7. Lifestyle Can Help Blood Pressure

You probably like to feel in control of your life: your finances, your schedule, your business and your personal life.

When it comes to your blood pressure, there are certain factors that strip you of the control you seek, such as your age, race, and genetic makeup. Quite simply, you can’t turn back the clock, change your race, or alter your genes to help control your blood pressure.

You can, however, modify certain aspects of your lifestyle and gain some control. Guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) recommend lifestyle changes as the first treatment for hypertension, and for good reason: They can have a profound effect on your blood pressure. So, regardless of where your blood pressure is or your cardiovascular risk level, you’ll need to adhere to a heart-healthy way of eating, become (or remain) physically active, and win the “battle of the bulge” by optimizing your weight. You’ll also need to work on your sleep habits, find healthy ways to manage the stress in your life, and address other factors that may be pushing your blood pressure in the wrong direction.

By adopting a blood-pressure-friendly lifestyle, you can do your part to reduce your risk of hypertension. Or, if you already have high blood pressure, you might gain better control and reduce your reliance on antihypertensive medications. The choice is yours.

Read on to learn how you can use your lifestyle to gain control of your blood pressure.

Healthy Eating

The choice of foods you put on your plate can play a major role in whether your blood pressure numbers go up or down. A poor diet is a key driver of hypertension, as well as obesity and an array of other diseases. In a study involving 6,897 people, 46 percent of black and 33 percent of white participants developed hypertension during a median follow-up period of 9.4 years. The researchers reported that a Southern dietary pattern (low in fruits, vegetables and healthy fiber and heavy in fried foods, processed meats, and sugary drinks) was the most significant factor responsible for the disparity between races, accounting for 51.6 percent of the excess risk in black men and 29.2 percent of the excess risk in black women (Journal of the American Medical Association, Oct. 2, 2018).

However, following the right eating plan, such as the DASH dietary pattern, can help you keep your blood pressure in check.

DASH to Better Blood Pressure

In an effort to identify the best foods for cardiovascular health and, more specifically, high blood pressure prevention, the National Institutes of Health sponsored two major trials. The first was the Dietary Approaches to Stop Hypertension (DASH) study, involving 459 people (average age, 45) with a systolic blood pressure below 160 millimeters of mercury (mmHg) and diastolic pressure between 80 and 95 mmHg.

The study found that, compared with consuming a typical “Western” diet low in fruits, vegetables, and dairy products, eating a diet rich in fruits and vegetables or a “combination” diet rich in fruits, vegetables, and low-fat dairy products was associated with significant reductions in systolic and diastolic blood pressure. The blood pressure reductions occurred within the first two weeks of starting the healthier diets and were particularly significant in the 133 hypertensive participants.

Then, in the DASH-Sodium study, 412 people were randomly assigned to follow either the Western diet (the control diet) or the DASH diet (the combination diet from the original DASH study). The participants consumed about 3,300 milligrams (mg) of sodium a day for 30 days, followed by 30 days of intermediate (about 2,300 mg a day) and 30 days of low (about 1,500 mg a day) sodium intake. “As compared with the control diet with a high sodium level, the DASH diet with a low sodium level led to a mean systolic blood pressure that was 7.1 mmHg lower in participants without hypertension and 11.5 mmHg lower in participants with hypertension,” the study authors wrote.

How to Do the DASH

In addition to its blood pressure-lowering benefits, the DASH eating method doesn’t require you to follow a complicated menu. Instead, the DASH diet outlines the types of foods you should consume and how much you should eat each day. For instance, according to the National Heart, Lung, and Blood Institute, if you follow a 2,000-calorie-per-day diet, the DASH eating plan suggests a daily intake of:

• 6 to 8 servings of grains (preferably, whole grains). Serving-size examples: 1 slice bread; 1 ounce dry cereal; half-cup cooked rice, pasta, or cereal.
• 6 or fewer servings of lean meat, fish, or poultry. Serving-size examples: 1 ounce cooked lean meat, skinless poultry, or fish; one egg.
• 4 to 5 servings of vegetables. Serving-size examples: 1 cup raw leafy vegetables; half-cup cut-up raw or cooked vegetables; half-cup vegetable juice.
• 4 to 5 servings of fruit. Serving-size examples: 1 medium fruit; quarter-cup dried fruit; half-cup fresh, frozen, or canned fruit; half-cup fruit juice.
• 2 to 3 servings of low-fat or fat-free dairy products. Serving-size examples: 1 cup milk; 1 cup yogurt; 1½ ounces cheese.
• 2 to 3 servings of fats and oils (preferably healthy options, such as olive oil). Serving-size examples: 1 teaspoon soft margarine; 1 tablespoon low-fat mayonnaise; 2 tablespoons light salad dressing; 1 teaspoon vegetable oil.
• 4 to 5 servings of nuts, seeds, and legumes per week. Serving-size examples: 1½ ounces nuts; 2 tablespoons nut butter; half-ounce seeds; half-cup cooked legumes (dried beans, peas).
• Limit sweets and added sugars to 5 servings or fewer per week. Serving-size examples: 1 tablespoon sugar; 1 tablespoon jelly or jam; ½ cup sorbet; 1 cup lemonade

The Perks of Eating Plants. As the DASH study findings suggest, a mostly plant-based diet can be beneficial for both your heart health and blood pressure.

Still, keeping meat off your plate is no guarantee you’ll control your blood pressure—you still need to focus on the right foods. For instance, French fries and salty potato chips, technically speaking, are vegetarian, but they don’t qualify as good choices for your heart, blood pressure, or your weight. Instead, fill your vegetarian plate with leafy greens, such as spinach, and high-fiber foods, such as beans and fresh fruit.

