Reviewed by Dietitian Karen Ansel, M.S., RDN
Credit: Photo: Getty Images. EatingWell design.
Key Points
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Some supplements can negatively impact individuals with high blood pressure.
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Experts in heart health shed light on the most concerning supplements for hypertension.
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Avoid bitter orange, licorice root, caffeine, yohimbine, and ephedra.
High blood pressure, or hypertension, is characterized by the excessive force of blood against artery walls. This persistent pressure compels the heart to exert itself more than normal, which over time can harm blood vessels and increase the risk of severe complications such as heart attack and stroke.
Approximately half of all adults in the U.S. are affected by high blood pressure, often remaining undetected in its early stages, which has led to its label as “the silent killer.” While managing high blood pressure usually involves lifestyle changes and medication, some individuals may seek out supplements for additional support. However, not all supplements containing natural ingredients are safe for heart health. To help you safeguard your heart, insights were gathered from a cardiologist and a cardiovascular dietitian on the supplements to avoid if you have high blood pressure.
1. Bitter Orange
Bitter orange extract, obtained from the dried peel of the bitter orange fruit, is often found in supplements aimed at weight loss and improved athletic performance. Unfortunately, this extract can be particularly hazardous for those with high blood pressure.
“This herb contains synephrine, which can elevate blood pressure and lead to dangerous heart rhythms,” explains Columbus Batiste, M.D., a board-certified interventional cardiologist and co-founder of Healthy Heart Nation. A systematic review and meta-analysis found that the prolonged use of bitter orange can lead to an increase in systolic blood pressure (the upper number) by 6 mmHg and diastolic pressure (the lower number) by 4 mmHg. Moreover, this supplement may heighten the risk of serious complications, such as heart attack and stroke. It’s also important to note that bitter orange is often combined with other ingredients, making careful label reading essential.
2. Licorice Root
Licorice root, with its unique sweet flavor and calming properties, has been traditionally used to address digestive issues, combat viruses, and soothe sore throats. However, “if you have high blood pressure, it’s advisable to steer clear of licorice supplements or those with licorice as a secondary ingredient,” warns Michelle Routhenstein, M.S., RD, CDCES, a cardiovascular dietitian and owner of Entirely Nourished. This caution is due to glycyrrhizic acid, a component in licorice that leads the body to retain sodium, possibly elevating blood pressure. One study indicated that even low doses of licorice root, containing as little as 100 milligrams of glycyrrhizic acid, can significantly increase blood pressure with regular consumption.
Furthermore, licorice root has been known to diminish potassium levels, resulting in muscle weakness and irregular heart rhythms, which can further strain the heart. Although some licorice supplements claim to be glycyrrhizic acid-free, it’s important to remember that supplements are not regulated as strictly as food products. Therefore, you might not always receive what the product label indicates; for instance, one study found that the glycyrrhizic acid content in a supplement was actually 50% higher than stated on the label.
3. Caffeine-Containing Supplements
Caffeine isn’t limited to just your morning coffee or afternoon tea; it’s also found in numerous supplements that purport to enhance energy, increase alertness, and boost physical performance. However, this widespread stimulant can lead to temporary spikes in blood pressure, which makes it a risky option for those managing hypertension, according to Routhenstein.
For example, a systematic review and meta-analysis concluded that caffeine supplements raised both systolic and diastolic blood pressure by 2 mmHg. While this seemingly small increase might not seem harmful, even a slight rise of around 2 mmHg can affect heart health in high-risk individuals. The safe amount of caffeine can vary by individual, as everyone metabolizes it differently. Even small doses can cause a spike in blood pressure for some, and increased consumption can exacerbate the issue.
In addition to checking your supplement’s label for caffeine, keep an eye out for guarana, another caffeine-rich ingredient commonly found in energy products, as it can also raise heart rate and blood pressure, says Batiste.
4. Yohimbine
Yohimbine, derived from the bark of the yohimbe tree, is often found in supplements and teas promoted for weight loss, enhanced athletic performance, improved sexual health, and—ironically—high blood pressure. However, Batiste warns against it. “Yohimbine is a stimulant that can dangerously elevate both blood pressure and heart rate.” Routhenstein concurs, explaining that it increases blood pressure by raising the levels of a hormone called norepinephrine. As norepinephrine rises, blood vessels narrow, impairing blood flow and contributing to higher blood pressure.
5. Ephedra
Ephedra is a herbal dietary supplement traditionally used for ailments like colds, headaches, coughs, and fevers, particularly in regions such as China and India. However, in the modern era, it has become a preferred ingredient in supplements aimed at weight loss, increased energy, and physical performance. Despite its popularity, it carries serious risks. “Ephedra contains ephedrine alkaloids, potent stimulant compounds linked to high blood pressure, heart attacks, strokes, and even sudden death,” cautions Batiste. “It can also interfere with blood pressure and heart medications, rendering them less effective.” Due to these severe side effects, the Food and Drug Administration has banned ephedra from supplement use. Even though it is prohibited in dietary supplements, its active ingredient, ephedrine, may be found in some allergy and asthma medications, so always consult your healthcare provider before using anything with ephedra in its ingredients.
Nutrition and Lifestyle Strategies for Healthy Blood Pressure
Maintaining healthy blood pressure involves more than simply avoiding certain supplements; an overall healthy lifestyle can significantly influence your blood pressure. Avoiding cigarettes and moderating alcohol consumption are proven methods for reducing hypertension risk. Here are some expert-recommended tips:
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Follow the DASH Diet: The DASH diet (Dietary Approaches to Stop Hypertension) has a strong history of helping lower blood pressure. It emphasizes a diet rich in fruits, vegetables, whole grains, beans, nuts, seeds, fish, lean meats, and low-fat dairy products, while being low in trans and saturated fats and added sugars.
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Exercise Regularly: The American Heart Association recommends engaging in at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous aerobic activity each week. Additionally, they advise incorporating muscle-strengthening exercises at least twice a week.
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Prioritize Sleep: Sleep also plays a role in blood pressure management! Aim for seven to nine hours of quality sleep each night. If you snore or experience pauses in breathing during sleep, you may suffer from sleep apnea, a hidden contributor to high blood pressure. If this resonates with you, consult a doctor for effective treatment options.
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Manage Stress: Though it’s normal to experience stress occasionally, chronic stress can elevate blood pressure. Meditation, deep breathing, practicing gratitude, engaging in enjoyable hobbies, and connecting with loved ones can all help reduce stress levels.
The Bottom Line
The market is flooded with supplements promising to enhance your health. While certain supplements may offer benefits, others can adversely affect blood pressure or interact negatively with medications designed to lower blood pressure. Experts, including cardiologists and dietitians, agree that you should avoid specific supplements if you have high blood pressure, particularly bitter orange, licorice root, caffeine, yohimbine, and ephedra. Given that supplements often contain multiple ingredients, it’s crucial to read the labels thoroughly. If you’re considering any supplements, consult your healthcare provider to ensure their safety and effectiveness for your individual health circumstances.
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