treatment with blood pressure-lowering drugs. In all of the trials, the subjects discontinued their medications and had baseline systolic blood pressures of greater than 155 mmHg before starting magnesium. Magnesium therapy in this population was found to reduce systolic blood pressure by an average of 18.7 mmHg and diastolic blood pressure by an average of 10.9 mmHg.
2–3 mg daily of sustained-released melatonin at bedtime
Melatonin helps to restore normal circadian control over blood pressure and reduces nighttime hypertension.
Normally, blood pressure declines at night. People with a blunted or no nighttime blood pressure dip are at increased risk of developing and dying from heart disease. Melatonin is a hormone regulator of circadian cycles and appears to play a vital role in relaxing blood vessels and reducing blood pressure at night. Melatonin also has decreases oxidative stress, reduces inflammatory signaling, and improves blood vessel function. Decreased production of melatonin, such as occurs naturally with aging, is strongly correlated with high blood pressure and other cardiovascular problems. In healthy individuals, single doses of melatonin ranging from 1 to 3 mg have been shown to substantially decrease systolic, diastolic, and mean (average) blood pressures. A meta-analysis of five randomized controlled trials found taking melatonin at bedtime for three to four weeks reduced systolic blood pressure by 3.43 mmHg and diastolic blood pressure by 3.33 mmHg. Some evidence suggests melatonin may only lower blood pressure in those with a blunted nocturnal blood pressure dip. In a meta-analysis of seven trials examining the effects of melatonin on nocturnal blood pressure in hypertensive subjects, only extended-release melatonin, at doses of 2–3 mg at bedtime, was found to have a significant nocturnal blood pressure-lowering effect. However, in one placebo-controlled trial with 40 participants, high-dose melatonin (24 mg in a sustained release formulation) taken for four weeks was not effective for lowering nocturnal blood pressure in hypertensive African Americans.
150 to 200 mg per day
Pine bark extract, often referred to by the trademark name Pycnogenol®, has been shown to reduce systolic blood pressure in people with mild hypertension.
Pine bark extract (often referred to by the trademark name Pycnogenol®) is high in the same polyphenols as grape seed extract—proanthocyanidins. Controlled clinical trials have found pine bark extract can reduce blood pressure in those with metabolic disease and pre-hypertension. Results from meta-analyses of clinical trials have suggested supplementing with pine bark extract for longer than 12 weeks can result in small reductions in systolic and diastolic blood pressures; nevertheless, high-quality trials have indicated no effect on systolic blood pressure. Another meta-analysis that included data only from double-blind placebo-controlled trials found no effect of pine bark extract on systolic or diastolic blood pressures.
10 grams soy protein or 16 ounces soy milk twice per day
Supplementing with soy protein may significantly lower blood pressure.
In a double-blind study of postmenopausal women, supplementing with 10 grams of soy protein twice a day for six weeks significantly reduced diastolic blood pressure by an average of 5 mm Hg, compared with a diet not containing soy protein. In another study, men and women with mild to moderate hypertension consumed 500 ml (approximately 16 ounces) of soy milk or cow's milk twice a day for three months. After three months, the average systolic blood pressure had decreased by 18.4 mm Hg in the soy group, compared with 1.4 mm Hg in the cow's milk group. The reductions in diastolic blood pressure were 15.9 mm Hg with soy milk and 3.7 mm Hg with cow's milk. In another study of people with hypertension who were consuming a low-protein, low-fiber diet, supplementing with a combination of soy protein and psyllium (a fiber source) lowered systolic blood pressure by an average of 5.9 mm Hg. The blood pressure reduction with soy protein alone or with fiber alone was less pronounced than that with combination treatment. Other research has also shown a blood pressure–lowering effect of soy protein.
1–6 grams per day
Taurine supplementation has been found to result in small reductions in both systolic and diastolic blood pressures.