If you want to transition to a vegetarian diet, consider starting with one meatless meal per week or one meatless day each week, and expand from there. And, whatever meatless choice you make, be mindful of the sodium content.

Shed the Sodium

Although your body needs some sodium to function normally, excess sodium causes your body to retain extra fluid, which drives up your blood pressure and places added strain on your heart and blood vessels.

So, based on the DASH study findings, the AHA and other experts recommend consuming no more than 2,300 mg of sodium per day (about the amount in a teaspoon of table salt), although the AHA advocates a more stringent goal of 1,500 mg or less daily for most adults, including those with high blood pressure.

Unfortunately, most people, including many with hypertension, still consume much more sodium than they need. A report from the Centers for Disease Control and Prevention (CDC) found that nearly nine out of 10 people ages 19 and older exceed the 2,300-mg recommended daily limit of sodium, and even 86 percent of adults with hypertension consume too much sodium.

Shake the Salt Habit. You don’t necessarily have to make huge changes to reduce your sodium intake. For instance, if your dinner plate is normally half full with meat and half full with a starch—both of which tend to be higher in sodium—try filling half the plate with a non-starchy vegetable (such as broccoli, cauliflower, asparagus, green beans, and peppers), a small amount of lean protein, and a small amount of a starch.

Use the U.S. Department of Agriculture’s MyPlate as a simple guide to making your dinner plate more heart healthy:

• Fruits and vegetables: Fill half your plate with an array of colors and types of whole fruits and vegetables.
• Grains: Fill a quarter of your plate with grains, with at least half of them whole grains, such as whole-wheat bread, brown rice, and whole-grain pasta.
• Protein: Protein-rich foods, such as beans, nuts and nut butters, skinless chicken, non-fried fish, lean meats, and eggs, should occupy the remaining quarter of your plate.
• Dairy: Include 3 cups of low-fat or fat-free dairy products a day, such as milk, yogurt, cheese, cottage cheese, and soy milk.

One obvious way to cut back on your sodium intake is to put away the salt shaker. Table salt, or sodium chloride, consists of about 40 percent sodium, with each teaspoon of salt containing 2,300 mg of sodium. Remove the salt shaker from your table, and don’t include salt in your cooking. Instead of salt, spice up your food with other seasonings, such as pepper, lemon juice, onions, garlic, onion, or garlic powder (not garlic salt), or herbs such as basil, thyme, or parsley.

But, if you must have salt, try setting aside a quarter teaspoon (581 mg of sodium) or a half teaspoon (1,162 mg of sodium) in an empty salt shaker so you can tell how much you’re allowed to use each day. And, be more selective in the foods you salt: Pick the foods you know you must add salt to and reserve your salt allotment for them.

Sodium: Boxed, Canned, and Packaged. The CDC notes that more than 70 percent of the sodium you consume is already in the foods you purchase in stores or at restaurants, not added during cooking or at the dinner table.

Chances are if your food comes in a box, can, jar, or plastic packaging, it’s high in sodium. Some sources of sodium might surprise you, and they don’t necessarily taste very salty. Consider these examples from the CDC:

• Breads and rolls: The sodium content in one slice of white bread can range from 80 to 230 mg.
• Lunch meats: The tasty meats you get at your local deli are major sodium suppliers. Just 3 ounces of turkey breast or other deli or pre-packaged lunch meat contains 450 to 1,050 mg of sodium.
• Frozen pizza: Just one 4-ounce slice can contain 370 to 730 mg of sodium.
• Canned soups: One cup of tomato soup may contain 700 to 1,260 mg of sodium.
• Burritos and tacos: 2 teaspoons of regular packaged taco seasoning can contain more than 400 mg of sodium.
• Chicken: Chicken and other meats may be packaged in high-sodium flavoring solutions that can drive up your sodium intake. A 4-ounce boneless, skinless chicken breast contains anywhere from 40 to 330 mg of sodium.
• Cheese: A 1-ounce slice of packaged or deli American cheese contains 330 to 460 mg of sodium.
• Canned vegetables: They tend to be higher in sodium than fresh or frozen vegetables. For example, a whole fresh tomato contains 6 mg of sodium, whereas a can of no-salt-added tomatoes contains 20 mg per half-cup and a can of regular tomatoes contains 220 mg per half-cup. Before you eat canned vegetables, rinse them under warm water to help remove some of the added sodium.

The sodium in your diet doesn’t only come from the foods you eat, but also the additions you make to them to spice up their flavor, such as condiments and other toppings. For example, just a tablespoon of reduced-fat Italian dressing can add 134 mg of sodium to your normally healthful salad. Sprinkle a tablespoon of soy sauce on your rice and you’re bathing it in more than 800 mg of sodium. Plus, if you want to turn that hamburger into a cheeseburger with a 1-ounce slice of cheddar cheese, you’ll add 174 mg of sodium to the 100 mg of sodium already in the burger patty. Flavor the burger with a tablespoon of ketchup and you increase the sodium content by another 154 mg.

Stay Sodium-Smart at the Supermarket. So, it’s easy to see how you can exceed daily recommended amounts of sodium. But you can start to limit the sodium you get from food by eating at home instead of dining out (see “Going Out to Eat”). It starts by making wise choices at the supermarket: Carefully review the Nutrition Facts label on all foods and beverages and learn which products to choose and which ones to skip.

The U.S. Food and Drug Administration (FDA) regulates the information required for each nutrition facts label, including the daily value, which represents the amount of nutrients recommended each day for people ages 4 and older. The daily value for sodium is 2,300 mg. Look at the sodium content of each product and use the Percent Daily Value (DV) to guide your choices. In general, a low-sodium product contains 5 percent or less of the DV of sodium per serving, while sodium content equaling 20 percent of the DV or greater is high, the FDA notes.

