Tips for Managing High Blood Pressure

High blood pressure, or hypertension, is diagnosed when blood pressure exceeds healthy limits. When you have high blood pressure, your blood exerts more force on the inner lining of blood vessels. Over time, excessive force and friction damage the inner lining of blood vessels. This increases your chances of developing cardiovascular diseases, such as stroke, heart attacks, kidney disease, vision loss, and sexual dysfunction.

The following statistics about high blood pressure epidemiology are concerning:^1,2,3,4

• Worldwide, about 1.28 billion adults have high blood pressure, including 122.4 million adults in the U.S.
• In 2021, hypertension caused or contributed to 691,095 deaths in the U.S.
• Just under half (46%) of people with high blood pressure do not know they have this condition.
• Less than half of adults with high blood pressure are being treated, and only one in every five adults with hypertension has it under control.
• High blood pressure is a leading cause of premature death worldwide.
• The prevalence of high blood pressure is rising due to an aging population and increased exposure to detrimental lifestyle factors.

As these statistics show, the first step to improving your heart health is to learn whether you have high blood pressure. TelegraMD doctors are available 24 hours a day to evaluate your medical history and blood pressure readings and provide an individualized plan for lowering your blood pressure to healthy levels.

High blood pressure is managed by modifying lifestyle factors that increase your risk and taking medications. Whether or not you have high blood pressure, consider changing any lifestyle factors that increase your risk.

What Causes High Blood Pressure?

Blood pressure is a measurement of the pressure exerted by circulating blood on the walls of arteries, similar to the pressure exerted by water on the walls of a hose. Systolic pressure is measured when the lower chambers of the heart contract and push blood into the circulation. Diastolic pressure is the number recorded when the heart relaxes.

Factors that can cause high blood pressure (hypertension) include:

• Blood volume/cardiac output: Excess blood volume from fluid retention (chronic kidney disease, heart failure, liver disease) or increased salt in your diet can raise blood pressure. Excess sympathetic nervous system stimulation, increased thyroid hormone, and high calcium levels can also increase blood pressure.
• Compliance: When blood vessels are stiff and non-compliant due to microscopic damage or fat and cholesterol deposits, it can increase blood pressure. Blood vessel compliance decreases with age and cholesterol deposition.
• Viscosity: Thicker blood from increased red blood cells or blood proteins can increase blood pressure.
• Vessel length: The longer a blood vessel, the higher its resistance and the blood pressure needed to overcome this resistance. Carrying extra body fat (obesity) increases total capillary length. Obesity is a strong risk factor for heart disease.  
• Resistance: Narrowing the lumen of a blood vessel increases its resistance, and high blood pressure is needed to overcome this resistance. Smoking, stress, and some medications (stimulants) may narrow blood vessels.

Having a genetic predisposition to high blood pressure can also increase your risk, as can medical conditions that are associated with high blood pressure, such as:

• Sleep apnea
• Chronic kidney disease
• Pheochromocytomas
• Adrenal gland tumors
• Thyroid disease
• Coarctation of the aorta

Ways To Reduce High Blood Pressure

Lifestyle factors contribute to high blood pressure. Mitigating these factors can reduce your blood pressure and your risk for chronic health conditions associated with high blood pressure. In addition to maximizing the benefits of healthy lifestyle choices, consult with an online doctor to get answers to your questions right away.

1. Get Regular Exercise

Regular exercise can reduce stress, improve mental health and cardiovascular function, and help you shed some extra pounds. Physical activity strengthens the heart, making it more efficient when pumping blood.

Research suggests that physical activity decreases systolic blood pressure by about 11 mm Hg and diastolic blood pressure by 8 mm Hg in about three-quarters of people with high blood pressure. Researchers also noted that:⁵

• Exercise reduces blood pressure more in women than in men.
• Middle-aged adults benefit more from exercise to reduce blood pressure than younger or older adults.
• Low- to moderate- levels of exercise yield as much or even more benefit than high-intensity exercise.
• Prolonged exercise improves blood pressure more than shorter episodes.
• Decreases in blood pressure remain for up to 24 hours after exercising.

The American College of Sports Medicine (ACSM)⁶ and the U.S. Department of Health and Human Services Physical Activity Guidelines⁷ jointly recommend:

• Aim for at least 150 to 300 minutes of moderate-intensity aerobic physical activity, 75 to 150 minutes of vigorous physical activity, or an equivalent combination of moderate- and vigorous-intensity activity throughout the week.
• Do muscle-strengthening exercises that target every major muscle group at least twice a week.

