High Blood Pressure: Risks, Prevention & Lifestyle Changes

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.

While hypertension was once thought to primarily affect older individuals, research now shows a growing proportion of people between the ages of 35 and 64 are dying from heart disease related to it.

“Hypertension is foundational because it’s the most modifiable risk factor for cardiovascular disease and stroke, and now, as evidence suggests, this may be true for cognitive decline as well,” said Dr. Eduardo Sánchez, chief medical officer for prevention at the American Heart Association. Lifestyle changes and medication can help lower blood pressure, which “drastically changes the trajectory” when it comes to heart attacks and strokes, he added.

Even simple steps can help you manage your blood pressure.

Know Your Numbers

It seems obvious, but knowing your blood pressure is a good starting point. Estimates suggest that more than half of people with uncontrolled hypertension are unaware they have it.

Blood pressure, the force of blood pushing 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. 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 that level, Dr. Sánchez explained, damage begins to occur to blood vessels and the organs they supply, such as the kidneys, heart, and brain.

It’s important to have your blood pressure checked at least once a year, according to Dr. Jennifer Cluett, director of the Complex Hypertension Clinic at Beth Israel Deaconess Medical Center in Boston. Ensure it’s measured correctly: with a cuff of the appropriate size, while seated with both feet flat on the floor, with your arm at heart level, and without speaking.

“The typical busy primary care clinic setting—where someone is sitting on an exam table with legs dangling and arm unsupported while someone is talking to them—is not ideal,” Dr. Cluett said.

Up to 30% of patients may also experience “white coat hypertension,” where blood pressure rises in the doctor’s office. Guidelines for managing blood pressure also recommend home monitoring to confirm diagnosis and track the condition.

Understand Your Personal Risk

Hypertension can have many causes, said Dr. Fatima Coronado, deputy scientific director of the division of heart disease and stroke prevention at the Centers for Disease Control and Prevention. It develops over time as a result of genetic and environmental factors, such as smoking, being overweight, and lack of sleep.

Individuals whose parents or grandparents experienced a heart attack or stroke may have a higher genetic risk of developing high blood pressure, Dr. Coronado said.

Age plays a role in risk because our arteries become stiffer as we age. Hypertension is also 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. This condition should be treated during pregnancy, and women should receive ongoing cardiac follow-up afterward, as they have a higher risk of developing hypertension and cardiovascular disease, noted Dr. Martha Gulati, director of the Davis Heart Center for Women at Houston Methodist Hospital.

Follow a Heart-Healthy Diet

You’ve heard it before: eating healthy is crucial for your heart. Specifically, the DASH (Dietary Approaches to Stop Hypertension) diet proved to be the most effective of 22 lifestyle changes and stress-reduction techniques for lowering blood pressure, according to an analysis of more than 100 studies.

One reason may be that it focuses on foods rich in potassium, an electrolyte that helps the body get rid of sodium and relaxes artery walls. Sodium causes the body to retain water, increasing fluid and pressure within blood vessels.

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

You can further lower your blood pressure by reducing your sodium intake alongside the DASH diet, Dr. Gulati said. The American Heart Association recommends limiting sodium consumption to a maximum of 2300 milligrams per day, and ideally, much less. In the United States, most dietary sodium comes from restaurant meals and processed foods.

Reducing these foods—for example, swapping a frozen dinner or slice of pizza for a salad bar—or making small changes while grocery shopping can make a big difference. Look for low-sodium versions of sauces. Rinse canned beans and vegetables, which are often stored in salty water, before eating.

Alcohol consumption is also associated with increased blood pressure. Physicians suggest abstinence. The benefits of reducing intake appear greatest for those consuming more than two drinks per day.

Move and Relieve Stress

Aerobic exercise, which strengthens the heart so it can pump with less effort, was the second most effective intervention, after the DASH diet. Isometric resistance exercise (contracting muscles and holding a position, like a wall sit or plank) was the third. Isometric exercise can help dilate blood vessels, improving blood flow.

Exercise can also reduce stress, as can meditation and yoga. Other forms of prayer and religious practice can also reduce it, Dr. Sánchez said.

And while exercise is beneficial even if you don’t lose weight, Dr. Cluett said, losing excess weight can also lower blood pressure.

Don’t Fear Medication

The goal of treatment is to keep blood pressure below 130/80 mmHg, though below 120/80 mmHg is even better. Often, this requires medication. Several generic and effective options are available for doctors to prescribe.

Patients may need to take multiple types of medications, which doctors say can sometimes be a deterrent. Combination pills containing two or more blood pressure medications in a single tablet can make adherence easier. While some medications can cause side effects like frequent urination or leg swelling, doctors can adjust medication regimens to mitigate them.

Even if you take medication, changes to your diet and exercise can help and reduce the likelihood of various health problems. “Lifestyle changes help with more than just controlling your blood pressure,” Dr. Cluett said.