You’ll encounter a bevy of products labeled as “reduced sodium” or “low sodium,” but the claims on those labels don’t all mean the same thing. So, the FDA provides this guide to the sodium vernacular found on food and beverage packaging:

• Light in sodium (lightly salted): At least 50 percent less sodium than the regular product
• Reduced sodium: At least 25 percent less sodium than the regular product
• Low sodium: 140 mg of sodium or less per serving
• Very low sodium: 35 mg of sodium or less per serving
• Salt/sodium-free: Less than 5 mg of sodium per servin
• No-salt-added/unsalted: No salt is added during processing, but the product still may contain some sodium.

Keep in mind that even foods labeled as “less sodium” or “reduced sodium” can still contain a lot of sodium, especially if the regular versions of a product are very high in sodium to begin with.

And, check the label for the serving size and the number of servings in the food package. If it contains two or three servings and you eat the entire package, you’re doubling or tripling the amount of sodium. So, find out how much sodium each product has per serving, and then multiply that amount by the number of servings per container.

Overall, consider this one simple tip to help minimize the amount of sodium you consume: Spend more of your time shopping at the perimeter of the supermarket, and less time in the aisles. The perimeter is where fresh fruits, vegetables, and other healthful foods tend to reside, while the sodium-rich processed and packaged foods typically are kept on shelves in the grocery store aisles. (Note: Frozen fruits and vegetables also are typically lower in sodium than canned varieties. Just avoid frozen fruit products with added sugar, as well as frozen vegetables with added butter, cheese, or other sauces that can drive up the sodium and calorie count.)

Nutrients That May Help Lower Blood Pressure

Fruits and vegetables, along with whole grains and low-fat/fat-free dairy products, are cornerstones of the heart- and blood-pressure-friendly DASH diet. Not only are they generally low in sodium, but many of them are good sources of other nutrients that are associated with lower blood pressure (see “Blueberries May Help Reduce Blood Pressure”):

• Potassium: Good dietary sources include bananas, sweet potatoes, tomatoes, winter squash, citrus fruits, apricots, orange juice, avocados, cantaloupe, yogurt, prunes, and lima beans. All meats and fish (salmon, cod, sardines) also provide some potassium.
• Calcium: Good dietary sources include low-fat/fat-free milk, yogurt, or cheese; canned sardines; calcium-enriched orange juice; and fortified cereals.
• Magnesium: Good dietary sources include dark green, leafy vegetables, such as spinach; fruits and vegetables such as bananas, avocados, and dried apricots; low-fat/fat-free milk; potatoes; peas and beans; nuts such as almonds and cashews; and whole grains such as brown rice, oatmeal, and millet.

Other Hopefuls

In addition to potassium, magnesium, and calcium, several other nutrients have been studied for their effects on blood pressure, although further research is necessary to confirm their potential benefits.

Omega-3 Fatty Acids. The omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been shown to lower blood fats known as triglycerides and reduce the risk of abnormal heart rhythms, and they also may offer some blood-pressure benefits, some research suggests.

EPA and DHA are found abundantly in fatty, cold-water fish, such as salmon, mackerel, herring, and tuna. Diets plentiful in omega-3-rich fish have been associated with reductions in cardiovascular risk. The American Heart Association recommends eating two 3½-ounce servings of non-fried fish (preferably fatty fish) a week. Some evidence suggests that plant-based sources of omega-3s also may be beneficial for blood pressure and heart health (see “‘Go Nuts’ to Lower Your Blood Pressure” and “Plant Sources of Omega-3s”). Overall, experts recommend getting omega-3s from your diet rather than from omega-3-rich fish oil supplements. Talk to your doctor before taking fish oil supplements.

Probiotics. You might not necessarily think of bacteria as being boons for your health. The mere thought of bacteria may conjure up associations with infection and illness. However, your body relies on certain healthy bacteria to help fight off disease and regulate your digestive system. Additionally, ingesting probiotic bacteria may help lower your blood pressure, some evidence suggests. Probiotics are beneficial bacteria found in supplements and fortified foods such as yogurt.

In one investigation, researchers reported regular consumption of probiotics, compared with non-consumption, was associated with an average 3.56 mmHg reduction in systolic blood pressure and 2.38 mmHg reduction in diastolic pressure. The beneficial effects occurred only with probiotics containing multiple types and higher concentrations of bacteria consumed regularly for at least eight weeks, and were greatest in people with blood pressure of 130/85 mmHg or higher, the study found. If you want to try probiotics, look for yogurt and other products containing the “Live and Active Cultures” label.

Vitamin D. In addition to its well-established benefits for bone health, vitamin D has been studied for potential effects on blood pressure. Some research has suggested a link between low levels of vitamin D and hypertension and that increasing vitamin D levels may help reduce blood pressure. However, it remains unclear whether vitamin D deficiency causes hypertension and whether taking vitamin D supplements reduces blood pressure or cardio­vascular risk.

Still, you need vitamin D for bone and muscle health. Medical experts recommend that all adults ages 70 and younger get 600 international units (IU) of vitamin D a day and those ages 71 and older should get 800 IU daily. About 10 to 15 minutes of sun exposure three times a week without sunscreen is sufficient to meet most people’s vitamin D requirements—your skin can synthesize vitamin D when exposed to sunlight. Dietary sources of vitamin D include cod liver oil, salmon, tuna, mackerel, flounder, eggs, and D-fortified juices, milk, yogurt, and ready-to-eat cereals.

