How to bring your blood pressure down

Finding and treating underlying causes and making lifestyle changes will help.

Many people have high blood pressure in older age, and sometimes it’s hard to control. That problem is called resistant hypertension — blood pressure that stays above a set goal, such as 140/90 millimeters of mercury (mm Hg), despite taking three classes of blood pressure drugs (including a diuretic) at the highest tolerable doses. The condition is a major risk factor for stroke, heart disease, dementia, and more. What can you do to tame it?

Reassess all medications

Bring your doctor a list of all the medications you are taking, or bring a bag with all the medication bottles. Include over-the-counter drugs, vitamins, and supplements. The list, or bag, of medicines can help your doctor identify drugs or supplements that may be raising your pressure.

For example, taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) can raise blood pressure. So can decongestants (such as phenylephrine found in many cold medicines), certain antidepressants, and corticosteroids. For example: "Alternative medications or physical therapy to relieve arthritis pain can decrease or eliminate the need for NSAIDs, helping reduce blood pressure in some patients," says Harvard cardiologist Dr. Deepak L. Bhatt, editor in chief of the Harvard Heart Letter.

Or the doctor may see that your medicines can be streamlined: fewer pills in total or fewer pills you need to take more than once a day.

Treat underlying causes

Underlying conditions can also keep your blood pressure high (see "What causes resistant hypertension?"). Getting them under control is essential. But figuring out if you have one can take detective work and a thorough physical evaluation.

For example, you may not know that you have a condition that boosts blood pressure, such as sleep apnea — pauses in breathing during sleep. Sleep apnea signs include chronic loud snoring, episodes where you stop breathing briefly (and perhaps gasp for breath), and being very sleepy during the daytime. A sleep study in a lab or at home (with a portable device) can provide answers.

What causes resistant hypertension?

Resistant hypertension (high blood pressure that won’t go down despite treatment with multiple drugs) has many possible causes. Top reasons include consuming too much salt, which can make blood pressure medications less effective; and missing doses or adjusting them on your own. Other reasons include

• weight gain
• sleep apnea
• high alcohol consumption
• chronic pain
• atherosclerosis causing inflammation in artery walls
• drug interactions
• panic attacks
• high levels of the hormone aldosterone (which causes the body to hold on to sodium and water)
• kidney problems
• eating black licorice (which contains a compound that can increase blood pressure).

Make lifestyle changes

You may need to ramp up healthy habits to maximize their effects. Start by eating a plant-based diet that’s low in salt; aim for less than 2,400 milligrams (mg) of salt per day. You should also be getting at least seven hours of sleep per night, limiting alcohol, avoiding smoking, and maintaining a healthy weight. "Sometimes losing just 5 or 10 pounds can make a meaningful difference in blood pressure for people who are overweight," Dr. Bhatt says.

And if you’re not exercising much, it’s time to start. Exercise boosts cardiovascular health in many ways. And a small, randomized trial published online Aug. 4, 2021, by JAMA Cardiology suggests that aerobic exercise (the kind that gets your heart and lungs pumping) may be another effective treatment for resistant hypertension.

In the study, people who walked, cycled, or both — for 40 minutes, three times per week, for 12 weeks — lowered their blood pressure by seven points in the top (systolic) number of their blood pressure measurement, and five points in the bottom (diastolic) number of the measurement, compared with people who didn’t exercise.

What else will help?

If these strategies don’t reduce your blood pressure, your doctor may feel it’s necessary to prescribe more pills. But don’t despair. "No matter what you are taking now, your doctor should be able to make affordable changes in your blood pressure medications to bring down your numbers," Dr. Bhatt says.

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Small changes can make a big difference in your blood pressure numbers.

If you suddenly find yourself with high blood pressure (hypertension) under the new guidelines from the American Heart Association and the American College of Cardiology, you might be wondering what to do. The guidelines lowered the definition for high blood pressure to 130/80 from 140/90 millimeters of mercury (mm Hg), meaning more people now meet the criteria for stage 1 hypertension.

While you shouldn't shrug off the change, there's also no need to panic. "Obviously, nothing happened overnight inside a woman's body or to her health with the release of the guidelines," says Dr. Naomi Fisher, director of hypertension service and hypertension innovation at the Brigham and Women's Hospital Division of Endocrinology, Diabetes, and Hypertension, and associate professor of medicine at Harvard Medical School.

The change, however, should spur you to take your blood pressure seriously. "These guidelines have been long anticipated and are very welcome by most hypertension experts. They may seem drastic, but in putting the knowledge we've gained from large trials into clinical practice, they will help thousands of people," says Dr. Fisher.

Why does hypertension matter?

If you are in this 130/80 range, reducing your blood pressure can help protect you from heart attack, stroke, kidney disease, eye disease, and even cognitive decline. The goal of the new guidelines is to encourage you to treat your high blood pressure seriously and to take action to bring it down, primarily using lifestyle interventions. "It is well documented that lifestyle changes can lower blood pressure as much as pills can, and sometimes even more," says Dr. Fisher.

Making those changes can be challenging. More than one woman has woken up in the morning committed to healthy eating only to be derailed by a plate of cookies on a table in the office or a dinner out with friends.

How lower your blood pressure with small changes

You don't have to embark on a major life overhaul to make a difference in your blood pressure. Here are six simple tips for actions you can take to help get your blood pressure back into the normal range.

1. Lose weight

By far the most effective means of reducing elevated blood pressure is to lose weight, says Fisher. And it doesn't require major weight loss to make a difference. Even losing as little as 10 pounds can lower your blood pressure.

2. Read labels

Americans eat far too much dietary sodium, up to three times the recommended total amount, which is 1,500 milligrams (mg) daily for individuals with high blood pressure, says Dr. Fisher. It doesn't take much sodium to reach that 1,500-mg daily cap — just 3/4 of a teaspoon of salt. There's half of that amount of sodium in one Egg McMuffin breakfast sandwich. Weed out high-sodium foods by reading labels carefully. "It is very difficult to lower dietary sodium without reading labels, unless you prepare all of your own food," says Dr. Fisher. Beware in particular of what the American Heart Association has dubbed the "salty six," common foods where high amounts of sodium may be lurking:

• breads and rolls
• cold cuts and cured meats
• pizza
• poultry
• soup
• sandwiches.

3. Get moving

It doesn't take much exercise to make a difference in your health. Aim for a half-hour at least five days a week. "Make sure you're doing something you love, or it won't stick," says Fisher. "For some that means dancing; for others, biking or taking brisk walks with a friend." Even everyday activities such as gardening can help.

4. Pump some iron

"Add some weightlifting to your exercise regimen to help lose weight and stay fit. Women lose muscle mass steadily as we age, and weightlifting is an often-overlooked part of an exercise plan for most women," says Fisher.

5. Limit alcohol to one drink per day

Drinking too much, too often, can increase your blood pressure, so practice moderation.

6. Relieve stress with daily meditation or deep breathing sessions

Stress hormones constrict your blood vessels and can lead to temporary spikes in blood pressure. In addition, over time, stress can trigger unhealthy habits that put your cardiovascular health at risk. These might include overeating, poor sleep, and misusing drugs and alcohol. For all these reasons, reducing stress should be a priority if you're looking to lower your blood pressure.

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