Taurine is a semi-essential amino acid (one that can be made in the body but not in sufficient quantity) that is especially important to normal heart and brain function. Its cardiovascular benefits may be related to its antioxidant properties, its role in regulating calcium flow across cell membranes, and its ability to relax blood vessels by increasing nitric oxide production. In a placebo-controlled trial, 120 subjects with pre-hypertension were given either 1.6 grams of taurine daily or placebo for 12 weeks; those who received taurine had an average 4.6 mmHg greater drop in systolic blood pressure and 3.3 mmHg drop in diastolic blood pressure. A meta-analysis pooled data from seven trials with a combined total of 103 participants and concluded taurine can effectively reduce both systolic and diastolic blood pressures by an average of 3 mmHg when used in doses between 1 and 6 grams per day for up to 12 weeks.
500 to 1,500 mg daily
Higher intake of vitamin C is associated with reduced risk of high blood pressure, and some doctors recommend people with hypertension supplement with vitamin C.
As a free radical scavenger, vitamin C is thought to mitigate oxidative injury to blood vessels that contributes to high blood pressure. A meta-analysis of findings from 18 observational studies noted people with high blood pressure have lower blood vitamin C levels than people with normal blood pressure. One of these studies found those with the highest vitamin C levels, a reflection of both dietary and supplement intake, had a 22% lower risk of hypertension than those with the lowest vitamin C levels. In another pooled analysis of 8 randomized controlled trials that included a combined total of 614 participants with high blood pressure, vitamin C supplementation resulted in an average systolic blood pressure decrease of 4.09 mmHg and an average diastolic blood pressure decrease of 2.30 mmHg. Doses of at least 500 mg per day and interventions lasting six weeks or longer had increased effectiveness.
Refer to label instructions
Arginine supports relaxation of the blood vessels and may help reduce blood pressure.
The amino acid arginine is needed by the body to make nitric oxide, a substance that allows blood vessels to dilate, thus leading to reduced blood pressure. Other mechanisms by which arginine may lower blood pressure include increasing antioxidant capacity and modulating the renin-angiotensin-aldosterone system that regulates salt and water balance. Clinical evidence from small trials shows oral arginine supplementation can modestly reduce systolic and diastolic blood pressures. Intravenous arginine, at 500 mg per kilogram of body weight, has been found in two trials to reduce blood pressure in hypertensive subjects, and the effect may be greater in those whose hypertension is salt-sensitive. Meta-analyses have shown arginine supplementation at doses of 8–11 grams per day can lower systolic blood pressure by 2.2–5.4 mmHg and diastolic blood pressure by 2.7–3.1 mmHg. In a placebo-controlled trial that enrolled 25 middle-aged adults with mildly elevated blood pressure, an arginine-based supplement providing 2.4 grams of arginine daily improved blood vessel function, but its blood pressure lowering effect was not statistically significant.
100 mg twice per day
Taking coenzyme Q10 may help lower high blood pressure.
Coenzyme Q10 (coQ10) is an intracellular antioxidant and anti-inflammatory compound, and tissue levels are decreased in people with chronic conditions such as heart disease. CoQ10 has multiple positive effects on blood vessel function that contribute to vasodilation and may reduce blood pressure. CoQ10 showed promising effects in individuals with high blood pressure in observational studies and preliminary clinical trials, but findings from randomized controlled trials have been mixed. A meta-analysis that included data from 17 randomized controlled trials with a combined total of 684 participants determined coQ10 lowers systolic, but not diastolic, blood pressure.
Refer to label instructions
In a double-blind trial, eating foods with milled flaxseed lowered both the systolic and diastolic blood pressure in patients with atherosclerosis of the lower extremities.
In a double-blind trial, patients with atherosclerosis of the lower extremities (most of whom had high blood pressure) consumed foods that provided daily 30 g of milled flaxseed or placebo foods for 6 months. After 6 months, mean systolic blood pressure was 9.4 mm Hg lower and mean diastolic blood pressure was 6.7 mm Hg lower in the flaxseed group than in the placebo group. It is not known whether flaxseed would have a similar effect in people who do not have atherosclerosis.
500–1,200 mg per day
Hawthorn leaf and flower extracts have demonstrated mild blood pressure–lowering effects.
