High Blood Pressure: Causes, Risks & Lifestyle Changes to Lower It

Nearly half of all adults in the United States live with high blood pressure. Often called a “silent killer,” hypertension can contribute to heart attack, stroke, and heart failure without causing symptoms.

A Shifting Landscape of Heart Disease

Research now shows a growing number of people between the ages of 35 and 64 are dying from heart disease related to hypertension, a shift from previous beliefs that it primarily affected older individuals.

According to Dr. Eduardo Sánchez, Chief Medical Officer for Prevention at the American Heart Association, “Hypertension is key because it’s the most modifiable risk factor for cardiovascular disease and stroke, and now, the evidence suggests this could be true for cognitive decline as well.” Both lifestyle changes and medication can help lower blood pressure, potentially “changing the trajectory” regarding heart attacks and strokes.

Know Your Numbers

Understanding your blood pressure is a crucial first step. Estimates suggest over half of those with uncontrolled hypertension are unaware they have it.

Blood pressure, the force of blood against artery walls, is measured in millimeters of mercury (mmHg). It’s expressed as two numbers: the top number, systolic pressure, measures the force when the heart beats, and the bottom number, diastolic pressure, measures the force between beats when the heart rests.

Normal blood pressure is less than 120 mmHg over 80 mmHg. Above this level, damage can begin to occur to blood vessels and organs like the kidneys, heart, and brain, explained Dr. Sánchez.

Dr. Jennifer Cluett, Director of the Complex Hypertension Clinic at Beth Israel Deaconess Medical centre in Boston, recommends checking blood pressure at least once a year. Proper measurement involves using the right size cuff, sitting with both feet flat on the floor, with your arm at heart level, and remaining silent.

Dr. Cluett notes that a typical, busy primary care clinic setting—with legs dangling and no arm support—is not ideal for accurate readings. Up to 30% of patients may experience “white coat hypertension,” where blood pressure rises in a medical office. Home monitoring is recommended to confirm diagnosis and track the condition.

Understand Your Personal Risk

Hypertension can stem from many causes, according to Dr. Fátima Coronado, Deputy Scientific Director of the Division for Heart Disease and Stroke Prevention at the centres for Disease Control and Prevention. It develops over time due to genetic and environmental factors, including smoking, being overweight, and lack of sleep.

A family history of heart attack or stroke may indicate a higher genetic risk. Age also plays a role, as arteries harden with time. Hypertension is more common among Black individuals and men than among White individuals and women.

Some women develop hypertension during pregnancy, which can be dangerous for both mother and baby. Dr. Martha Gulati, Director of the Davis Heart centre for Women at Houston Methodist Hospital, emphasizes the need for treatment during pregnancy and ongoing cardiac follow-up, as these women have a higher risk of hypertension and cardiovascular disease.

Follow a Heart-Healthy Diet

A healthy diet is essential for heart health. The DASH (Dietary Approaches to Stop Hypertension) diet has proven most effective in reducing blood pressure.

What we have is partly because the diet emphasizes foods rich in potassium, an electrolyte that helps the body eliminate sodium and relax artery walls. Sodium causes the body to retain water, increasing fluid and pressure within blood vessels.

Bananas aren’t the only source of potassium; an avocado or a cup of cubed melon contain even more. Citrus fruits like oranges and leafy green vegetables like spinach and chard are also rich in this electrolyte.

Reducing sodium intake alongside the DASH diet can further lower blood pressure, according to Dr. Gulati. The American Heart Association recommends limiting sodium to 2300 milligrams per day, and ideally, much less. Most dietary sodium in the U.S. Comes from restaurant meals and processed foods.

Small changes, like swapping a frozen dinner for a salad bar or choosing low-sodium sauces, can make a difference. Rinsing canned legumes and vegetables—often stored in saltwater—before consumption can also help.

Alcohol consumption is also linked to increased blood pressure. Doctors suggest abstinence, with the greatest benefits seen in those who consume more than two drinks per day.

Move and Relieve Stress

Aerobic exercise, which strengthens the heart, was the second most effective intervention after the DASH diet. Isometric resistance exercise—contracting muscles and holding a position, like a wall squat or plank—was the third.

Exercise also reduces stress, as do meditation and yoga. Other forms of prayer and religious practices can also be beneficial, according to Dr. Sánchez.

Even without weight loss, exercise is beneficial, but losing excess weight can also lower blood pressure, Dr. Cluett added.

Don’t Fear Medication

Treatment aims to keep blood pressure below 130/80 mmHg, and ideally below 120/80 mmHg. This often requires medication. Several generic and effective options are available.

Patients may need multiple medications, which can be a deterrent. Combination pills containing two or more blood pressure medications simplify administration. While some medications may cause side effects like frequent urination or leg swelling, doctors can adjust regimens to mitigate them.

Even while taking medication, dietary and exercise changes can help and reduce the likelihood of various health problems. “Lifestyle changes help with more than just controlling your blood pressure,” Dr. Cluett stated.

Frequently Asked Questions

What is normal blood pressure?

Normal blood pressure is less than 120 mmHg over 80 mmHg.

What can increase my risk of hypertension?

Factors that can increase your risk include genetics, smoking, being overweight, lack of sleep, age, race, and sex. Women who develop hypertension during pregnancy are also at increased risk.

What diet is most effective for lowering blood pressure?

The DASH (Dietary Approaches to Stop Hypertension) diet has been shown to be the most effective diet for lowering blood pressure.

Considering the widespread prevalence of hypertension and its potential consequences, what steps will you take to prioritize your heart health?