They don’t call high blood pressure a “silent killer” for nothing. Turns out, about half of Americans have this condition, which, left unaddressed, can cause hardening of the arteries, stroke, kidney damage, and even early cognitive decline and dementia. Yet most people with high blood pressure (also called hypertension) have no idea they’re affected.
“High blood pressure, in most cases, is asymptomatic,” says Lawrence Phillips, M.D., cardiologist and assistant professor of medicine at NYU Langone Health. “So people don’t feel that they have it, which is why regular screening is so important.” (If you haven’t had your numbers checked in two years, see a doc.)
In the simplest terms, blood pressure is the force of your blood against the walls of your blood vessels and arteries, and it is expressed as two numbers: The top number (systolic blood pressure) represents the pressure or force in the arteries when your heart beats, and the bottom number (diastolic blood pressure) is the pressure measured between heart beats, explains Amnon Beniaminovitz, M.D., a cardiologist at Manhattan Cardiology.
Anything over 130/80 mmHg is considered high blood pressure.
While normal blood pressure is necessary for survival, high blood pressure is dangerous because it means your heart is working much harder to pump blood throughout your body. “You can sort of think of high blood pressure as your blood punching the walls of the heart and other organs over and over again,” says Dr. Philips. “If that punching is at a high force, you’re going to develop thickening and damage over time.”
According to the American Heart Association, anything above 120/80 mmHg is considered elevated blood pressure, while anything over 130/80 mmHg is considered high blood pressure. The good news: Elevated and high blood pressure can often (but not always) be addressed with diet and lifestyle modifications, says Dr. Philips.
Step one: Figure out what’s causing your high blood pressure in the first place. For most people, it’s multifactorial, meaning a bunch of factors work in tandem to spike your levels into unsafe territory. Here, the most common causes of blood pressure and how to address them to bring your numbers back down.
1. You rely too heavily on convenient processed foods.
Excessive sodium intake has a direct impact on blood pressure. “More salt equals more sodium in the blood, which then pulls water from the surrounding tissues into your vessels and increases blood volume,” says Dr. Beniaminovitz. “More blood volume leads to higher blood pressure.”
But if you’re thinking, I don’t even use that much salt, it’s probably still hiding elsewhere in your diet. According to the Centers for Disease Control and Prevention (CDC), Americans are consuming an average of 3,400 mg of sodium per day, which is well beyond the recommended cap of 2,300 mg per day. And of that, more than 70% of a person’s sodium intake is coming from processed and restaurant foods, including things like bread, breakfast cereal, chips, cookies, pizza, canned beans and veggies, canned soups, and pasta sauce—not the salt shaker itself.
Additionally, a diet heavy in processed foods can cause weight gain, and “when people are overweight, the body has to pump blood to more tissue, which can increase blood pressure,” says Dr. Philips. “We see an extremely large amount of high blood pressure in obese patients.”
BP fix: Cut way back on packaged foods.
Instead, load up on whole foods rich in beneficial nutrients, like vegetables, fruits, whole grains, legumes, fish, nuts, seeds, and olive oil, suggests Dr. Beniaminovitz. Potassium and magnesium are both minerals that help blood vessels relax, which in turn can help lower blood pressure; and recent research links high-fiber diets to significant reductions in systolic blood pressure.
If you want to follow a specific dietary plan that’s been proven to lower blood pressure, Dr. Beniaminovitz recommends either the DASH (Dietary Approaches to Stop Hypertension) diet or a well-formulated Mediterranean Diet.
2. You’re having more than one alcoholic drink per day.
For people who already drink, moderate alcohol consumption (one drink a day for women, two a day for men) is often not a problem, and some research suggests it may even help prevent heart disease. However, heavier alcohol consumption—especially frequent binge drinking episodes—can lead to chronically elevated blood pressure, says Dr. Philips. Research has also tied binge drinking to an increased risk of developing atherosclerosis—buildup of fatty plaque in the arteries, which can lead to heart attack and stroke.
BP fix: If you’re going to drink, drink moderately.
One drink equals 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of spirits. And if it’s really more about the ritual than the alcohol itself, consider periodically swapping out your glass of cabernet for a kombucha or one of those trendy new non-alcoholic cocktails from brands like Curious Elixirs, Seedlip, and Kin.
3. You’re not getting enough exercise.
Sitting too much or leading a sedentary lifestyle can mess with just about every aspect of your health, and your cardiovascular health is no exception. “Being sedentary leads to elevated blood pressure, both indirectly and directly,” says Dr. Beniaminovitz. Sedentary people tend to be overweight or obese, and, as mentioned above, weight is one of the main driving causes of high blood pressure.
Additionally, getting regular aerobic activity helps you maintain a healthy blood pressure by making blood vessels more compliant (or flexible) and less sensitive to hormonal influences, he explains—so a lack of such activity may accelerate arterial hardening, forcing the heart and blood vessels to work that much harder.
BP fix: Get your heart pumpin’ (in a good way).
A research analysis of nearly 400 studies suggests that regular exercise could be as effective as commonly prescribed blood pressure drugs. “In the pantheon of physical activity, aerobic exercising is the best for blood pressure,” says Dr. Beniaminovitz. Aim for at least 150 minutes of moderate aerobic exercise per week (about 20 to 30 minutes a day) such as biking, brisk walking, swimming, a barre class, or even higher-speed varieties of yoga like vinyasa.