Hawthorn (Crataegus species) leaf and flower extracts have been used historically to prevent and treat a range of cardiovascular ailments and have demonstrated positive effects on heart and blood vessel function in laboratory and animal research. A ten-week trial that included 36 mildly hypertensive subjects noted a promising reduction in blood pressure in those taking 500 mg of hawthorn extract daily compared with placebo but the effect did not reach statistical significance. Another placebo-controlled trial that included 92 participants with mildly elevated blood pressure found treatment with hawthorn lowered both systolic and diastolic blood pressure after three months. Supplementing with 1,200 mg of hawthorn extract daily for 16 weeks was found to reduce diastolic, but not systolic, blood pressure significantly better than placebo in a trial with 79 subjects with type 2 diabetes. Several trials have reported small reductions in blood pressure in people with early stage congestive heart failure taking hawthorn.
300–600 mg per day of hesperidin
Hesperidin, a flavonoid found primarily in oranges and other citrus fruits, has been found to decrease high blood pressure.
Hesperidin is a flavonoid found primarily in oranges and other citrus fruits. Orange juice is a rich source of hesperidin and several controlled trials have found regular consumption of orange juice reduces blood pressure in healthy volunteers. In a placebo-controlled trial that included 159 participants with borderline or high blood pressure, drinking a hesperidin-enriched orange juice providing 600 mg of hesperidin daily for 12 weeks reduced systolic blood pressure more than unenriched orange juice providing 345 mg of hesperidin per day, and both orange juice drinks reduced blood pressure more than a placebo drink. In addition, pulse pressure decreased in both groups given orange juice, indicating improvement in blood vessel stiffness. A similar placebo-controlled trial in overweight men found drinking orange juice and hesperidin-enriched orange juice for 4 weeks significantly decreased diastolic, but not systolic, blood pressure. Another placebo-controlled trial in 64 participants with type 2 diabetes found 500 mg of hesperidin lowered systolic blood pressure and levels of C-reactive protein, a marker of systemic inflammation. Not all trials have found benefits from orange juice or hesperidin supplements: two meta-analyses that each included ten randomized controlled trials concluded that neither orange juice nor hesperidin supplements significantly lowered blood pressure. Because hesperidin is not biologically active until it has been processed by intestinal microbes, it is thought differences in gut microbial presence may explain some of the variability in its effects on blood pressure.
1,000 to 1,600 mg of whole olive leaf extract per day
Olive leaf has been found to reduce high blood pressure, and one clinical trial showed it may be as effective as a blood pressure-lowering medication.
Olive leaf contains a number of active constituents, including flavonoids and other phenolic compounds, that have positive health effects, and has been used traditionally to support respiratory, digestive, immune, and cardiovascular health. Among its many positive metabolic effects, olive leaf has been shown to lower high blood pressure. An uncontrolled pilot trial with 663 pre-hypertensive subjects found taking a supplement providing 240 mg of compounds found in olive leaves and fruit (200 mg of oleuropein and 40 mg of hydroxytyrosol) daily for two months was associated with a 13 mmHg drop in systolic blood pressure and 7.1 mmHg drop in diastolic blood pressure. Another uncontrolled trial that enrolled ten volunteers with hypertension or pre-hypertension found treatment with 1,600 mg of olive leaf extract (providing 240 mg of oleuropein and 16 mg of hydroxytyrosol) daily for 28 days lowered systolic and diastolic pressures, and the effect was stronger in those with higher baseline blood pressure. In a randomized, double-blind, placebo-controlled, crossover trial (in which all participants receive placebo during one phase and treatment during another phase, in random order) that included 60 participants with borderline high blood pressure, six weeks of treatment with olive leaf extract providing 136 mg of oleuropein and 6 mg of hydroxytyrosol per day resulted in small (approximately 3 mmHg) reductions in systolic and diastolic pressures. In a double-blind trial, the blood pressure-lowering effect of 500 mg of olive leaf extract twice daily for eight weeks was nearly as great as that of captopril, a drug used to treat hypertension: systolic pressure was 11.5 mmHg lower and diastolic pressure was 4.8 mmHg lower in those who received olive leaf extract, versus drops of 13.7mmHg and 6.4 mmHg in those who received captopril.
