Beyond sodium: what pharmacists should know about nonpharmacological strategies for hypertension

“Are there natural ways to lower my blood pressure that actually work?”When patients ask us for alternative ways to lower their blood pressure, pharmacists have the unique opportunity to deliver evidence-based guidance that blends clinical urgency with practical, sustainable lifestyle advice. “Hypertension (high blood pressure) is the world’s leading risk factor for common chronic diseases, and is highly responsive to healthy behaviour changes, particularly alterations in dietary habits.” Hypertension Canada[1]Early action is paramountAn estimated 40% of adults over the age of 25 have hypertension[2] and many do not yet know they have it.Though your patient may want to delay pharmacotherapy, the evidence suggests otherwise.In fact, a recent analysis of over 15,000 adults with newly diagnosed hypertension found that initiating antihypertensive monotherapy within the first month significantly improved blood pressure control at six months—a benefit that persisted for up to 30 months. However, more than 30% of patients remained uncontrolled at three years, even with early treatment, underscoring the need for a more comprehensive management strategy and consistent follow-up. Notably, patients who began treatment within the first month were 21% more likely to achieve blood pressure control compared to those who remained untreated during that period.[3]While timely pharmacologic intervention is beneficial, pharmacists can empower patients to take an active role in lowering their blood pressure and reducing their risk of cardiovascular disease.Here we will briefly review the evidence behind nonpharmacologic strategies to support patients who are either initiating treatment or are seeking lifestyle-based ways to better manage their blood pressure.The potassium paradigm: more mattersWhile one of the cornerstones of hypertension management is limiting dietary sodium intake, what is often overlooked is the impact that increasing dietary potassium can have on blood pressure. Despite its benefits, dietary potassium intake remains suboptimal in Canada and other Western nations, largely due to low fruit and vegetable consumption and the widespread intake of processed foods.Potassium is an essential mineral involved in critical physiological processes including nerve transmission, muscle contraction, kidney function and cardiovascular function.Increasing dietary potassium has been shown to lower blood pressure, reduce cardiovascular risk, and even mitigate the adverse effects of high sodium intake. Potassium-rich food sources include:Fruits: Bananas, kiwifruit, apricots, and guavaVegetables: Avocados, cooked spinach, broccoli, and potatoes, and sweet potatoesDairy products, legumes, and certain fish (e.g., halibut, salmon).At-risk populations: Pharmacists should exercise caution when recommending potassium-rich diets or salt substitutes, particularly in patients with chronic kidney disease (GFR

Beyond sodium: what pharmacists should know about nonpharmacological strategies for hypertension

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Lindsay Dixon

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