Anti-Age Your Blood Vessels

Article at-a-glance:

  • Blood pressure is controlled by a combination of blood vessel elasticity and blood viscosity.
  • High blood pressure increases your risk for a heart attack and stroke.
  • Most doctors don’t think about blood vessel elasticity and viscosity, or discuss them with their patients. 
  • Fortunately, there are many natural approaches that can improve blood vessel health, reduce blood pressure and drive down your risk.

by Dr. John Neustadt

High blood pressure is such a huge risk for heart disease and stroke that it’s called the “silent killer.” Often it has no warning signs or symptoms, and many people don’t even know they have it. When it comes to blood pressure, two main components determine whether or not it starts to creep up. One is decreased blood vessel elasticity. The other is increased blood viscosity.

Each topic is large enough and important enough that they deserve their own blogs. I encourage you after reading this one, to read the other blog, Top Tips for Improving Blood Viscosity.Both give concise recommendations about what you can do to naturally maintain healthy blood pressure. To get the maximum benefits, put into practice the recommendations from both blogs.

Collectively your arteries, veins, and heart from our cardiovascular system. It’s a miraculous system that works around the clock, without us even having to think about it. Until something goes wrong. 

There are nearly 800,000 strokes in the U.S. annually, and as our population ages, those numbers are projected to soar.1 The impact is even greater, however, when you include subclinical cerebrovascular disease. These “silent strokes,” which don’t produce outward symptoms and are identified on brain imaging, occurs in up to 28% of people over age 65. Meanwhile, nearly 610,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths. Heart disease is the leading cause of death for both men and women.2

The most important risk factor for having a stroke is high blood pressure.3 High blood pressure also increases your risk of a heart attack. But why exactly do blood vessels get stiff and create high blood pressure? And, importantly, what can you do to improve blood vessel elasticity and reduce your blood pressure? 

When you feel your pulse—for example in your wrist or neck—that’s your arteries expanding and relaxing as the heartbeats and pumps blood through the body. With each heartbeat, this muscle that never sleeps creates a “wave” of blood traveling away from the heart. When you check your blood pressure, it indicates how hard the heart has to pump to move blood through the body. High blood pressure means added stress is being put on your heart and blood vessels. 

Two major components influence blood pressure: the flexibility (or stiffness) of arteries and veins, and the thickness (or blood viscosity) of blood. Both impact how easily blood flows through the circulatory system. This blog discusses the first risk factor: arterial stiffness. 

Arterial stiffness increases as we age and predicts stroke risk and even recovery after a stroke.4 It’s also a powerful independent predictor of heart disease,5 cognitive impairment and Alzheimer’s disease,6,7 and death from all causes (“all-cause mortality”).8 In people with rheumatoid arthritis, arterial stiffness predicts more disability.9 Even conditions like depression and osteoporosis have been found in multiple studies to correlate with arterial stiffness, suggesting that the health of the arterial wall is intimately connected to overall health and its many manifestations.10

60,000 Miles of Blood Vessels

Your marvelous cardiovascular system is composed of arteries, veins, capillaries and the heart. If your blood vessels were laid out end to end they would stretch for an astonishing 60,000 miles—long enough to take a cruise ship around the world twice.11 

Arteries carry oxygen-rich blood away from the heart, delivering it to all the tissues of the body. As arteries branch out they become smaller and smaller, like an interstate turning to side streets and finally small alleyways. Veins carry blood that is depleted of oxygen, but also has waste from cells, back to the heart; they in turn get larger as they approach the heart. The waste products will be disposed of and the heart will once again enrich the blood with oxygen for the next journey into the arteries and through the body. 

When the arterial wall stiffens and becomes less elastic, a smaller amount blood flows through the blood vessels, and the “wave” that carries the blood through normally flexible arteries is reduced. This requires the heart to pump harder to circulate the same amount of blood, dangerously increase the amount of pressure in the arteries and can reduce the amount of blood reaching your kidneys, liver, intestines, brain, muscles, and other organs. The reduction in delivery of oxygen and nutrients can in turn make it harder for tissues to do their job and cause further damage. 

Over time, elevated blood pressure can weaken arteries and cause them to bleed out. When this happens in the brain, it’s called a stroke. The added work on your heart over time can also damage it and people with high blood pressure are more likely to develop atherosclerosis (hardening of the arteries). 