Choosing a sedentary lifestyle has many potential health effects, including an increased risk for metabolic syndrome, high blood pressure, and obesity. Any physical activity that you incorporate into your daily schedule will pay off in health benefits. The best exercises are ones you enjoy and will continue doing.

Examples of heart-healthy exercises include:

• Aerobic exercises: walking, jogging, cycling, rowing, swimming, and dancing to improve cardiovascular fitness.
• Strength training: push-ups, squats, and planks to increase muscle mass.
• High-intensity interval training to improve cardiovascular fitness and burn calories.
• Yoga or Pilates to improve flexibility and posture.

2. Cut Back on Sugary and Salty Foods

When researchers compared 14 different macronutrient diets, they found all diets resulted in modest weight loss and improved blood pressure over six months, but at 12 months, weight reduction decreased, and blood pressure improvements largely disappeared. Reviewers pointed out that very low-carbohydrate diets were not included in the study.⁸

Long-term follow-up data from the Framingham Heart Study revealed that compared to normal-weight adult men and women, the relative risks for developing high blood pressure were 1.48 and 1.70 for overweight men and women and 2.23 and 2.63 for men and women with obesity, respectively.⁹ Losing weight to a healthy body mass index can reverse this risk.¹⁰

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure found that weight reduction by 22 pounds resulted in a 5 to 20 mm Hg reduction in systolic blood pressure.¹¹

Sodium can increase water retention and blood volume, leading to high blood pressure. Reduce sodium intake to less than 2,400 mg sodium per day. Optimally, decrease it even further to 1,500 mg per day. Restricting sodium is expected to decrease systolic blood pressure by 2 to 8 mm Hg.¹¹ Most sodium in the typical American diet comes from consuming processed foods, not from adding salt to foods at the table.

Increasing potassium in your diet can lower your blood pressure. A low potassium-to-sodium ratio is associated with increased blood pressure. The DASH diet recommends a daily intake of 4.7 g of potassium.¹²

3. Eat More Heart-Healthy Foods

Consuming a diet rich in fruits and vegetables and low-fat dairy products with reduced saturated and total fat, such as the DASH (Dietary Approaches to Stop Hypertension) diet, can reduce blood pressure by 8 to 14 mm Hg.¹¹  Heart-healthy foods are rich in antioxidants and healthy sources of fat and low in saturated fat and sodium.

The DASH diet emphasizes eating:

• Fruits
• Vegetables
• Whole grains
• Fish
• Poultry
• Beans
• Nuts and seeds
• Vegetable oils

Besides lowering blood pressure, a heart-healthy diet can lower low-density lipoprotein (LDL) bad cholesterol and increase high-density lipoprotein (HDL) cholesterol.

4. Reduce Smoking and Alcohol Consumption

Chemicals in cigarette smoke constrict blood vessels, increasing resistance and, therefore, blood pressure. These chemicals damage the inner lining of blood vessels and can negatively impact heart health. Increased risk of cardiovascular disease from smoking is not life long. After one year of smoking cessation, the risk of coronary heart disease is cut in half and continues to decline. After 15 years of abstinence, coronary heart disease risk is comparable between smokers and nonsmokers.¹³

Long-term or excessive alcohol consumption can damage the liver and affect the heart. For every 10 grams of alcohol consumed, blood pressure increases by about 1 mm Hg. After 2 to 4 weeks of abstinence, the effect of alcohol on blood pressure declines to baseline. The relationship between alcohol consumption and blood pressure is the same regardless of the type of alcohol consumed.¹⁴

Drinking alcohol in moderation, which is less than or equal to two drinks per day for men and one drink per day for women, can reduce your systolic blood pressure by 2 to 4 mm Hg.¹¹

5. Manage Stress to Reduce Blood Pressure

Unmanaged stress stimulates the sympathetic nervous system (“fight or flight”), which releases hormones that narrow blood vessels and increase resistance and, therefore, blood pressure. Stress can have a significant impact on heart health. Unmanaged stress does not directly cause high blood pressure but can increase risk.¹⁵

Many people find that some of the following activities can help them manage stress:

• Meditation
• Being in nature
• Exercising
• Playing with a pet
• Taking a nap
• Yoga or Pilates
• Hobbies

6. Take the Right Medication or Supplements

Lifestyle changes are the first-line treatment for managing blood pressure. Blood pressure medications are frequently needed if lifestyle changes alone don’t reduce blood pressure to a healthy level.

Some potentially heart-healthy supplements that may improve heart health and blood pressure include:

• Omega-3 fatty acids
• Magnesium
• Fiber
• Folate
• Coenzyme Q-10
• Vitamin E

Before taking supplements to improve your heart health or blood pressure, schedule a medical consultation to discuss your best treatment options.

