New Blood Pressure Guidelines: Can “Alternative Approaches” Work?

Each year, the American Diabetes Associations issues its “Standards of Medical Care in Diabetes.” Basically, these are medical guidelines that most health-care practitioners use to help better care for (and guide) their patients with diabetes. In every new edition there are at least a few changes, which is a good thing. This year, one of the most notable changes is in regard to blood pressure: Previously, the blood pressure guideline for most people with diabetes was less than 130 over 80. This year, it’s been changed to less than 140 over 80 (written as 140/80).


You might be scratching your head wondering what the fuss is all about. After all, what’s the big difference between 130 and 140? Frankly, not a whole lot. However, you might breathe a little easier knowing that studies have shown that there’s little benefit in aiming to keep your systolic (the top number) blood pressure less than 130. But clinical trials have shown a benefit in keeping your systolic blood pressure less than 140. Trying to get it much lower doesn’t significantly reduce the risk of heart attack or death. And while a lower blood pressure may further reduce the risk of stroke, researchers believe the benefit is overshadowed by the need to take more medication and possibly experience more side effects.

Here’s the catch, though: Lower blood pressure goals MAY still be appropriate for younger people or for those who have a higher risk of stroke. So, it’s always important to talk with your health-care provider when targets like this change and find out what’s best for you. Also, don’t let the slightly higher target give you a false sense of security if you already have high blood pressure. High blood pressure is usually silent, but left untreated, it can be deadly. One in three American adults (31%) has high blood pressure, and a lot of them don’t realize that they have it. Now is a good time to make sure of a few things:

• That your blood pressure is checked at every medical visit
• That you know what your result is when it’s checked (ask if you’re not told)
• That you know what your blood pressure target is (again, ask!)
• That you have a treatment plan if your blood pressure is high

Treatment options
Unfortunately, many people don’t take their blood pressure seriously. Unlike blood glucose, high blood pressure usually doesn’t cause any symptoms. Hey, if you’re feeling OK, nothing’s wrong, right? Not necessarily. Another reason that some people don’t always take blood pressure seriously is that they dread having to take yet another medicine. Yes, medicine is an effective (and often, necessary) way to treat blood pressure. The downside is the inconvenience, the side effects, and, for some, the cost. Fortunately, there are other ways to help treat high blood pressure.

Last week, the American Heart Association published a statement in its journal Hypertension saying that “alternative approaches” can be helpful for people whose blood pressure levels are higher than 120/80 and for those who don’t tolerate or respond well to blood pressure medicine. An expert panel assessed three alternative remedy categories: exercise, behavioral therapies, and noninvasive procedures or devices (they didn’t address dietary and herbal treatments, unfortunately). Here’s the gist of the statement:

Exercise. Aerobic, resistance (weight training), and isometric exercises all help reduce blood pressure. Walking provides a modest benefit while isometric exercises, like handgrip exercises, can actually lead to 10% drop in both systolic and diastolic blood pressure.

Behavioral therapies. Biofeedback and transcendental meditation can modestly lower blood pressure. But data is lacking showing that other types of meditation give the same benefit. The same holds for yoga and other types of relaxation: while they offer other benefits, lowering blood pressure isn’t one of them.

Noninvasive procedures or devices. Acupuncture wasn’t found to be all that effective in lowering blood pressure. But device-guided slow breathing is effective when done three to four times a week in 15-minute sessions .

The panel stated that most of these approaches reduce systolic blood pressure by 2 to 10 points; most blood pressure medicines lower blood pressure by 10 to 15 points, so it’s understandable why most providers favor medicines. However, these alternative treatments can be added to medicines for an even greater benefit.

What else?
It never hurts to be reminded of other approaches that help lower blood pressure (and by pretty impressive amounts, I might add!):

DASH diet. Remember this? Dietary Approaches to Stop Hypertension. This “diet,” which is really a way of eating, focuses on a lot of vegetables, fruits, whole grains, and low-fat dairy products, along with slashing sodium. A DASH plan can lower blood pressure by 8 to 14 points, which is pretty much the same as most blood pressure meds.

Weight loss. For every 20 pounds you lose (assuming you need to lose those 20 pounds), you can lower your systolic blood pressure by up to 20 points. Losing weight isn’t always easy, but there are a lot of good reasons to try (namely, in this case, your blood pressure).

Alcohol…in moderation. Drinking alcohol may lower blood pressure by 2 to 4 points. But go above the “moderation” mark and it can actually raise blood pressure. Moderation means no more than two drinks per day for men, and no more than one drink per day for women.

Hibiscus tea. Like tea? Try hibiscus tea. Three cups per day, to be exact. Doing so may drop your systolic blood pressure by 7 points.