800 to 2,000 IU daily, ideally based on blood levels; up to 7,000 IU per day temporarily to reverse deficiency
Vitamin D may reduce blood pressure in hypertensive people with vitamin D deficiency.
Vitamin D is best known for its role in calcium metabolism but is also now recognized as an important modulator of immune function, inflammatory signaling, and oxidative stress. Research shows vitamin D receptors exist on cells in the heart and blood vessels, indicating vitamin D also influences cardiac and vascular function. Furthermore, vitamin D affects the renin-angiotensin-aldosterone system, which controls blood pressure by regulating sodium and water balance. Low vitamin D levels have been linked to increased risk of high blood pressure and other cardiovascular conditions. Although supplementation has not been found to reduce blood pressure in the general population, it has been found to reduce both systolic and diastolic blood pressures in vitamin D deficient subjects with hypertension. Variations in the genes related to vitamin D receptors appear to contribute to susceptibility to hypertension.
200 IU daily
Supplementing with a modest dose of vitamin E may have a small positive impact on blood pressure in those with mild hypertension, but the evidence is not conclusive.
Dietary vitamin E is necessary for cardiovascular health, and observational studies have linked higher intake of vitamin E with lower risk of high blood pressure. Nevertheless, most clinical trials have found no benefit from vitamin E supplementation at doses of 200–600 IU per day in people with high blood pressure, though it may be effective in those with mild hypertension. A meta-analysis of 18 randomized controlled trials with a combined total of 839 participants found vitamin E supplementation mildly lowered systolic blood pressure but had no impact on diastolic blood pressure.
Vitamin E is a naturally occurring complex made up of multiple tocopherols and tocotrienols, each of which may have unique properties in the body. Some evidence suggests tocotrienols have greater antioxidant capacity than tocopherols and may have stronger benefits in cardiovascular and metabolic disease, but most supplements contain only alpha-tocopherol.
15 to 20 drops of an herbal tincture twice per day
In one trial, people with mild hypertension who took a tincture of Achillea wilhelmsii experienced reductions in both systolic and diastolic blood pressure.
In a double-blind placebo-controlled trial that included 120 participants with mild hypertension, 15–20 drops of a tincture of Achillea wilhelmsii (an herb used in traditional Iranian herbal medicine) twice daily for six months lowered both systolic and diastolic blood pressures. Results from laboratory, animal, and computer models suggest extracts from Achillea millefolium (yarrow) and Achillea wilhelmsii lower blood pressure by relaxing blood vessel walls.
600 to 2,000 mg daily to prevent pregnancy-related hypertension, and not more than 600 mg per day for other adults
Calcium supplementation can help to prevent pregnancy-related hypertension; however, calcium supplements may actually increase cardiovascular risk in older women.
Calcium appears to have its most beneficial effects in pregnant women: a meta-analysis of 27 studies found taking 600–2,000 mg of calcium per day lowered the risk of pregnancy-related hypertension and a dangerous pregnancy complication called pre-eclampsia. The benefit of calcium supplementation, beyond repairing insufficient intake, on blood pressure in non-pregnant adults is less clear. Although calcium supplements have been found to have small blood pressure-lowering effects in those with high and normal blood pressure, the effect appears to be strongest in those under 35 years old. Importantly, older women who take calcium supplements have been found to have increased calcification of major arteries and slightly increased risk of stroke. A meta-analysis of 13 double-blind placebo-controlled trials, mainly in postmenopausal women, found taking 1,000 mg of calcium per day increased the risk of cardiovascular disease and coronary artery disease by 15%. Vitamin D regulates calcium metabolism and may impact calcium’s effect on blood pressure. A meta-analysis of eight randomized controlled trials found Calcium and vitamin D co-supplementation lowered diastolic but not systolic blood pressure.