Coenzyme Q10 (CoQ10). CoQ₁₀ is an enzyme and a powerful antioxidant found in all human cells, where it’s used for cell growth, energy, and other basic functions. Some studies suggest that CoQ10 may have some blood-pressure-lowering effects and can help some patients discontinue or significantly reduce their dose of blood pressure medications. Other studies, including a systematic review of the medical literature, have found no clinically significant blood-pressure-lowering benefits for CoQ₁₀ supplements.

Garlic. Garlic does more than add flavor to many of your favorite foods. It also might help to reduce blood pressure. Your kidneys produce the hormone angiotensin, which plays a role in blood vessel constriction. Blood pressure drugs known as angiotensin-converting enzyme (ACE) inhibitors work by blocking the conversion of angiotensin to its blood-vessel-constricting form (angiotensin II), thus lowering blood pressure. Garlic contains gamma-glutamylcysteine, a natural ACE inhibitor, which, combined with other components, gives garlic an ability to dilate arteries and potentially reduce blood pressure.

In a meta-analysis of nine studies, systolic and diastolic blood pressure were more effectively reduced in people treated with garlic preparations versus those given a placebo, although the evidence “is not strong,” the researchers concluded.

Aside from bad breath and garlicky body odor, garlic’s main side effects include upset stomach, heartburn, diarrhea, and nausea. Also, garlic can thin the blood, so if you’re taking blood-thinning medications—such as aspirin, clopidogrel (Plavix), warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis)—talk to your doctor before adding garlic to your diet or taking garlic supplements, and be aware of your increased ­bleeding risk.

A Note About Supplements

It’s difficult to tell how a dietary supplement will affect a medical condition, including high blood pressure. Often, the beneficial effects of a vitamin, mineral, or other nutrient are produced as a result of a synergistic relationship between it and other nutrients in a particular food. That’s why most health experts recommend getting your nutrients from foods first, and then using supplements to fill any nutritional shortfalls you might have.

Today, herbal and other dietary supplements are a multibillion-dollar industry, and chances are you or someone you know is taking one or more of these products as a “natural” remedy to improve some aspect of your health. But natural doesn’t mean risk-free, and just because an herbal supplement is easily available over the counter doesn’t necessarily mean it’s right for you.

Be aware that any supplement potent enough to confer therapeutic benefits may be strong enough to cause side effects, and some herbal supplements can interact adversely with prescription medications (see “Smart Supplement Use”).

Furthermore, herbal supplements are not subjected to the same regulatory approval process as conventional pharmaceuticals. The manufacturers do not have to seek FDA approval before marketing a supplement, although the FDA is responsible for overseeing the safety of a supplement once it’s on the market. Investigations have found that some supplements contained little or no traces of the active ingredient, but often contained fillers like houseplants and powdered rice. In some instances, the supplements contained substances that could be hazardous to people with allergies, authorities have reported.

Physical Activity

You know that exercise is good for your heart, but you might not be aware that staying physically active also can help reduce your blood pressure. Regular physical activity strengthens your heart muscle, and a strong heart can pump blood more easily and efficiently. The result is less force placed on your arteries and a lower blood pressure. Exercise also helps to prevent weight gain and eases stress, two factors that can increase blood pressure.

Unfortunately, only 26 percent of men and 19 percent of women in the United States meet recommendations for physical activity, according to the 2018 Physical Activity Guidelines (PAG) for Americans. The guideline authors noted that a single episode of moderate to vigorous physical activity, among other benefits, can lower blood pressure, as well as reduce anxiety and improve sleep on the day it’s performed.

By some estimates, regular aerobic exercise can reduce resting systolic blood pressure by 10 to 15 mmHg and diastolic pressure by 5 to 10 mmHg—an effect comparable to some blood pressure medications. In some patients, regular exercise is enough to reduce the dose of blood pressure medication or reduce the number of medications they need. So, whether you’ve been inactive and noticed a rise in your blood pressure or you’re already hypertensive, it’s time to get moving and get your blood pressure moving in the right direction (see “Break Up Sitting with Morning Exercise”).

Activity Recommendations

Generally, experts such as the PAG committee and the AHA recommend that adults get at least 150 minutes, or 2½ hours, of moderate-intensity physical activity a week. That total can be broken down into 30 minutes a day on five days a week. If you’re more physically fit and/or want to gain additional benefits, aim for 300 minutes of moderate-intensity activity per week. An alternative for more fit adults is a goal of 75 minutes of vigorous exercise a week.

Previous guidelines recommended performing aerobic exercise in bouts of at least 10 minutes spread throughout the day, but the PAG authors note that physical activity done in episodes of less than 10 minutes also can provide benefits and that any amount of moderate to vigorous physical activity counts toward meeting your goals.

Be Smart When You Sweat

Multiple studies have found that regular physical activity is safe for most people and, more importantly, that the benefits of physical activity greatly outweigh the risks.

Still, although physical activity is crucial for managing hypertension, exercise caution when you work out. If you’ve been relatively sedentary or you’re starting a new exercise regimen, start out slowly and increase your physical activity gradually. You don’t want to overdo it and injure yourself so that you can’t exercise or, even worse, suffer a cardiovascular event.

If you’re new to exercise and you have hypertension and/or other cardiac-related conditions, talk to your doctor and ask if you should take part in a supervised exercise program to make sure the exercises you do are appropriate for your individual medical condition and that you do them safely and correctly. In the program, you’ll also be instructed on how intense your exercise should be, based on your target heart rate, and you may be given an exercise prescription.