Top Ways to Reduce Your Risk

Arterial stiffness and cardiovascular disease are not inevitable. Arterial stiffness can be prevented and reversed by many lifestyle factors. Things you can do to reduce your risk include: 

  • Don’t smoke cigarettes or stop if you do12,13
  • Maintain healthy blood pressure and cholesterol14
  • Reduce triglycerides if elevated and increase HDL (the good cholesterol) if low15
  • Prevent and reverse metabolic syndrome16
  • Reduce inflammation and oxidative stress17,18,19
  • Additionally…


Moderate or vigorous physical activity reduces the risk of arterial stiffness, while a sedentary lifestyle increases it.20 One ten-year study found that 150 minutes of moderate to vigorous physical activity each week was associated with less arterial stiffness.21 


With every bite of food you’re either creating health or feeding disease. Diet is one of the biggest predictors of chronic diseases, including cardiovascular disease, and early death. But the beautiful thing is that regardless of your age, research shows that changing your diet improves your health and reduces your risk. 

Reduce Salt

If you’re eating the Standard American Diet (SAD) you’re consuming too much salt. A low salt diet can be protective.22 While you can read labels that emphasize low-sodium prepared foods, you will naturally be eating less sodium if you transition away from a SAD and toward a whole foods, Mediterranean Diet. 

Improve Blood Sugar 

Elevated blood sugar, seen in metabolic syndrome and diabetes, increases vascular stiffness.23 Reducing sugar in the diet, eating a more whole-foods, plant-based diet, and exercising can all help improve blood sugar control. 

Eat Plants 

A plant-based, whole foods diet provides vitamins, minerals, antioxidants and other nutrients with powerful effects on blood pressure. A randomized, controlled clinical trial (the gold standard in medical research) published in 2019 in the journal Hypertension followed nearly 1300 adults (65-79 years old) with high blood pressure. After a year, those following a Mediterranean diet significantly reduced their blood pressure and arterial stiffness.24

Other research that looked at dietary patterns across ethnicities and races in US adults discovered that not eating enough green leafy vegetables is an independent predictor of high arterial pulse pressure. Green leafy vegetables include kale, spinach, turnip greens, collards, Swiss chard, mustard greens, parsley, romaine, and green leaf lettuce.25 

But you don’t have to wait an entire year to experience the benefits of eating more of a whole foods diet. Researchers fed volunteers two meals that were rich in spinach. In addition to containing vitamin K1, magnesium, and other nutrients, spinach is a great source of nitrate. Other vegetables that contain high amounts of nitrate include lettuce, beetroot, celery, spinach, Chinese greens, other leafy greens, parsley, and related herbs. Nitrate helps arteries to relax and can reduce blood pressure. After only two meals, blood pressure and arterial elasticity both significantly improved.26

So your parents were right—eat your vegetables.  

But you can also enjoy some dark chocolate and tea. Research shows that flavonoids, a class of food compounds found in cocoa, tea, and other foods can be helpful. A flavonoid rich diet full of fruits and vegetables is linked to less severe arterial stiffness.27,28

For my step-by-step guide to transitioning to a Mediterranean diet and eating healthy for life, see Dr. Neustadt’s 3-Steps to Eating Healthy for Life.

Omega-3 Fatty Acids

Omega-3 fatty acids, like those found in fish and flaxseed, may protect against arterial stiffness.29 Regular tea consumption can have protective effects against arterial stiffness.30


Turmeric, that golden spice so popular today for everything from tea to “golden milk”, has significant cardiovascular benefits, including reduction in arterial stiffness.31

Pine Bark Extract

Pine bark extract (Pinus massoniana) contains a blend of polyphenols called procyanidins. These powerful nutrients have remarkable effects on cardiovascular health and promote healthy blood pressure and arterial flexibility.32

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1Boehme AK, Esenwa C, Elkind MSV. Stroke Risk Factors, Genetics, and Prevention. Circ Res. 2017 Feb 3;120(3):472–95 [Article]

2Centers for Disease Control (CDC). Heart Disease Facts. November 2017. [Report]

3American Heart Association. How High Blood Pressure Can Lead to Stroke. October 2016 [Report]

4Chen Y, Shen F, Liu J. Arterial stiffness and stroke: de-stiffening strategy, a therapeutic target for stroke. Stroke Vasc Neurol. 2017 Mar 17;2(2):65-72. [Article]

5Bonarjee VS. Arterial stiffness: a prognostic marker in coronary heart disease. Available methods and clinical applications. Front Cardiovasc Med. 2018; 5: 64. [Article]

6Li X, Lyu P, Ren Y  et al. Arterial stiffness and cognitive impairment. J Neurol Sci. 2017 Sep 15;380:1-10. [Article]

7Hughes TM, Wagenknecht LE, Craft S  et al. Arterial stiffness and dementia pathology: Atherosclerosis Risk in Communities (ARIC)-PET Study Neurology. 2018 Apr 3;90(14):e1248-e1256. [Article]

8Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis J Am Coll Cardiol. 2010 Mar 30;55(13):1318-27. [Article]

9Crilly MA, Clark HJ, Kumar V et al. Relationship between arterial stiffness and Stanford Health Assessment Questionnaire disability in rheumatoid arthritis patients without overt arterial disease.J Rheumatol. 2010 May;37(5):946-52. [Article]