100 to 300 mg per day of Coleus extract with 10–20% forskohlin
A small amount of preliminary evidence suggests Coleus forskohlii and its active ingredient forskohlin may have blood pressure-lowering effects.
Coleus forskohlii and its active constituent forskolin have been found to relax blood vessel walls and lower blood pressure in laboratory and animal studies. A pilot trial evaluated the effect of two preparations of Coleus forskohlii in subjects with high blood pressure and found 31 of the 41 participants who completed the trial (75.6%) experienced mild blood pressure reductions. Forskolin was also found to lower blood pressure and increase cardiac output in an uncontrolled preliminary trial with 12 subjects suffering from cardiomyopathy.
2 to 5 grams of hydrolyzed egg protein per day
People with high blood pressure might be able to lower their blood pressure by using egg protein.
Egg protein is broken down into short amino acid chains via enzymatic action in the digestive tract or during processing through hydrolysis. Some of these small peptides (short amino acid chanis) have been found to inhibit angiotensin I-converting enzyme (ACE), an enzyme involved in blood vessel constriction, while others act as antioxidants in the blood vessels. Hydrolyzed egg white protein has been found to lower blood pressure in animal models of hypertension. However, findings from clinical trials has been mixed. A dose-finding trial was performed in 92 subjects with normal, high-normal, or mildly elevated blood pressure and found 2 grams of hydrolyzed egg protein per day for seven days reduced daytime systolic and diastolic blood pressures, and 5 grams per day reduced nighttime blood pressures, in those with mild hypertension. In a randomized, placebo-controlled, crossover trial (in which subjects participate in treatment and placebo phases, in random order) that included 75 subjects with mild hypertension, taking 3 grams of hydrolyzed egg protein per day for six weeks had no effect on arterial stiffness or blood pressure.
30 grams of hemp meal (providing about 15 grams of hemp protein) one to three times daily
Animal research suggests hemp protein may help with prevention and treatment of high blood pressure.
Hemp protein is high in arginine, an amino acid that helps keeps blood vessels healthy and may reduce high blood pressure. There is also evidence that peptides (short chains of amino acids) produced through hemp protein digestion could contribute to lowering blood pressure. Although hydrolyzed hemp protein supplementation has been found to have preventive and therapeutic benefits in animal studies, the effects have yet to be demonstrated in humans.
The dose should be determined by a healthcare provider knowledgeable about its use
While Indian snakeroot has been used effectively to treat hypertension, it should be used with caution due to the possibility of adverse side effects.
Indian snakeroot (Rauwolfia serpentina) contains powerful alkaloids, including reserpine, that affect blood pressure and heart function. Indian snakeroot has been used traditionally to treat hypertension, especially when associated with stress and anxiety. A meta-analysis of four randomized controlled trials found reserpine lowered systolic blood pressure similarly to other anti-hypertensive medications, but the effective dose could not be identified with the existing data. A combination of Ayurvedic herbs including 50 mg of a low-reserpine Rauwolfia was given to 30 patients with borderline or mild hypertension for six months in a preliminary trial and was found to lower systolic and diastolic blood pressure without causing any serious adverse side effects. However, because serious side effects (specifically, depression and increased breast cancer risk) have been attributed to the use of reserpine and Rauwolfia in the past, this herb should only be taken under the careful supervision of a physician trained in its use.
3 to 4 grams per day
Supplementing with L-tryptophan can temporarily raise blood serotonin levels and lower blood pressure, but whether L-tryptophan can help prevent and manage hypertension in the long-term is still unknown.
The brain chemical serotonin may play a role in blood pressure regulation, and animal research suggests L-tryptophan, a precursor of serotonin, might be helpful in the prevention and treatment of hypertension. A preliminary study in 14 subjects with hypertension found 3 to 4 grams per day of L-tryptophan had an immediate blood pressure-lowering effect. However, because long-term use of L-tryptophan may alter serotonin metabolism, it is unclear whether it would be effective for preventing or treating high blood pressure. Another pilot trial reported blood pressure reductions in eight of nine volunteers with mild to moderate high blood pressure treated with 4 grams of tryptophan daily and five of eight similar subjects treated with 800 mg of 5-hydroxytryptophan (a breakdown product of tryptophan and a direct precursor of serotonin) per day.