For most adults, brisk walking, biking, and swimming are examples of moderate-intensity exercise, while vigorous activities include jogging, running, or brisk walking on hilly terrain. However, what constitutes moderate or vigorous intensity varies from person to person, depending on your fitness level. To gauge the intensity of your workout and your level of exertion, use one or more of these methods:

Percentage of Maximum Heart Rate. Measure your pulse on your wrist or neck, or wear a heart-rate monitor. To find out your maximum heart rate, subtract your age from 220. Then, multiply that figure by the percentage of your maximum heart rate at which you should exercise, based on your doctor’s advice (50 percent = 0.5, 80 percent = 0.8, etc.), to determine your target heart rate during exercise. In general, a typical heart rate during moderate-intensity exercise is about 50 to 69 percent of your maximum heart rate, and 70 to 89 percent during vigorous exercise, according to the AHA. When you first start out, aim for the 50 percent range of your target heart rate and gradually build up. If you have a heart condition or take a medication that can affect your heart rate, ask your health-care professional what your target heart rate should be.

The “Talk-Sing” Test. During your exercise, you should be able to talk with some effort. If you can sing during your workout, or if you can converse without much effort, the exercise is probably not vigorous enough. If you can’t carry on a conversation at all while exercising, you are exercising vigorously.

Perceived Exertion Scale. This method rates your exertion from zero (no difficulty) to 10 (very heavy). For most people, exercising in the range of 5 to 6 is moderately intense, while 6 to 9 is vigorous.

Warm up for five to 10 minutes before you exercise, performing a lower-intensity version of the exercise you plan to do, such as a light stroll before a brisk walk. Follow your exercise with a cool-down period to allow your heart to adjust gradually from a state of activity to rest. Be aware that stopping your exercise too abruptly can cause a sharp drop in blood pressure.

If you exercise outdoors, be cautious in cold weather and very hot and humid conditions, as extreme temperatures can contribute to high blood pressure. The same problem can develop if you go in and out of hot tubs or saunas. Moving from a cool swimming pool or a cold environment to the extreme heat from hot tubs or saunas can increase blood pressure, so avoid this practice if you have hypertension.

Lift with Care

Some research suggests that strength (resistance) training can help reduce blood pressure modestly over the long term.

However, if you have hypertension, strength train with caution, as strenuous lifting may cause temporary, but severe, spikes in blood pressure. This is especially true if you do high-intensity strength training, exercising to the point where you must strain and hold your breath. Breathing throughout your workout helps to regulate blood pressure. In general, high-intensity strength training is not recommended if you have uncontrolled hypertension or problems such as aortic aneurysms or aortic or coronary artery dissections. (Also, if you have diabetes, be aware that strength training, particularly at high intensity, can reduce blood-sugar levels and increase your risk of hypoglycemia. So, be sure to check your blood sugar before you exercise.)

As you strength train, breathe out as you exert yourself and breathe in while you do the easier motion of the exercise. Do some light physical activity to warm up your muscles before strength training. Lift as much weight or use as much resistance as will allow you to do two to three sets of eight to 12 repetitions of each exercise without breaking your form or holding your breath. Use your breathing as a guide to determine whether you’re lifting too much: If you must hold your breath to lift something, it’s probably too heavy. As your fitness improves and you can complete your repetitions fairly easily, gradually increase the amount of weight or resistance.

Importantly, listen to your body, and stop what you’re doing if you feel sharp joint/muscle pain, chest discomfort, dizziness, or lightheadedness. In general, the long-term benefits of strength training on blood pressure outweigh the potential risks from temporary blood pressure spikes. But, just as with aerobic exercise, it’s best to seek your doctor’s guidance before you embark on a strength-training regimen.

Weight Management

Obesity can tax your heart and contribute to hypertension. It also raises your odds of obstructive sleep apnea, a significant hypertension risk factor.

Use these methods to determine whether you’re overweight or obese and at risk for hypertension and other health problems:

• Body mass index (BMI): To calculate, divide your weight in pounds by your height in inches squared and multiply by a factor of 703. Here’s an example for a 6-foot-tall (72-inch), 200-pound man: 200 ÷ 5,184 (72 squared) × 703 = 27.1. Generally, a BMI value between 18.5 and 24.9 is considered normal, while 25 to 29.9 is overweight, and 30 and higher is obese. (You can also go online and search for BMI and find a plethora of sites that allow you to simply plug in your numbers and learn your BMI.)
• Waist circumference: Wrap a tape measure around your bare abdomen at the level of your navel. A waist circumference of more than 40 inches for men and 35 inches for women indicates greater cardiovascular risk.

Treating Obesity

With the help of your health-care team, avoid hypertension and other obesity-related complications by treating obesity like a disease. Even a small weight loss of about 5 to 10 percent of your body weight can reduce blood pressure enough to help manage or prevent hypertension in many people who are overweight.

With guidance from your health-care professionals, develop a sensible diet and exercise regimen that can help you lose weight and maintain a healthier weight. If you’re having difficulty losing weight on your own, ask for a referral to a medical weight-loss program, which can include advice from a registered dietitian, physical activity recommendations from an exercise professional, and, in some cases, guidance from a mental health professional or a behavioral coach, who can identify any emotional issues or everyday behaviors that prompt you to overeat. You also might discuss the use of weight-loss medications to help you achieve your goals if you have hypertension or other cardiovascular risk factors and cannot lose enough weight through diet and exercise alone.

Bariatric surgery may be recommended if you’re severely obese and can’t achieve healthy, sustained weight loss with conservative methods. Research suggests that bariatric surgery can produce dramatic improvements in blood pressure, blood sugar, and other cardiovascular risk factors. According to the American Society for Metabolic and Bariatric Surgery, you may be a candidate for bariatric surgery if you have a BMI of 40 or higher or you’re more than 100 pounds overweight, or if your BMI is 35 or more and you have at least one or more obesity-related conditions, such as hypertension, heart disease, cholesterol abnormalities, type 2 diabetes, sleep apnea, nonalcoholic fatty liver disease, osteoarthritis, or gastrointestinal problems.

