Harvard Medical School: 10 steps to lower your blood pressure


High blood pressure isn’t usually something that can be cured. Like an in-law who comes to stay for good, it’s something most people need to learn to live with. Drugs offer an easy fix, but most also cause unwanted side effects. Making healthful lifestyle changes is harder, but it yields benefits far beyond better blood pressure. That’s why it makes sense to start with these, and add medications only if needed. Here are 10 steps that can help you lower your blood pressure and keep it under control.

1. Check it. You can’t do much about your blood pressure unless you know what it is. Your doctor should check it at every visit. Measuring it at home is even better. Relatively inexpensive home monitors are available in most pharmacies.

2. Get moving. Regular exercise, even something as simple as brisk walking, improves blood vessel flexibility and heart function. It can lower blood pressure by 10 points, prevent the onset of high blood pressure, or let you reduce your dosage of blood pressure medications.

3. Eat right. A landmark study called Dietary Approaches to Stop Hypertension (DASH) showed that you can eat your way to better blood pressure. The DASH diet emphasizes fruits, vegetables, low-fat dairy products, whole grains, poultry, fish, and nuts, and downplays red meat, sweets, sugar-containing beverages, and saturated fat and cholesterol.

4. Control your weight. If you are carrying too many pounds for your frame, losing weight can lower your blood pressure. You don’t need to become rail-thin — losing 10% of your current weight, or even 10 pounds, can make a big difference.

5. Don’t smoke. Nicotine constricts small blood vessels. Smoking a cigarette can cause a 20-point spike in systolic blood pressure. Quitting is tough, but there are now more aids to help.

6. Drink alcohol in moderation. A drink a day for women and one or two a day for men is good for the heart and blood vessels. Going beyond that can contribute to higher blood pressure.

7. Shake up your salts. Too much sodium and too little potassium boost blood pressure in people who are sensitive to salt. The imbalance is so great that the American Medical Association is calling for food makers and restaurants to cut the sodium content of food by 50% by 2016. Aim for less than 1.5 grams of sodium a day, and at least 4.7 grams of potassium.

8. Sleep is good. Burning the candle at both ends night after night can contribute to high blood pressure, not to mention increase the chances of developing heart disease or a sudden cardiac arrest. How much sleep is enough? At least six hours a night, though eight hours is probably more like it for most people.

9. Reduce stress. As surely as mental and emotional stress can raise blood pressure, meditation, deep breathing, and other stress-busting activities can lower it.

10. Stick with your medications. Taking pills to keep your blood pressure in check won’t make you feel any different. But it can keep you from having a stroke, heart attack, or other problem.

Dozens of drugs are available for lowering blood pressure. They come in a range of regimens (once a day to several times a day) and costs, and have a range of effects on other conditions, interactions with other drugs, and potential side effects.

Which drug is best for treating high blood pressure is one of the major controversies in medicine today. Current guidelines as of 2006 say that the first choice should be an inexpensive diuretic (water pill). Some experts argue that an ACE inhibitor or a calcium-channel blocker is a better place to start. In reality, what’s best for you isn’t necessarily right for someone else. Most people need more than one medication to get their blood pressure under control, and one of these should probably be a diuretic.

High blood pressure, like almost everything else in medicine, is a highly personal condition. Preventing it, and keeping it from doing you harm, requires careful, individualized evaluation from your doctor and focused commitment on your part.