Refer to label instructions
European mistletoe appears to have a blood pressure-lowering effect, but should be used with caution.
European mistletoe(Viscum album) has a long history of medicinal use in cardiovascular ailments. Compounds from mistletoe have demonstrated antioxidant, anti-inflammatory, and blood pressure-reducing effects in the laboratory and in animal research. In a pilot trial that included 41 participants who had high blood pressure, twelve weeks of treatment with mistletoe tincture, at a dose of 10 drops three times daily, reduced systolic blood pressure by an average of 14.3 mmHg and diastolic blood pressure by 4.9 mmHg. In addition, triglyceride levels decreased; however, changes in other lab values suggesting a possible toxic effect on heart muscle also occurred. A mistletoe extract was also reported to reduce headaches and dizziness associated with high blood pressure in preliminary research. Due to possible serious side effects, European mistletoe should only be taken under the careful supervision of a physician trained in its use.
20 to 30 grams of hydrolyzed pea protein up to three times per day
Pea protein may help reduce blood pressure.
Pea protein is high in arginine, an amino acid that promotes relaxation of blood vessel walls. In addition, there is evidence that peptides produced during hydrolysis or digestion of pea protein could have blood pressure-lowering effects. Taking a combination protein isolate supplement made from pea, soy, egg, and milk, at a dose of 20 grams three times per day for four weeks, was found to lower high blood pressure more than the placebo in a controlled trial that enrolled 99 participants with high blood pressure. In a small, three-week, placebo-controlled, crossover trial (in which subjects participate in both the treatment and placebo phases, in random order) with seven hypertensive participants, hydrolyzed pea protein reduced systolic blood pressure by 6 mmHg.
165 mg per day of a 25:1 concentrated extract
Reishi mushroom has anti-inflammatory and antioxidant effects, but clinical trials have not consistently shown it can lower blood pressure.
Reishi (Ganoderma lucidum) is a medicinal mushroom used mainly for its anti-stress and immune-modulating effects. Both the fruiting body and mycelium have been shown to contain biologically-active peptides (short amino acid chains) that may lower blood pressure. In a placebo-controlled trial that enrolled 26 subjects with borderline-high blood pressure and/or cholesterol levels, those given 1.44 grams of reishi per day for 12 weeks had improvements in some metabolic parameters, but no changes in blood pressure were noted. Another placebo controlled trial with 84 participants found 3 grams of reishi per day for 16 weeks had no impact on aspects of metabolic syndrome, including high blood pressure. One trial, however, reported that reishi mushrooms significantly lowered blood pressure in humans. The trial used a concentrated extract of reishi (25:1) in the amount of 55 mg three times per day for four weeks.
Refer to label instructions
A limited body of research suggests sea buckthorn may have blood pressure–lowering effects.
Preclinical research shows sea buckthorn (Hippophae rhamnoides) has several properties that may benefit cardiovascular health, including anti-hypertensive, anticoagulant, lipid-lowering, and antioxidant. A controlled trial in which 111 participants with high cholesterol levels were given 90 ml of sea buckthorn puree or placebo for 90 days found sea buckthorn lowered diastolic blood pressure, though it did not change lipid levels. Another placebo-controlled trial with 74 hypertensive participants found 0.75 ml of sea buckthorn seed oil normalized high blood pressure as well as high cholesterol and triglyceride levels.
1. Narkiewicz K, Maraglino G, Biasion T, et al. Interactive effect of cigarettes and coffee on daytime systolic blood pressure in patients with mild essential hypertension. J Hypertens 1995;13:965-70.
2. Keil U, Liese A, Filipiak B, et al. Alcohol, blood pressure and hypertension. Novartis Round Symp 1998;216:125-44 [review].
3. Kukkonen K, Rauramaa R, Voutilainene E, Lansimies E. Physical training of middle-aged men with borderline hypertension. Ann Clin Res 1982;14(Suppl 34):139-45.
