In 2017, new blood pressure guidelines were released that lowered the numbers for what is diagnosed as hypertension (high blood pressure). Under those guidelines roughly 30 million more Americans could be considered to have high blood pressure.
For many, that may mean it’s time to make some simple lifestyle changes to lower blood pressure. And you don’t need to transform into a vegan triathlete, either. Even modest changes can have a big impact on blood pressure.
Lowering Your Blood Pressure Without Medication
DASH toward healthy blood pressure. The Dietary Approaches to Stop Hypertension (DASH) features fruits, vegetables, low-fat dairy, and whole grains, and emphasizes whole foods high in nutrients that can suppress blood pressure, like calcium, potassium, and magnesium. In the original DASH trial, DASH lowered systolic and diastolic pressure 5.5 and 3.0 points more, respectively, than a diet low in produce and dairy with a fat content typical of the average American diet.
“With respect to diet, DASH is the mainstay,” says Mark Supiano, MD, professor and chief of the division of geriatrics at the University of Utah School of Medicine. “It is the most evidence-based.” A low sodium intake seems to enhance DASH’s blood pressure-lowering effects.
Start by eating one DASH meal a week and gradually adding more. Get more bang for your buck by buying frozen produce, stocking up on beans, shopping seasonally and looking out for sales. You can find plenty of easy DASH recipes on the Mayo Clinic website or Epicurious.
Eat foods you enjoy. Some find it hard to stick to a DASH diet, and not because they lack motivation, says Kevin Hwang, MD, an internist at McGovern Medical School at University of Texas Health in Houston. “If you give them examples of foods they don’t already eat, they’re probably not going to go for it,” Hwang says. A diet’s effectiveness depends not so much on the diet itself as whether you follow it, he adds. He recommends following a diet that lowers your overall calorie and sodium intake, and increases your intake of fruits and vegetables — even if it’s not DASH.
Easy on the salt. Federal guidelines recommend limiting sodium to only 2,300 milligrams per day or less — the amount in a teaspoon of table salt. The ideal limit is 1,500 milligrams, according to the American Heart Association(AHA). Yet most adults consume more than 3,400 milligrams of sodium per day, on average.
In a 2017 study, reducing daily sodium intake from high (3,450 milligrams) to low levels (1,150 milligrams) was associated with a 3- to 9-point drop in systolic pressure, on average, with the greatest improvements among those with the highest blood pressure.
After a few weeks of lowering your sodium intake, you may notice a shift in your palate. Suddenly, the chips you used to routinely devour will taste way too salty. “It takes about 21 days to really wash out your taste,” says Mary Ann Bauman, MD, a primary care internist and AHA spokesperson. “You can change your taste buds.” Here’s how:
- Beware of hidden sodium. “Most of the sodium we consume we’re not even aware of,” says Michael Hochman, MD, an associate professor of clinical medicine at the Keck School of Medicine of the University of Southern California. Most comes from processed foods, such as deli meats or canned foods, or hides in items like bread and pasta. “Start reading food labels so you know the sodium content,” Bauman says.
- Say “no” to the salt shaker. “No one should be adding salt to their food, period,” Supiano says.
- Dine in. Many restaurant dishes are teeming with sodium. But, “if you cook at home, you know exactly what you’re putting into your food,” Hochman says.
- Build your spice rack. Expand your seasoning repertoire beyond salt by experimenting with spices, Bauman says. Boost flavor with herbs, spices, lemon, chili pepper, garlic, and ginger, instead of salt. Supiano also suggests salt-free seasoning blends like Mrs. Dash.
Avoid saturated fats, trans fats, and cholesterol. Saturated and trans fats can increase cholesterol, which, in turn, is connected to high blood pressure.
Get moving. Although diet is important, sometimes “exercise is a stronger driver to bringing blood pressure down than losing weight or diet,” Supiano says. Aerobic exercise is “good for the heart, and it helps relax the blood vessels,” Hochman says. The most recent evidence suggests that aerobic exercise can reduce blood pressure within a matter of months. One recent study of middle-aged men with high, normal, or mildly elevated blood pressure, found that a 16-week aerobic exercise program led to 12- and 6.5-point drops in resting systolic and diastolic pressure, respectively.
The AHA recommends at least a half hour of moderate intensity aerobic activity at least five days a week, or at least 25 minutes of vigorous aerobic activity at least 3 days a week for overall heart health. It also recommends moderate to high intensity strength training two days a week.
Break it up. In fact, a 2012 study found that taking three 10-minute walks throughout the day was effective at lowering blood pressure. Build short aerobic activity sessions into your daily life, Bauman says. Park farther away from your office, and take the stairs instead of the elevator, for example.