Practical Weight Loss

Losing weight requires a commitment to significant lifestyle changes that you’ll need to maintain the rest of your life. So, be patient. After all, you didn’t put on all your excess weight overnight, so it’ll take more than a day to shed those extra pounds. Start small, and set realistic goals, such as losing 5 pounds or eating more fruits and vegetables.

Get your spouse or other members of your household on board with your weight-loss program and your meal planning. Recruit support from your loved ones to help you eat better, move more, and improve your blood pressure and your overall health. Both you and your family will reap the benefits.

You also might find it helpful to keep a food journal and document the foods and drinks you consume and the circumstances in which you consume them. Keeping track of what and when you eat can help you avoid situational eating, such as snacking while you watch television. When those situations arise, you can take a walk or do anything to break a routine that causes you to eat.

Moreover, you can employ some strategies that may help you eat less at the dinner table:

• Eat more slowly to help you feel full, and put your fork down between bites.
• Don’t cut all your food at once.
• Use smaller plates. Smaller portions look larger when served on a smaller dish.
• To help fill you up, drink a glass or two of water before your meal.
• Avoid going to a restaurant on an empty stomach. Eat some vegetables or fruit before you go.
• At the restaurant, ask for a takeout container and put half your entrée in the container before you start eating.

Manage Stress

Mark Twain once said, “I’ve been through some terrible things in my life, some of which actually happened.” His quote applies to many people battling chronic stress, who feel anxious and endangered but aren’t truly in danger.

Indeed, life can be stressful, and the same natural “fight-or-flight” stress response your body produces in times of crisis is triggered when you face everyday pressures. If you lack strategies to manage daily stress, that fight-or-flight response may continue unabated, and potentially have deleterious effects on your cardiovascular health, including your blood pressure.

Scientists have yet to determine exactly how emotional stress contributes to heart disease. However, it’s known to prompt many people to make poor health decisions and overeat, abuse alcohol, smoke, and engage in other behaviors that can increase blood pressure and adversely affect other cardiovascular risk factors.

Some research suggests that stress reduction may have some blood-pressure-lowering effects. While you can’t eliminate stress completely, you can learn to minimize and manage it. The first step is to take an inventory of the things that cause you stress (stressors) and determine which ones you can modify and which ones you can’t. For example, if you’re too busy and feel time is your enemy, look for ways to loosen your schedule and better manage your time. And, don’t spread yourself too thin: Learn to say “no” and shorten your to-do list. Remember that it’s OK to take some time for yourself.

Adopt practices that promote health and well-being and can ease stress. You might find a guide, coach, or therapist who can help you develop coping strategies. Your friends and loved ones can play a major role in this area by offering you an objective opinion of how you handle stress, and by helping you think more positively.

One well-established stress reliever that’s also good for blood pressure control is exercise, preferably with family or friends. Although just about any exercise is good for your blood pressure and overall health, you might take up yoga or tai chi: Several studies have found that these exercises can reduce blood pressure, while easing stress and improving balance and flexibility. In one analysis, Chinese researchers reviewing data from 35 studies involving a total of 2,249 people with cardiovascular disease found that tai chi and other Chinese exercises, such as qigong, helped reduce systolic blood pressure by 9.12 mmHg and diastolic pressure by more than 5 mmHg, on average.

Expressing gratitude and giving back to others is another stressbuster. Take stock of the positives in your life and focus on them. Consider volunteering at your local community center, church, or shelter, or try mentoring a young person who could benefit from your wisdom.

Learn to relax. Take a warm bath, listen to your favorite music, enjoy your favorite hobbies, or engage in prayer or meditation—anything that can take your mind off your worries.

Therapies to Help Ease Stress

Since most stress originates from negative thoughts about the past or concerns about the future, try to focus on the present moment. Consider seeking out a mental health professional specializing in cognitive behavioral therapy, which trains you to identify negative thoughts or behaviors and replace them with positive ones, thus calming your mind and body.

Also, try to find a therapist who can teach you mindfulness training, in which you become aware of thoughts and sensations that may be correlated with anxiety, without stressing about ways to fix them. Practicing one of these mindfulness techniques can help quiet the stressors:

Mindful Breathing. Set aside five minutes in the morning and five minutes in the evening for one simple task: Pay attention to your breathing. You don’t have to breathe in any particular way. In a quiet room, sit comfortably and direct your focus to your breath. Pay attention to how you feel as you inhale and exhale, noticing how your belly rises and falls and not trying to alter your breathing in any way.

If your mind wanders or you notice any distracting sounds, smells, or sensations, simply re-direct your attention back to your breathing. Practice for five minutes at first (you might set a timer) and gradually build up as it becomes easier to sustain your attention. Practice as often as you can.

Body Scan. While lying down with your eyes closed, relax every muscle in your body and take note of your breathing. Notice how your toes feel; then slowly turn your attention to your feet, ankles, calf muscles, and thighs. Continue to move gradually up the front and back sides of your body until you finish with your face, jaw, and the top of your head.

Improve Your Sleep

You know how you feel when you don’t get a good night’s sleep. Sapped of energy, you struggle to get through the workday. You have trouble concentrating, and you feel mentally foggy. And, at the end of the day, you might lack the energy to socialize or enjoy quality time with your family.