4. Young DR, Appel LG, Jee SH, Miller ER III. The effect of aerobic exercise and T'ai Chi on blood pressure in older people: results of a randomized trial. J Am Geriatr Soc 1999;47:277-84.
5. Kelley GA, Kelley KS. Progressive resistance exercise and resting blood pressure. A meta-analysis of randomized controlled trials. Hypertension 2000;35:838-43.
6. Alderman MH. Nonpharmacologic approaches to the treatment of hypertension. Lancet 1994;334:307-11 [review].
7. Stevens VJ, Obarzanek E, Cook NR, et al. Long-term weight loss and changes in blood pressure: results of the Trials of Hypertension Prevention, Phase II. Ann Intern Med 2001;134:1-11.
8. He J, Whelton PK, Appel LJ, et al. Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension. Hypertension 2000;35:544-9.
9. G Bakris, M Dickholtz, P M Meyer, et al. Journal of Human Hypertension 21, 347-52; doi:10.1038/sj.jhh.1002133
10. Markovitz JH, Matthews KA, Kannel WB, et al. Psychological predictors of hypertension in the Framingham Study. Is there tension in hypertension?JAMA 1993;270:2439-43.
11. Schnall PL, Schwartz JE, Landesbergis PA, et al. Relation between job strain, alcohol, and ambulatory blood pressure. Hypertension 1992;19:488-94.
12. Matthews KA, Cottington EM, Talbott E, et al. Stressful work conditions and diastolic blood pressure among blue collar factory workers. Am J Epidemiol 1987;126:280-91.
13. Pickering TG. Does psychological stress contribute to the development of hypertension and coronary heart disease? Eur J Clin Pharmacol 1990;39(Suppl 1):S1-S7.
14. Perini C, Müller FB, Bühler FR. Suppressed aggression accelerates early development of essential hypertension. J Hypertens 1991;9:499-503.
15. Eisenberg DM, Delbanco TL, Berkey CS, et al. Cognitive behavioral techniques for hypertension: are they effective? Ann Intern Med 1993;118:964-72.
16. Irvine MJ, Logan AG. Relaxation behavior therapy as sole treatment for mild hypertension. Psychosomatic Med 1991;53:587-97.
17. Johnston DW, Gold A, Kentish J, et al. Effect of stress management on blood pressure in mild primary hypertension. BMJ 1993;306:963-6.
18. Patel CH. Yoga and bio-feedback in the management of hypertension. Lancet 1973;2:1973-5.
19. Schneider RH, Staggers F, Alexander C, et al. A randomized controlled trial of stress reduction for hypertension in older African Americans. Hypertension 1995;26:820-9.
20. Patel C, Marmot MG, Terry DJ, et al. Trial of relaxation in reducing coronary risk: four year follow up. BMJ 1985;290:1103-6.
21. Lee HS, Kim JY. Effects of acupuncture on blood pressure and plasma renin activity in two-kidney one clip goldblatt hypertensive rats. Am J Chin Med 1994;22:215-9.
22. Chiu YJ, Chi A, Reid IA. Cardiovascular and endocrine effects of acupuncture in hypertensive patients. Clin Exper Hypertens 1997;19:1047-63.
23. Peng L, Feng-yen S, An-zhong Z. The effect of acupuncture on blood pressure: the interrelation of sympathetic activity and endogenous opioid peptides. Acupunct Electrother Res 1983;8:45-56.
24. Zhou Y, Wang Y, Fang Z, et al. Influence of acupuncture on blood pressure, contents of NE, DA and 5-HT of SHR and the interrelation between blood pressure and whole blood viscosity. Chen Tzu Yen Chiu 1995;20:55-61 [in Chinese].
25. Radzievsky SA, Lebedeva OD, Fisenko LA, Majskaja SA. Function of myocardial contraction and relaxation in essential hypertension in dynamics of acupuncture therapy. Am J Chin Med 1989;17:111-7.