10van Sloten TT1, Mitchell GF, Sigurdsson S Associations between arterial stiffness, depressive symptoms and cerebral small vessel disease: cross-sectional findings from the AGES-Reykjavik Study.J Psychiatry Neurosci. 2016 Apr;41(3):162-8. [Article]

11Web MD. What are the three main types of blood vessels? November 2019. [Report]

12Katsiki N, Kolovou G. Smoking and arterial stiffness. Angiology. 2015 Nov;66(10):969-70. [Article]

13Fu S, Luo L, Ye P et al. Multimarker analysis for new biomarkers in relation to central arterial stiffness and hemodynamics in a Chinese community-dwelling population. Angiology. 2015 Nov;66(10):950-6. [Article

14Si XB, Liu W. Relationship between blood lipid and arterial stiffness in hypertension.Clin Invest Med. 2019 Sep 29;42(3):E47-E55. [Article]

15Chung TH, Shim JY, Kwon YJ et al. High triglyceride to high-density lipoprotein cholesterol ratio and arterial stiffness in postmenopausal Korean women J Clin Hypertens (Greenwich). 2019 Mar;21(3):399-404. [Article]

16Peñaherrera CA, Peñaherrera R2, Duarte MC et al. Assessment of arterial stiffness in patients with metabolic syndrome in Ecuador: A cross-sectional study. Diabetes Metab Syndr. 2017 Jul – Sep;11(3):199-202. [Article]

17Massaro M, Scoditti E, Carluccio MA et al. Oxidative stress and vascular stiffness in hypertension: A renewed interest for antioxidant therapies? Vascul Pharmacol. 2019 May;116:45-5 [Article]

18Maloberti A, Vallerio P, Triglione N. Vascular aging and disease of the large vessels: role of inflammation. High Blood Press Cardiovasc Prev. 2019 Jun;26(3):175-182. [Article]

19Della Corte V, Tuttolomondo A, Pecoraro R et al. Inflammation, endothelial dysfunction and arterial stiffness as therapeutic targets in cardiovascular medicine. Curr Pharm Des. 2016;22(30):4658-4668 [Article]

20Gomez-Marcos MA, Recio-Rodriguez JI, Patino-Alonso MC et al. Relationship between objectively measured physical activity and vascular structure and function in adult. Atherosclerosis 234 (2) (2014) 366–372 [Article]

21Endes S, Schaffner E, Caviezel S et al. Long-term physical activity is associated with reduced arterial stiffness in older adults: longitudinal results of the SAPALDIA cohort study. Age Ageing 45 (1) (2016) 110–115 [Article]

22Chen CH. SSA 01-4 the characteristics of arterial stiffness in east Asia, J. Hypertens. 2016; (34 Suppl. 1) e1. [Article]

23 Chen Y, Shen F, Liu J, Yang GY. Arterial stiffness and stroke: de-stiffening strategy, a therapeutic target for stroke. Stroke Vasc Neurol. 2017;2(2):65-72. [Article]

24 Jennings A, Berendsen AM, de Groot L, et al. Mediterranean-Style Diet Improves Systolic Blood Pressure and Arterial Stiffness in Older Adults. Hypertension. 2019;73(3):578-586. [Article]

25Vaccaro JA, Huffman FG. Phylloquinone (vitamin K₁) intake and pulse pressure as a measure of arterial stiffness in older adults.J Nutr Gerontol Geriatr. 2013;32(3):244-57. [Article]

26 Liu AH, Bondonno CP, Croft KD, et al. Effects of a nitrate-rich meal on arterial stiffness and blood pressure in healthy volunteers. Nitric Oxide. 2013;35:123-130. [Article]

27Macready AL, George TW, Chong MF et al. Flavonoid-rich fruit and vegetables improve microvascular reactivity and inflammatory status in men at risk of cardiovascular disease—FLAVURS: a randomized controlled trial, Am. J. Clin. Nutr. 2014;99 (3) 479–489. [Article]

28Crichton GE, Elias MF, Alkerwi A et al. Relation of habitual chocolate consumption to arterial stiffness in a community-based sample: preliminary findings. Pulse 4 2016;1) 28–37. [Article]

29Reinders I, Murphy RA, Song X et al. Higher plasma phospholipid n-3 PUFAs, but lower n-6 PUFAs, are associated with lower pulse wave velocity among older adults. J. Nutr.2015;145 (10) 2317–2324 [Article]

30Lin QF, Qui CS, Wang SL et al. A cross-sectional study of the relationship between habitual tea consumption and arterial stiffness. J. Am. Coll. Nutr. 2016;35 (4) 354–361. [Article]

31Campbell MS, Fleenor BS. The emerging role of curcumin for improving vascular dysfunction: A review. Brit Rev Food Sci Nutr. 2018;58(16):2790-2799. [Article].

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