These are the visible problems that poor sleep can cause. But the ones that aren’t so apparent, such as hypertension, can be the most worrisome. Sleep disorders such as insomnia and obstructive sleep apnea (OSA) have been linked with greater risks of hypertension, atherosclerosis, coronary heart disease, cardiac arrhythmias, stroke, and heart failure, as well as metabolic disorders such as obesity, type 2 diabetes, and cholesterol abnormalities.

The National Sleep Foundation recommends that adults ages 26 to 64 get seven to nine hours of sleep each night, while people over age 65 should aim for seven to eight hours nightly (see “Lower Your Blood Pressure with a Daytime Nap”). However, many people fail to get the restorative sleep they need.

Battling Insomnia

The term insomnia refers to difficulty falling or staying asleep. In one study, researchers examining the relationship between chronic insomnia (defined as difficulty falling asleep during a span of more than six months), physiological hyperarousal (defined as a longer time to fall asleep), and high blood pressure found that, compared with normal sleepers, people with chronic insomnia who took more than 14 minutes to fall asleep faced a threefold greater risk of hypertension, while the risk rose fourfold in those who took 17 minutes or longer to fall asleep..

If you have insomnia, over-the-counter or prescription sleep aids may offer some short-term relief. Prescription drugs such as eszopiclone (Lunesta) and zolpidem (Ambien) work by slowing brain activity to promote sleep, while prescription suvorexant (Belsomra) alters the action of chemicals that keep you awake. The choice of sleep aid depends largely on the nature of your insomnia. Some medications, such as triazolam (Halcion) and zaleplon (Sonata), only help you fall asleep, while drugs such as eszopiclone, suvorexant, and extended-release zolpidem help you fall asleep and stay asleep. Sleep aids may cause daytime sleepiness and some mental fogginess. Rarely, they may cause unusual nocturnal behaviors, such as eating or walking while asleep. Some people develop dependence on sleep aids, especially if they use them for a long time.

Supplements of the hormone melatonin (available without a prescription) may be helpful for insomnia associated with problems with the sleep/wake cycle and shifting sleep times (as in those with jet lag and shift work disorder). If you are using melatonin to improve sleep patterns, take it three to four hours before desired sleep, unless you will be driving or operating machinery. Use small doses of melatonin—about 0.5 mg—as taking too much may cause dizziness, headaches, and daytime grogginess.

In some cases, insomnia may be caused by pain or restless legs syndrome (RLS), characterized by unpleasant burning or creeping sensations in the legs that spark an urge to move. To manage these problems, your doctor might recommend a medication like gabapentin (Neurontin) or pregabalin (Lyrica), both of which can improve pain and RLS symptoms and help you sleep.

Improve Your Sleep Hygiene. Sleep aids may provide short-term relief of insomnia, but for more permanent improvements, many experts recommend cognitive behavioral therapy for insomnia (CBT-I). This therapy teaches you skills to improve your sleep, such as ways to manage stress or avoid negative thoughts or fears that keep you awake, even if you use sleep aids. You’ll learn relaxation techniques or decrease the time you spend in bed, which may help make you sleepier.

Among other things, CBT-I teaches you about the importance of sleep hygiene, lifestyle practices that promote good sleep. Consider these recommendations to improve your sleep hygiene and combat insomnia:

• Get exposure to bright light in the morning and avoid bright lights at night.
• Find ways to unwind—reading, taking a warm bath, listening to soft music—before you go to bed.
• Keep your bedroom dark and remove pets or any sources of noise that could disrupt your sleep.
• Use your bedroom only for sleep or sex. Leave the bedroom if you can’t fall asleep within 20 to 30 minutes.
• Minimize your caffeine intake and avoid caffeinated beverages or alcohol at night.
• Put your clock out of sight. Fixating on the clock will only promote insomnia.
• Ask your doctor if the medications you take are making you sleepy or keeping you awake.
• Turn off the television and computer at least two hours before bedtime, and don’t eat or exercise vigorously before bedtime.

Better Sleep, Better BP

If you sleep for seven or eight hours a night and you still feel sleepy, you may have sleep apnea—including the most common form, obstructive sleep apnea (OSA)—which causes repeated interruptions in breathing during sleep.

If you’re like many people with OSA, you might not realize you have the disorder unless your bed partner tells you that you snore loudly or gasp for breath during sleep. Other potential OSA warning signs are not as readily identifiable:

• Nighttime symptoms: Snoring, halts in breathing, recurrent awakenings, night sweats, increased nighttime urination (nocturia), grinding of teeth (bruxism), nocturnal heartburn, drooling on the pillow
• Daytime symptoms: Excessive sleepiness/fatigue, depression, irritability, decreased sex drive, memory problems, morning headaches, dry mouth/sore throat upon waking

It’s often insidious, but OSA is not innocuous. The effects of OSA may extend beyond disruptive sleep. The disorder may contribute to hypertension and may be suspected especially if you have resistant hypertension (blood pressure that remains elevated despite treatment). OSA also has been associated with increased risks of heart attack, stroke, irregular heart rhythms, heart failure, and cardiovascular death.

If you have the symptoms of OSA, tell your physician and undergo an evaluation. Your doctor may recommend an overnight sleep study, done at home or at a sleep laboratory, to confirm an OSA diagnosis and help determine a course of treatment.

Since obesity is a leading risk factor for OSA, guidelines from the American College of Physicians (ACP) recommend weight loss as a key to addressing OSA in overweight people. Research suggests that losing weight can reduce the severity of OSA and, in some cases, might even halt the disease. The ACP and other experts recognize continuous positive airway pressure (CPAP) as the primary treatment for OSA. CPAP employs a machine that pumps air through your nose and/or mouth to prevent your airway from collapsing.