Put some muscle into it. A 2011 analysis on the effects of resistance training on blood pressure and other cardiovascular risk factors, found that dynamic resistance training — which includes activities like lifting weights, which makes the muscles contract as they shorten and lengthen — led to 2.8- and 2.7-point drops in systolic and diastolic pressure, respectively. Robert D. Brook, MD, director of the comprehensive hypertension program at the University of Michigan’s Frankel Cardiovascular Center, recommends 20 minutes of light resistance exercise, two to three times a week.
Get a grip. Early evidence suggests that resistance training exercises that use an isometric handgrip — a small spring that you squeeze with your hand — may result in even steeper declines in blood pressure than dynamic resistance training. An AHA statement on alternative approaches to lower blood pressure, co-written by Brook and colleagues, recommends squeezing the handgrip at 30 percent of your maximum strength for about two minutes at a time for a total of 12 to 15 minutes, at least three times a week. “You can do it on the couch for 12 minutes every other day,” Brook says.
Lose weight: Losing just five to ten percent of your body weight can lower your blood pressure. Consult with your doctor about finding the right, healthy weight loss approach for you.
Have fun. While each type of exercise differs in its ability to lower blood pressure, don’t sweat over picking the “right” one. “The main point is just do something to get your heart rate up,” Supiano says.
The more, the better. Combining lifestyle changes has an additive effect, Brook says, meaning the more of them you adopt, the more your blood pressure will decrease. In a 2010 study, for instance, overweight adults with above-normal blood pressure who followed a DASH diet plus a weight management program — which included exercise — had greater decreases in blood pressure than those who followed DASH alone.
Cut back on alcohol. Sure, research over the years has suggested that moderate drinking may be good for heart health. But drinking alcohol beyond the recommended amount — one drink a day for women and one to two drinks a day for men — can increase blood pressure, not to mention the risk of stroke, obesity, and cancer. The AHA advises against taking up drinking for heart health benefits if you don’t already do so.
If you smoke, quit. Smoking causes a momentary spike in blood pressure and can increase your likelihood of developing atherosclerosis, a disease that can lead to heart attack or stroke — and exacerbated by high blood pressure.
Relax. Possibly the easiest way to lower blood pressure by a few points? “Figure out what types of activities you do that make you relax, whether listening to classical music or going to yoga class,” Hochman says. In their AHA statement, Brook and colleagues note that transcendental meditation — a method to foster relaxed awareness by focusing on a mantra — can modestly lower blood pressure. One analysis found it could lower systolic and diastolic pressure by 4.7 and 3.2 points, respectively. The deep breathing techniques practiced in meditation, yoga and other forms of relaxation could also help. In a Japanese study, a short deep breathing session in a clinical setting lowered systolic and diastolic pressure 8.3 and 4.4 points, respectively, in people with hypertension.
Lowering Your Blood Pressure With Medication
Many people will need to take blood pressure medications along with lifestyle changes to get their blood pressure down. Reviews of various classes of blood pressure medicines show some can reduce systolic and diastolic pressure by about 5 to 10 points
If you do need medications, “don’t beat yourself up,” Brook says. “It’s only a minority of people who are going to be able to persist with achieving blood pressure control with lifestyle alone.” But that’s not to say you should let your lifestyle fall by the wayside. Medication should be taken in addition to — not instead of — diet, exercise, quitting smoking, cutting back on alcohol, and managing your stress.
Talk to your doctor. Your doctor will take factors such as your ethnicity, as well as any other health conditions you might have, into consideration when prescribing blood pressure-lowering medications. But to figure out the right drug — or combination of drugs — to reach your blood pressure goals, you should have an ongoing conversation with your doctor. Here are some questions to ask him or her:
- How will this drug help me? Know why you are being prescribed the drug and how to tell if it’s working.
- What are the potential side effects? Know which potential side effects to anticipate, and which ones are serious enough to report to your doctor, Supiano says.
- How will my response be monitored? Do you need to monitor your blood pressure at home? Do you need follow up blood tests or other tests to make sure it’s not having any negative effects on your body?
- Are there any interactions with other medications? Whenever you add a prescription, discuss whether it could interact with other medications or supplements you take.
- Can I be prescribed a generic, once-a-day version? Generics are cheaper. And you may find it easier to take the required dose if you only need to remember to take it once a day.
- I’m having trouble with my medication. What should I do? Sometimes, Bauman’s patients stop taking their blood pressure medication — and don’t tell her until after the fact. That can be dangerous. If you have any problems staying consistent with your medication, speak up. “Don’t just stop taking your medication,” she says. “Let your doctor know.” That way, you can work together to figure out a different dosage, or some other alternative.
- When should I call a doctor? Ask if there are any warning signs from drug side effects, or from any condition you may have that mean you should pick up the phone.
Originally published in 2018. Updated in 2021
