Fermented foods like yogurt, kimchi, and miso contain peptides that inhibit angiotensin-converting enzyme (ACE), much in the same way as ACE inhibitor drugs like Vasotec (enalapril) and Privnil (lisinopril) used to lower blood pressure. Although the following foods cannot “treat” hypertension (high blood pressure), they can be a beneficial part of a heart-healthy diet.
1. Yogurt
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Yogurt is made by fermenting milk with live bacterial cultures. The fermentation process transforms milk’s natural sugar (lactose) into lactic acid. Lactic acid, in turn, breaks down milk proteins (casein) into compounds called peptides that may inhibit angiotensin-converting enzyme (ACE).
Among the peptides in yogurt that exert the strongest action are VPP (valine-proline-proline) and IPP (isoleucine-proline-proline).
Even so, the action tends to be modest. A 2024 review of studies concluded that regular yogurt consumption may lower blood pressure in people without hypertension but has a minimal effect on those with hypertension.
With that said, the choice of bacteria used to make yogurt may increase the effect. This includes probiotic strains like Bifidobacterium lactis and Lactobacillus rhamnosus, which appear to have greater blood pressure-lowering effects than non-probiotic strains.
What Is Angiotensin-Converting Enzyme?
Angiotensin-converting enzyme (ACE) is an enzyme that indirectly increases blood pressure by triggering vasodilation (the narrowing of blood vessels). By blocking ACE, blood vessels can relax, thereby lowering blood pressure.
2. Kefir
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Kefir is a fermented milk, similar to thin yogurt, that is produced with a special combination of yeast and bacteria (known as “kefir grain”).
Research has shown that certain peptides in kefir, such as PYVRYL (proline-tyrosine-valine-arginine-tyrosine-leucine), have potent ACE-inhibitory effects. These are mainly produced by a strain of bacteria in kefir grain called Lactobacillus helveticus.
A small study published in the European Journal of Public Health reported that drinking 250 milliliters (1 cup) of kefir for 28 days helped lower systolic blood pressure (the upper blood pressure reading) in 42 adults with hypertension.
However, a meta-analysis of seven randomized controlled trials found that kefir consumption had no impact on blood pressure in adults. These conflicting findings may stem from differences in study design and duration; further research is needed.
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3. Kimchi
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Kimchi is produced when salt draws water out of cabbage, creating a brine where “good” bacteria can thrive and “bad” bacteria are suppressed by the high sodium content. These include helpful bacterial strains such as Lactobacillus plantarum and Companilactobacillus kimchii.
Certain peptides produced by L. plantarum, including GA (glycine-alanine), are thought to exert strong action against ACE. Though beneficial in theory, it is unclear how potent these are in practice.
While studies have shown that high kimchi consumption (more than 210 grams per day, or 1.5 cups) is linked to a lower risk of heart disease, the high amount of sodium in kimchi (781 milligrams per 100 grams) may undercut its benefit in people with uncontrolled hypertension.
4. Sauerkraut
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Sauerkraut is produced similarly to kimchi, but without the addition of chili powder, garlic, ginger, and fish sauce. As incidental as this may seem, the differences in ingredients can affect the types of peptides produced by fermentation.
Comparatively, sauerkraut has fewer bioactive peptides than kimchi. Some may have beneficial effects, but research is lacking as to how effective they are in lowering blood pressure.
As with kimchi, the high sodium content of sauerkraut may reduce its benefits in people with pre-existing hypertension.
5. Tempeh and Other Fermented Soy Products
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Tempeh is a traditional Indonesian food made from fermented soybeans that are pressed into a dense, cake-like product. The fermentation process, which binds whole soybeans together with a special mold, produces peptides with especially strong action against ACE.
Unlike some peptides comprised of a short chain of amino acids (like VPP and IPP), those produced by tempeh fermentation tend to be longer and exert substantially greater inhibitory effects.
Although research is limited, a 2017 review of studies from Japan suggests that the high consumption of fermented soybean products—including tempeh, miso, and natto—is linked to a reduced risk of hypertension in adults with normal blood pressure.
Tempeh and natto are also low in sodium, unlike miso.
6. Kombucha
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Kombucha is a fizzy drink made from sweetened tea and a diverse colony of bacteria and yeast. As a fermented beverage, kombucha is a rich source of probiotics, (beneficial microbes that normally live in the gut), including several Lactobacillus strains.
Studies have shown that certain peptides produced by kombucha fermentation may help lower blood pressure. Even so, it remains unclear how potent these compounds are compared with casein-derived peptides such as VPP and IPP.
According to a 2021 study in Current Developments in Nutrition, the effect of kombucha on blood pressure was “not significant.” Blood oxygen, blood sugar, and blood cholesterol levels were also not affected.