If you cannot tolerate CPAP or prefer an alternative, the ACP recommends dental appliances, which gradually push your jaw forward and pull your tongue away from the back of your throat to open your airway. A more advanced OSA treatment is hypoglossal nerve stimulation, in which an implantable pacemaker-like device monitors your breathing and, if it senses your airway collapsing, delivers mild stimulation to the nerve controlling the base of the tongue to reopen your airway.

If you suspect you have OSA, avoid consuming alcohol near bedtime, and refrain from using sleeping pills or muscle relaxants—all of which can weaken the muscles that keep your airway open and contribute to OSA. And, if you experience sleep-disordered breathing only when you lie on your back, using a pillow to help you sleep on your side may help.

Snuff Out Smoking

By now, you’re aware of the hazards of tobacco smoking. Although the link between smoking and hypertension is still being determined, smoking and exposure to secondhand smoke are risk factors for heart attack and stroke, and they’re known to heighten the risk of atherosclerosis.

If you’re a longtime smoker and you’re trying to quit, chances are you won’t do it without some help. Most smokers have tried to quit multiple times before finally finding success. Prepare yourself to quit by establishing a quit date, and then work on a plan for how you’ll quit.

Overcome Your Addiction

To overcome their addiction, many smokers rely on a smoking-cessation aid, such as nicotine replacement therapy (NRT) or medications. Some use multiple forms of NRT, such as wearing a daily nicotine patch and then using gum or lozenges to curb cravings as they arise. However, although NRT products are available without a prescription, it’s best to consult a health-care professional to find out the right dosing, how long you should use these products, and whether NRT is safe for you.

Other smokers have quit using prescription medications, such as the antidepressant bupropion (Zyban) and the smoking-cessation drug varenicline (Chantix). Bupropion may cause dry mouth and sleep difficulties, and it’s not recommended for people with a history of seizures, eating disorders, or suicidal thoughts, or those taking other antidepressants. And, although effective, varenicline carries a warning about an increased risk of depression, anxiety, and suicidal thoughts. The drug also may cause nausea and vivid dreams.

Some research findings have raised concerns about the cardiovascular safety of these medications and NRT products. However, in an international study involving more than 8,000 smokers, researchers concluded that use of NRT, bupropion, or varenicline did not increase the risk of serious cardiovascular events (JAMA Internal Medicine, May 2018).

More smokers are turning to electronic cigarettes, or e-cigarettes, to help them kick the habit. These battery-powered devices convert nicotine and certain flavorings into an inhalable vapor. Although some research suggests that the electronic devices may help with smoking cessation, questions remain about their safety and whether they serve as a “gateway” to cigarette smoking for young people and other nonsmokers.

A committee from the National Academies of Science, Engineering, and Medicine reviewed over 800 studies on e-cigarettes and concluded in a 2018 report that more research on the long-term effects of the devices is necessary. The committee wrote that, among other findings, e-cigarettes may help adults with smoking cessation, but they also might cause young people to transition to conventional cigarettes. Additionally, conclusive evidence supports the notion that completely substituting e-cigarettes for tobacco cigarettes can reduce a person’s exposure to the toxic chemicals in conventional cigarettes. However, the committee noted that e-cigarettes may lead to dependence on the devices, “though with apparently less risk and severity than that of combustible tobacco cigarettes.”

Break the Habit. Not only is smoking an addiction, but it’s also a habit, perpetuated in large part, by lifestyle and environmental cues that prompt you to crave a cigarette and smoke it. You might associate smoking with a certain person, situation, or even an emotion, such as anger or stress.

So, identify and avoid the situations in which you’re most likely to smoke, or find ways to distract yourself until the urge to smoke passes. For example, if you typically reach for a cigarette after a meal, immediately clean the dishes or go for a walk as soon as you’re done eating. If you normally smoke while you consume alcohol, cut back or cease your drinking. If you smoke to calm your nerves, take a walk, do deep breathing exercises or other exercises to help you cope with stress. Staying active also can curb cravings and help you shed the average three to four pounds of weight that smokers gain after quitting.

You might change your routine to make it more difficult or less pleasurable to smoke. For example, if you’re thinking about quitting, switch to a brand of cigarettes you don’t enjoy. Or, put your cigarettes someplace where you have to get up and walk to get them—if you smoke when you drive, put your cigarettes in the trunk so you have to pull over to retrieve them.

Most importantly, don’t go it alone. Build a support network of nonsmokers, and find someone who will quit smoking along with you. If you’re at home and have a tobacco craving, call that support person, as a simple phone call may distract you long enough for your craving to pass. Ask your doctor or local hospital about one-on-one counseling or group therapy programs to help you quit smoking. Also, take advantage of telephone support programs, such as the U.S. Department of Health and Human Services’ 1-800-QUIT-NOW.

Think of Your Finances

As you can see, you have plenty of ways to help control your blood pressure on your own and avoid hypertension without the need for blood-pressure-lowering medications. By following a heart-healthy eating pattern like the DASH diet, staying physically active, optimizing your weight, getting a better night’s sleep, minimizing stress, and avoiding or quitting smoking, you can do your part to keep your blood pressure in check and reduce your overall cardiovascular risk as well.

Understand that by making these healthful lifestyle changes, not only can you save your heart and blood vessels from the damage of hypertension, you also might save money on the treatments you’d need to manage high blood pressure and its consequences. In one study, researchers reviewed data on 224,920 adults, including about a third with hypertension. After accounting for other factors, they calculated that annual health-care expenditures were almost $2,000 higher among people with hypertension compared with those who had normal blood pressure. Also, prescription drug expenses were nearly three times higher for people with hypertension than they were for their non-hypertensive peers, the study found (Journal of the American Heart Association, May 30, 2018).

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