How to Beat the Silent Killer

A plant-based diet and moderate exercise can help you reduce or eliminate the need for side-effect inducing drugs

October 2020

By Alex White, Dr. Nick Beard and Dr. Robert Ostfeld

What is high blood pressure?

A blood pressure reading is made up of two numbers. The top (systolic) number in a blood pressure reading is the pressure when your heart squeezes. The bottom (diastolic) one is the pressure when it rests. They’re measured in millimeters of mercury (mm Hg) because the first blood pressure monitors used it. A reading systolic number above 129 or a diastolic one above 89 is regarded as high blood pressure. There’s no low category, but a reading below 90 systolic or 60 diastolic can be of concern – especially if you also feel dizzy, faint or unusually tired.

Why does high blood pressure matter?

The Silent Killer

The American Heart Association (AHA) and other authorities call high blood pressure the Silent Killer. Here’s why:

The lack of symptoms means some people don’t realize they have it, some ignore it, and some think meds alone will ‘cure’ it (they won’t). As a result, only about half of cases are under control. High blood pressure causes damage in lots of ways.

What are the risks of high blood pressure?

Heart Disease

High-blood pressure damages the heart and speeds up the development of blockages in our arteries putting us at greater risk of heart disease – the leading cause of death in the United States. About 69% of people who suffer a first heart attack have high-blood pressure.


High-blood pressure damages the arteries to our brain making us more likely to suffer a stroke – our third biggest killer. 77% of first-time stroke victims have high-blood pressure. As one doctor put it bluntly: “if you don’t want to have a stroke, get your blood pressure under control.”

Kidney Disease

High-blood pressure can starve your kidneys of blood over time by making the arteries that supply them weaker and narrower. High blood pressure may also damage the delicate network of blood vessels within the kidney itself. All of that makes high blood pressure a leading cause of this debilitating condition.

Vision Problems

The tiny vessels that supply blood to our eyes are easily damaged by high-blood pressure. This damage can be severe and permanent. Worse still, symptoms often do not appear until it is too late.


High-blood pressure can reduce blood flow to our brains contributing to muddled thinking and problems with memory and speech. It has also been linked it to Alzheimer’s disease which has similar symptoms.

Sexual Dysfunction

In men, high blood pressure reduces blood flow to the penis making it harder to get and keep an erection. For women it can cause vaginal dryness, loss of desire, and inability to have an orgasm.


Researchers at the University of Oxford found a 20-point increase in blood pressure was associated with a 58% higher risk of diabetes.


High blood pressure increases our risk of suffering a life-threatening aneurysm – a balloon-like swelling of an artery which can cause internal bleeding or a stroke if it breaks.

Can high blood pressure be prevented?

Over 100 million Americans have high blood pressure and almost two thirds of us get it by our sixties. As a result, it is often seen as inevitable, but it’s not. It can be almost non-existent when people live differently. A study of 1,800 Kenyans found no cases and people’s blood pressure even improved as people hit their sixties.[xiv] Nor do genes dictate our fate. They are a factor, but things within our control can greatly reduce our risk of developing high blood pressure. As some doctors like to say: “genes load the gun, but lifestyle pulls the trigger”

How can I beat high blood pressure?

In the 1940s Dr. Walter Kempner helped patients with readings like 240/150 get to 105/80 with dietary changes alone. More recently, study after study has shown the power of diet and lifestyle to reduce blood pressure. One study found that blood pressure dropped by five points when people ate mainly plant-based foods for six weeks but rose when they ate meat again. Another found people’s blood pressure dropped by 16 points and their weight by 19 pounds after four months of plant-based eating and regular exercise. Findings like this are exciting. They point to a chance for millions of us to live longer, fuller, happier lives.


Where do drugs fit in?

While drugs may lower blood pressure, they do not typically address its underlying causes. Also, many people have no response to a given drug, may have a side effect from a given drug, or may find that several drugs are needed to have the desired effect. Hence, it can take months for doctors to find the ‘cocktail’ that works best.

Side Effects

About 20 percent of people with high blood pressure take all their meds. One reason is the side effects. Here are some examples by drug type:

  • Ace Inhibitors. Potentially fatal swelling, kidney failure, chronic cough, vomiting, diarrhea, rash, dizziness

  • Beta Blockers. Impotence, fatigue, weakness, headache, dizziness, diarrhea or constipation, dry eyes

  • Calcium Channel Blockers. Weight gain, trouble breathing, rashes, sexual dysfunction.

  • Diuretics. Headaches, cramps, gout, increased cholesterol, kidney failure, allergic reactions


Some blood pressure drugs now cost up to $200 a month. With deductibles and copays rising, that can mean hefty out of pocket expenses.


Given all this, most medical authorities now see diet and lifestyle as the first line of defense against the high blood pressure. Still, that doesn’t mean you should forget about drugs. Here are the key things to remember:

  • Drugs can play a life-saving role in treating high blood pressure.

  • It is critical to stick to any plans your doctor prescribed for you.

  • It may be possible to change your medications over time, but you should never make such a decision without consulting your doctor first.