4. You’re chronically stressed.
From an evolutionary standpoint, stress hormones like cortisol and adrenaline are released into the blood to help us escape danger (to fight or flee)—they increase heart rate, elevate blood pressure, constrict blood vessels, and enlarge our pupils to help us think and move fast, explains Dr. Beniaminovitz.
In the past, the stressful event was typically over pretty quickly—but today, relentless work demands, overbooked schedules, challenging relationships, and even social media have led to an epidemic of chronic stress, which triggers the same release of stress hormones. But unlike our ancestral past, there’s often no reprieve—it’s constant—and thus, blood pressure may remain elevated. One study found that logging more than 41 hours a week at work raised the risk of hypertension by 17%.
BP fix: Find your zen.
Physical activity is one of the most effective ways to reduce levels of stress hormones and minimize their impact on blood pressure, says Dr. Beniaminovitz. Mindfulness practices like deep breathing, meditation, and yoga, or even reading a book or listening to your favorite music, can also keep stress hormones in check.
You may also need to cut out certain activities, like checking those work emails at all hours. “People have to get to know themselves and their triggers, and how they may be able to remove themselves from situations that increase stress and anxiety,” says Dr. Philips.
5. You’re feeling lonely or socially isolated.
You may not necessarily feel stressed when you experience loneliness or social isolation, but these feelings—when they persist—can trigger the same dangerous release of stress hormones that spike blood pressure, says Dr. Beniaminovitz. Not to mention, chronic loneliness is associated with depression, and research has shown a correlation between depression, subsequent weight gain, and increase in blood pressure.
BP fix: Make (and keep) more plans with friends.
“We are social beings and we need a certain amount of social interaction to function optimally,” says Dr. Beniaminovitz. But if the idea of putting yourself out there seems impossible, start small. Send a friend a quick DM to say you’re thinking of them, and see where things go. Combine physical activity and social time by committing to a weekly Saturday morning yoga class with a pal. Want to make new friends? Try volunteering to meet like-minded people. (Here are eight actionable ways to deal with loneliness.)
6. You have sleep apnea (or your partner says you snore, a lot).
In general, inadequate sleep may lead to high blood pressure by increasing stress hormones, or by increasing your cravings for junk food and thus contributing to weight gain, says Dr. Beniaminovitz. But the biggest sleep-related cause of hypertension is obstructive sleep apnea (OSA)—a disorder that causes someone to stop breathing for brief periods of time while sleeping due to an obstruction of their upper airway.
“With higher obesity rates, more and more people are developing OSA,” says Dr. Philips. “This leads to broken sleep and decreased oxygen levels in the body, and part of the body’s response is to increase blood pressure.” In fact, it’s estimated that half of people with hypertension also suffer from OSA. Some signs you may have sleep apnea? Your partner says you snore or gasp in your sleep and you’re always tired despite going to bed at a reasonable hour.
BP fix: Book an appointment with a sleep specialist.
If you suspect OSA, see your doctor ASAP so they can conduct a sleep study in which your oxygen levels will be measured throughout the night, says Dr. Philips. If you are diagnosed, you will likely be prescribed a CPAP (continuous positive airway pressure) machine to wear over your mouth and nose at night to help you breathe.
7. You have another health condition—or you take one of these meds.
If you do have high blood pressure, your doctor will likely take into consideration the range of other diseases and disorders that, when poorly managed, cause your blood pressure to become elevated. These include thyroid problems, renovascular disease, Cushing’s syndrome, and a number of others. “The key to all these conditions is the correct diagnosis,” says Dr. Beniaminovitz. “When the proper diagnosis is made, working with your doctor to reverse and or treat these conditions often cures high blood pressure.”
Additionally, a number of common medications can increase blood pressure such as antidepressants, decongestants, St. John’s Wort, oral contraceptives, NSAIDs, and prednisone.
BP fix: Document symptoms that seem unusual.
If your doc says your BP is high, bring up any strange symptoms that could indicate an underlying cause (for example, if you’re experiencing weight gain, exhaustion, and hair loss, it could be hypothyroidism), and always provide them with a list of your current medications and supplements.
If your meds are the issue, “ideally they would be discontinued or changed to ones that have no or less effect on blood pressure,” says Dr. Beniaminovitz. “If a change in medication is not possible, often your doctor will prescribe optimal lifestyle and blood pressure medication to combat the effects.”
8. You have a strong family history of hypertension.
Genes do play some role in high blood pressure, which is why younger people in seemingly great health can still be diagnosed with hypertension, says Dr. Philips. However, more often than not, it’s also likely that people with a family history of high blood pressure share common environments (similar diets, similar sedentary lifestyles, etc) that increase their risk—and these are very much modifiable.
“Our genes also interact with the environment and we can influence them by the choices we make,” says Dr. Beniaminovitz. “While lifestyle changes may not help you in never developing high blood pressure if you have a strong family history, optimal lifestyle will aid in delaying the onset of blood pressure and the need for early medications. Instead of developing high blood pressure in your 30s or 40s, with optimal diet and lifestyle you may delay the onset of high blood pressure to your late 60s or 70s.”
BP fix: Keep up with the tips above!
There’s no magic bullet, but if you have a strong family history, that’s even more reason to implement all of the dietary and lifestyle recommendations above—eat whole foods, move your body more, manage stress—and get your blood pressure checked regularly.