26. Williams T, Mueller K, Cornwall MW. Effect of acupuncture-point stimulation on diastolic blood pressure in hypertensive subjects: a preliminary study. Phys Ther 1991;71:523-9.
27. Weihai Y, Hongxu L. Clinical observation on the immediate hypotensive effect of zanzhu point. J Tradit Chin Med 1996;16:273-4.
28. Utsunomiya N, Shigematsu Y, Ikeda K, et al. Fall in high blood pressure after applying acupuncture to SHR. Jpn Heart J 1978;19:594.
29. Yiping Z, Qiong C, Zhengming H, Yinong C. Experimental research on treatment of hypertension with acupuncture. J Tradit Chin Med 1993;13:277-80.
30. Tam K-C, Yiu H-H. The effect of acupuncture on essential hypertension. Am J Chin Med 1975;3:369-75.
31. Kraft K, Coulon S. Effect of a standardized acupuncture treatment on complains, blood pressure and serum lipids of hypertensive, postmenopausal women. A randomized, controlled clinical study. Forsch Komplementarmed 1999;6:74-9 [in German].
32. Rongxing Z, Yanhua Z, Lu Y. Hypotensive effect of ototherapy in relation to symptomatic and dispositional types of patients. J Tradit Chin Med 1992;12:124-8.
33. Kangmei C, Shulian Z, Ying Z. Clinical application of traditional auriculoacupoint therapy (continued). J Tradit Chin Med 1993;13:152-4.
34. Rongxing Z, Yanhua Z, Jialiang W, et al. Anti-hypertensive effect of auriculo-acupoint pressing therapy—clinical analysis of 274 cases. J Tradit Chin Med 1991;11:189-92.
35. Peng Y, Fenglan L, Xin W. Treatment of essential hypertension with auriculopressure. J Tradit Chin Med 1991;1117-21.
36. Tran T, Kirby J. Effects of upper cervical adjustments upon the normal physiology of the heart. ACA J Chiro 1977;XI:S58-62.
37. McGuiness J, Vicenzino B, Wright A. The influence of a cervical mobilization technique on respiratory and cardiovascular function. Man Ther 1997;2:216-20.
38. Vicenzino B, Cartwright T, Collins D. Cardiovascular and respiratory changes produced by lateral glide mobilization of the cervical spine Manual Therapy 1998;3(2):67-71.
39. Dulgar G, Hill D, Sirucek A, et al. Evidence for possible anti-hypertensive effect of basic technique apex contact adjusting. J Chiro 1980;14:S97-S102.
40. Nansel D, Jansen R, Cremata E, et al. Effects of cervical adjustments on lateral-flexion passive end-range asymmetry and on blood pressure, heart rate and plasma catecholamine levels. J Manipulative Physiol Ther 1991;14:450-6.
41. Fichera AP, Celander DR. Effect of osteopathic manipulative therapy on autonomic tone as evidenced by blood pressure change and activity of the fibrinolytic system. J Am Osteopath Assoc 1969;68:1036-8.
42. McKnight M, DeBoer KD. Preliminary study of blood pressure changes in normotensive patients under chiropractic care. J Manipulative Physiol Ther 1988;11:261-6.
43. Yates RG, Lamping DL, Nancy LA, Wright C. Effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial. J Manipulative Physiol Ther 1988;11:484-8.
44. Morgan JP, Dickey JL, Hunt HH, Hudgins PM. A controlled trial of spinal manipulation in the management of hypertension. J Am Osteopath Assoc 1985;85(5):308-12.
45. Mannino J. The application of neurologic reflexes to the treatment of hypertension. J Am Osteopath Assoc 1979;79:225-31.
46. Wagnon RJ, Sandefur RM, Ratliff CR. Serum aldosterone changes after specific chiropractic manipulation. Am J Chiropr Med 1988;1(2):66-70.
47. Goodman R. Hypertension and the atlas subluxation complex. Chiropractic: J Chiropractic Res Clin Invest 1992;8(2)30-2.
Last Review: 06-08-2015
Copyright © 2022 TraceGains, Inc. All rights reserved.
The information presented by TraceGains is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2022.