What should I eat?

We encourage our members to try to move as far as they feel able towards a whole-foods, plant-based diet. It sounds like a fad but in fact it is how many people have eaten for most of history. The Roman army is said to have marched on an essentially vegetarian diet, with small quantities of meat used as an occasional flavoring. Now it is growing in popularity again thanks to famous fans like Beyoncé, Jay-Z, Venus Williams, Arnold Schwarzenegger, Mike Tyson and others.

It is similar to the Mediterranean or ‘DASH’ diet which can lower blood pressure by over 11 points but it goes further by proposing we avoid dairy and fish as well. That’s because evidence suggests the more whole plant foods you eat, the healthier you’re likely to be. If it bothers you to go ‘all in’ on being plant-based early on then don’t worry. You can set your own limits knowing that each step in this direction should help.

So, what will you be eating if you go this route? Basically, a lot of whole, unrefined or minimally refined plant-based food – like fruits, vegetables, grains, beans, nuts and seeds. We also suggest you try to limit any processed foods and snacks which are often high in salt, sugar and unhealthy fats as well as reducing your intake of meat, fish and dairy.

It is also recommended to limit alcohol, caffeine (especially from energy drinks) and sugary drinks.

This may seem extreme at first but there are plenty of healthy and tasty foods available to you. Most people who try this find it surprisingly enjoyable and easy to maintain given time and support.

How do plant-based diets lower blood pressure?

Sodium-Potassium Balance

To maintain a healthy blood pressure, we need to get the right balance of sodium and potassium. Sadly, the food system has been rigged against us so that 95 percent of us consume too much sodium and/or too little potassium. By eating more whole plant foods, you will:

  • Reduce sodium intake from processed and packaged foods and sauces. Manufacturers add salt to help get you hooked, increase their products’ shelf life, cover for cheap ingredients and boost their profits.

  • Reduce your sodium intake from animal products. Meat and poultry are often pumped full of salt to increase their weight and price. A serving of all-natural baked chicken can have more salt than a large pack of fries.

  • Increase your potassium intake. Whole fruits and vegetables are the best source of this important mineral. If your kidneys are healthy, it helps your blood vessels dilate and eases pressure naturally and without the side-effects of prescription drugs.

We’ll help you make these changes. If you want to start now though, just restrict any food that has more milligrams (mg) of sodium on the label than calories. That will help bring you in line with 1,500-2,300 mg daily intake of sodium that the AHA suggests.

Healthy Arteries

Healthy plant-based foods help your arteries in two ways. First, they contain magnesium, calcium, potassium and other nutrients which:

Second, most plants have minimal saturated fat and zero cholesterol. By eating more plants, we replace animal products. Animal products are often high in saturated fat and cholesterol which:

  • Stiffen our arteries, halving their ability to relax and let blood through within a few hours of eating them.

  • Inflame, thicken and damage our artery walls increasing the risk of heart attacks and strokes.

  • Accelerate the formation of fatty deposits, raising blood pressure and potentially damaging other organs.

What are the health benefits of a plant-based diet?


What do we mean by lifestyle changes?

By lifestyle we just mean all the small habits that can impact your blood pressure. In other words, we are talking about what you do not who you are. You don’t need a big effort or a personality transplant to get results. Evidence shows small changes in three areas can dramatically improve our blood pressure.

First, there’s relaxation. Finding ways to unwind and to sleep better is one of the best ways to bring your numbers down. Second there’s exercise. You should consult your doctor before starting a new program but, for most people, even a few minutes a day can have a big impact. Finally, there’s ‘connecting’ to things beyond yourself (like family and friends).

Why do lifestyle changes work?

Healthy Arteries

A healthy lifestyle:

  • Increases blood flow, relaxes arteries and reduces pressure.

  • Boosts nitric oxide, a molecule that helps arteries relax properly.

  • Reduces inflammation and helps arteries heal.

Soothed Nerves

Stress stimulates our ‘sympathetic’ nervous system – making us feel on edge. That’s good if a bear is chasing us, but bad if you can’t sleep because of an argument at work. Relaxation, exercise and connecting to things beyond ourselves (like family, friends, pets, or the natural world) help us manage these feelings and reduce our blood pressure.

Slower Rhythms

Our ‘autonomic’ nervous system controls things we don’t think about like our heart rate, breath, digestion and blood pressure. We can’t ‘wish’ our blood pressure down – but we can help regulate our blood pressure though tricks like deep breathing.

Weight Loss

Diet drives weight loss, but lifestyle choices accelerate the journey. Exercise burns calories directly and can help build muscle to increase the amount you burn each day. Relaxation and connection help you stick to your plans and sleep appears to reduce blood pressure directly as well.

Alex White and Dr. Nick Beard Co-Founded Brightplate.

Dr. Ostfeld is the Director of Preventive Cardiology at Montefiore Health System and a Professor of Medicine at Albert Einstein College of Medicine. He has an MD. form Yale University School of Medicine and an MSc. from Harvard School of Public Health. He is a Fellow of the American College of Cardiology.