Beetroot juice. A small study found that people who drank one cup of beetroot juice every day lowered their systolic blood pressure by 10 points. The hope is that other vegetables that contain nitrates, such as leafy greens, can do the same, so stay tuned (meanwhile, eat a lot of vegetables!).

As always, if your provider has prescribed medicine for blood pressure control, don’t stop taking it. But think about the above approaches and which ones you might try. Also, if you have high blood pressure, get a home blood pressure monitor and check it often. Keep a record of your results and show them to your provider at your regular visits.

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  • jim snell

    My biggest problem with this is my brain. My blood pressure tends to reflect how hard and agressively my brain is cranking.

    The meds help over ride this. If I could live in a Benidictine Monastory peacefully living my life peacefully and quietly praying, my blood pressure is generally lower and much better. Unfortunately, that is not a practical solution.

  • Joe

    I lost 50 pounds with no corresponding affect on my blood pressure or glucose, so that certainly doesn’t work for everyone.

    One correspondence I have noted, when my glucose readings are good, my BP spikes. When my BP is under control, my glucose goes wild. It seems I can only control one thing at a time (and my cholesterol is never right, no matter what I do.)

  • gmb

    I was diagnosed with severe anxiety due to medical trauma…no amount of meds short of sedation is going to lower my bp when in medical establishments, fear and terror do that. As a type 1, i have docs who understand and then those who donot which cause it to go higher

  • Tiffany

    You have told us things to lower systolic pressure, but what about diastolic pressure? Isn’t that the most serious number, especially if high?

  • Eileen

    Checking my blood glucose and my blood pressure twice a day, I notice that when my BP is good, my glucose tends to be a bit high and when my glucose is good, my BP is high. Also, after exercising, sometimes either the BP or the glucose will be higher than I thought they would be. This is very frustrating and something I will be discussing at my endocrinologist at my next appointment.

  • dolores beauchamp


  • Carol A

    I have postprandial hypotension – my systolic BP drops 20-50 points after I eat, especially with carbohydrates. Since in recent years I had tended to be low normal weight, it worked for me to just eat all the time. I could keep my BP at a good level on the amount of meds I was prescribed. But a year and a half ago I became diabetic and had to cut the carbs drastically. So my BP soared. I’ve had to increase my BP meds.

  • Nasiru Abubakar

    a time if my BP is high my BG is somehow good.But now the case has change,my BP is now high that is 165/90 my doctor double my medication.I dont know what to do.

  • acampbell

    Hi Eileen,

    In some people, both blood pressure and blood glucose increase temporarily after exercise. But I’m not familiar with an inverse relationship between blood glucose and blood pressure. It’s a good question for your endocrinologist, though, and perhaps you’ll share what you find out!

  • acampbell

    Hi Dolores,
    First, don’t stop taking your Diovan unless instructed otherwise by your doctor. Second, bring your blood pressure monitors to your next doctor’s visit and use them while you’re there. It’s possible that your monitors are not reading accurately, so the best way to find out is to compare their readings with the reading you get at the doctor’s office. Here is a link about highly rated blood pressure monitors that may be helpful: It’s certainly possible, too, that your blood pressure goes up when you go to the doctor’s. Once you know that your own monitors are accurate, I’d suggest checking your blood pressure at various times of the day to get a better picture of what happens. Also, let your doctor know of your findings and ask what he/she would advise.

  • Anne

    I wanted to respond to Dolores regarding white coat syndrome. I have it too, and my doctor explained that a trauma at the doctors office or hospital (possibly in childhood and not remembered) will trigger this reaction at the doctors office. My bp can be through the roof there – and then a few hours later at home, when I take it, it’s back to where it was before! Personally, I don’t even worry about it anymore and my doctor doesn’t take my bp – I do!

  • acampbell

    Hi Nasiru,

    Please let your doctor know if your blood pressure continues to be high. However, it’s not uncommon for people with high blood pressure to need a higher dose of medicine and/or even a second or third blood pressure medicine, as well. Hopefully you are checking your blood pressure at home with a blood pressure monitor. Make sure, too, that you are not consuming too much sodium or alcohol, either.

  • Margaret

    Older patients need higher systolic pressures to perfuse the brain. Pulses that are too slow (Bradycardia) can reduce brain and kidney perfusion. It is a mistake to lower BP of people who have been running 140 systolic to 120. L
    “Low” blood pressure also increases falls which can be deadly to old people.

  • jim snell

    Amy: one item that I have had to do was put pills twice a day as the morning dose runs out at worst case drug effigy time and then rest of day blood pressure cranks back up. Where does this one a day mentality come from or just add more once a day and body redistributes longer. Not on my body!