What Kind of Doctor Manages High Blood Pressure?

Typically, a primary care doctor manages blood pressure. This could be a pediatrician to manage high blood pressure in children, a family medicine or internal medicine doctor for adults, and an obstetrician-gynecologist for pregnant people.

Schedule an online appointment with a TelegraMD doctor to discuss your concerns about your blood pressure and potential risk for heart disease. They will review your medical history and develop an individualized treatment plan incorporating heart-healthy lifestyle recommendations and prescription medications (if needed).

How To Monitor Your Blood Pressure

Blood pressure fluctuates from minute to minute, so it is important to monitor your blood pressure using a wearable device that tracks blood pressure or by taking your blood pressure at home.

When taking your blood pressure:¹⁰

• Avoid caffeine, alcohol, tobacco use, or exercise within 30 minutes of taking your blood pressure.
• Sit upright with your back against the back of the chair and your feet flat on the floor.
• Avoid tight-fitting clothing.
• Wrap the blood pressure cuff around your upper arm, not over clothing.
• Place your arm on the table with your palm up so the cuff is even with your heart.
• Push start on the machine and sit quietly until your blood pressure is measured.
• Recheck your blood pressure on the other arm.

Tracking your blood pressure and making lifestyle changes that are linked to better heart health and lower blood pressure can pay off with a longer, healthier life.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

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2. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020 Apr;16(4):223-237. doi: 10.1038/s41581-019-0244-2. Epub 2020 Feb 5. PMID: 32024986; PMCID: PMC7998524.

3. National Center for Health Statistics. Multiple Cause of Death 2018–2021 on CDC WONDER Database. Accessed September 8, 2023.

4. Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Beaton, A. Z., Boehme, A. K., Buxton, A. E., Commodore-Mensah, Y., Elkind, M. S. V., Evenson, K. R., Eze-Nliam, C., Fugar, S., Generoso, G., Heard, D. G., Hiremath, S., Ho, J. E., … on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2023). Heart disease and stroke statistics—2023 update: A report from the American Heart Association. Circulation, 147(8). https://doi.org/10.1161/cir.0000000000001123

5. Hagberg JM, Park JJ, Brown MD. The role of exercise training in the treatment of hypertension: an update. Sports Med. Sep 2000;30(3):193-206. doi:10.2165/00007256-200030030-00004

6. American College of Sports Medicine. Trending Topic | Physical Activity Guidelines. Accessed September 8, 2023. https://www.acsm.org/education-resources/trending-topics-resources/physical-activity-guidelines

7. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Accessed September 8, 2023. https://health.gov/sites/default/files/2019-09/paguide.pdf

8. Ge L, Sadeghirad B, Ball G D C, da Costa B R, Hitchcock C L, Svendrovski A et al. Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials BMJ 2020; 369 :m696 doi:10.1136/bmj.m696

9. Leggio, M., Lombardi, M., Caldarone, E. et al. The relationship between obesity and hypertension: an updated comprehensive overview on vicious twins. Hypertens Res 40, 947–963 (2017). https://doi.org/10.1038/hr.2017.75

10. Whelton, P.K., Carey, R.M., Aronow, W.S., Casey, D.E. Jr., Collins, K.J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner,  P., Ovbiagele,  B., Smith, S. C. Jr., Spencer,  C. C., Stafford, R. S., Taler,  S. J., Thomas, R. J., Williams, K.A. Sr., Williamson, J.D., & Wright,  J.T. Jr.(2018).  2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol.;71(19): e127-e248. DOI: 10.1016/j.jacc.2017.11.006. Epub 2017 Nov 13. Erratum in: J Am Coll Cardiol.;71(19):2275-2279. PMID: 29146535.

11. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. (2004). National High Blood Pressure Education Program. Bethesda, MD: National Heart, Lung, and Blood Institute (U.S.); Report No. 04–5230.

12. Staruschenko, A. (2018). Beneficial Effects of High Potassium. Hypertension. 71, 1015-1022. https://doi.org/10.1161/HYPERTENSIONAHA.118.10267

13. Puig-Cotado F, Tursan d’Espaignet E, St Claire S, Bianco E, Bhatti L, Schotte K et al. Tobacco and coronary heart disease: WHO tobacco knowledge summaries. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.

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15. Kulkarni, S., O’Farrell, I., Erasi, M., & Kochar, M.S. (1998). Stress and hypertension. WMJ.; 97 (11):34-8. PMID: 9894438.