The most reliable ways to lower blood pressure are cutting back on salt, eating more fruits and vegetables, moving most days, limiting alcohol, losing extra weight and sleeping well, and, when those are not enough, taking a blood pressure medication your doctor matches to you. High blood pressure rarely causes symptoms, so the first step is knowing your numbers. Here is how we approach it as internists at Radiant Primary Care in Millburn, NJ.
What Counts as High Blood Pressure?
Blood pressure is written as two numbers: the top number (systolic) is the pressure when your heart beats, and the bottom number (diastolic) is the pressure between beats. The American Heart Association uses these adult categories:
- Normal: below 120/80
- Elevated: 120 to 129 on top, with the bottom number below 80
- Stage 1 high blood pressure: 130 to 139 on top, or 80 to 89 on the bottom
- Stage 2 high blood pressure: 140 or higher on top, or 90 or higher on the bottom
One high reading does not mean you have hypertension. Pressure rises with stress, caffeine, pain and even the walk into a doctor’s office. A diagnosis is based on several readings over time, ideally including readings taken at home.
Does High Blood Pressure Cause Symptoms?
Usually not. Most people with high blood pressure feel completely fine, which is why it is often called a silent condition. Over years, untreated high blood pressure strains the heart, blood vessels, kidneys, brain and eyes, and raises the risk of heart attack, stroke and kidney disease. Headaches, nosebleeds or feeling flushed are not reliable signs. The only way to know is to measure.
How to Lower Blood Pressure Naturally
Lifestyle changes are the foundation of treatment for everyone with high blood pressure, whether or not they also take medication. The changes with the strongest evidence are:
- Eat less salt. Most sodium comes from packaged, restaurant and takeout food, not the salt shaker. The American Heart Association recommends no more than 2,300 mg of sodium a day, and ideally closer to 1,500 mg for most adults with high blood pressure.
- Follow a DASH-style eating pattern. Fill your plate with vegetables, fruit, beans, whole grains, nuts and low-fat dairy, and cut back on red and processed meat, sweets and sugary drinks.
- Move most days. Aim for about 150 minutes a week of moderate activity, such as brisk walking, plus some strength training. Regular movement matters more than intensity.
- Lose extra weight. Even a modest weight loss often brings blood pressure down. If weight has been hard to lose on your own, medical weight management can help.
- Limit alcohol. Less is better for blood pressure; if you drink, keep it to no more than one drink a day for women and two for men.
- Sleep well and get screened for sleep apnea. Loud snoring, gasping at night or daytime sleepiness can be signs of sleep apnea, a common and treatable cause of high blood pressure.
- Quit smoking and vaping, which raise blood pressure and damage blood vessels.
Two cautions: many supplements marketed for blood pressure have little evidence behind them, and potassium supplements can be dangerous for people with kidney disease or on certain medications. Some over-the-counter products, including decongestants and anti-inflammatory pain relievers such as ibuprofen, can raise blood pressure. Check with your doctor before starting anything new.
When Is Blood Pressure Medication Needed?
Your doctor weighs your readings together with your overall risk of heart disease and stroke, your kidney health and conditions such as diabetes. In general, medication is recommended when blood pressure stays in stage 2, or in stage 1 when your overall cardiovascular risk is higher or lifestyle changes have not been enough after a few months. Many people end up needing two medications, often combined in a single pill, to reach their goal. Needing medication is not a failure: it protects your heart, brain and kidneys while lifestyle changes do their part.
The Main Types of Blood Pressure Medication
These are the medication groups doctors use most often. Which one is right for you depends on your age, other health conditions, other medications and how you respond.
- Thiazide-type diuretics (for example, chlorthalidone or hydrochlorothiazide) help the kidneys remove extra salt and water. We check potassium and other blood levels while you take them.
- ACE inhibitors (for example, lisinopril) relax blood vessels and protect the kidneys, which makes them a common choice for people with diabetes or kidney disease. A dry cough is a known side effect.
- ARBs, or angiotensin receptor blockers (for example, losartan) work in a similar way to ACE inhibitors and are often used when an ACE inhibitor causes a cough. ACE inhibitors and ARBs are not used during pregnancy.
- Calcium channel blockers (for example, amlodipine) relax the muscles in blood vessel walls. Ankle swelling is a common side effect.
- Beta blockers (for example, metoprolol) slow the heart rate. They are usually chosen for people who also have certain heart conditions rather than as a first medicine for high blood pressure alone.
Never stop or change a blood pressure medication on your own. Stopping some of them suddenly can cause blood pressure to spike. If a side effect bothers you, tell your doctor: there is almost always another option.
How to Check Your Blood Pressure at Home
Home readings give your doctor a far better picture than an occasional office check. Use a validated cuff that goes on your upper arm, not your wrist or finger. Sit with your back supported and feet flat for five minutes first, keep your arm at heart level, and avoid caffeine, exercise and smoking for 30 minutes before. Take two readings a minute apart in the morning and evening for about a week, write them down or save them in an app, and bring them to your visit.
When to See a Doctor About Your Blood Pressure
Book a visit if your home readings are regularly 130/80 or higher, if you have never had your blood pressure checked as an adult, or if you are on medication and your numbers are not at goal. At Radiant Primary Care, the same board-certified internist follows your blood pressure over time, reviews your home readings, checks related labs and adjusts treatment with you. Follow-up check-ins and prescription renewals can often happen by telehealth, and we see patients Monday through Saturday. Blood pressure is also reviewed at every annual physical.
Call 911 if your blood pressure is 180/120 or higher and you have chest pain, shortness of breath, back pain, numbness or weakness, a change in vision, confusion or difficulty speaking. These can be signs of a heart attack, stroke or other emergency.
Frequently Asked Questions
Can I lower my blood pressure without medication?
Many people with elevated or stage 1 blood pressure can reach their goal with lifestyle changes alone, especially by eating less salt, losing extra weight, exercising and limiting alcohol. Others need medication as well. Your doctor will help you decide based on your readings and overall risk.
Will I have to take blood pressure medication forever?
Not always. Some people who make lasting lifestyle changes, such as significant weight loss, are able to reduce or stop a medication under their doctor’s supervision. Many people do need long-term treatment, which is safe and protects the heart, brain and kidneys.
What are the side effects of blood pressure medication?
Side effects depend on the type of medication. Common examples include a dry cough with ACE inhibitors, ankle swelling with calcium channel blockers and changes in potassium or more frequent urination with diuretics. Many people have no side effects. If one bothers you, your doctor can usually switch you to another option.
What blood pressure is an emergency?
A reading of 180/120 or higher needs prompt attention. If it comes with chest pain, shortness of breath, back pain, numbness or weakness, vision changes, confusion or trouble speaking, call 911. If you feel fine, rest for a few minutes, recheck, and contact your doctor right away if it is still that high.
This article is for general information only and is not medical advice. Talk with your doctor about your own blood pressure goals and treatment. If you are experiencing a medical emergency, call 911.
Book a visit with Radiant Primary Care to check your blood pressure and build a plan that fits you. Learn more about our high blood pressure and cholesterol care.