Harvard Health Letter

Pill-free ways to lower high blood pressure

Reduce your dependence on medications with these strategies.

More than a third of all adults in the United States have high blood pressure—a systolic pressure (the top number in a reading) of at least 140 millimeters of mercury (mm Hg), or a diastolic pressure (the bottom number) of at least 90 mm Hg, or both. The condition injures blood vessel walls and forces the heart to work harder, increasing the risk for heart disease and stroke.

Taking medication to treat high blood pressure is just part of the solution.

“Lifestyle modification is equally important,” says Dr. Randall Zusman, medical editor of the Harvard Special Health Report Controlling Your Blood Pressure (www.health.harvard.edu/ht).

Lifestyle changes, such as modifying your diet or starting an exercise program, affect your heart and blood vessels in various ways. For example, exercise helps to lower the resistance to blood flow, so your heart can pump blood with less force.

Just one change can begin to lower your blood pressure. With several, “we may be able to take you off some medications,” says Dr. Zusman.

Lose weight

High blood pressure risk increases approximately threefold for people who are overweight. For each pound you lose, you may be able to drop both systolic and diastolic pressure an average of one point.

Exercise

Getting 30 minutes of moderate aerobic exercise (the kind that gets your heart pumping) on most days of the week has the potential to lower systolic blood pressure as much as four to nine points.

Eat a heart-healthy diet

Shift to a diet with less fat and more antioxidant-rich fruits and vegetables (blueberries, strawberries, spinach, red cabbage), lean meats, legumes, chicken, fish, and whole grains. “Antioxidants have been shown to improve vascular health and reduce inflammation. Whole grains and better protein sources reduce cholesterol and triglycerides, and improve vascular health as well,” says Dr. Zusman.

Reduce sodium intake

In some people, too much sodium increases the amount of body fluid and blood volume, which makes the heart work harder. Limiting sodium to 2,300 milligrams per day has the potential to lower systolic blood pressure by two to eight points.

Cut back the booze

Limit daily alcohol intake to one drink (if you’re a woman) or two drinks (if you’re a man). Cutting down has the potential to reduce systolic blood pressure by two to four points. If you don’t drink, don’t start.

Boost potassium-rich foods

Foods that are high in potassium, such as sweet potatoes, white beans, and bananas, help relax blood vessels and eliminate excess sodium.

Manage stress

Chronic stress can lead to high blood pressure. Meditation, guided imagery, deep breathing exercises, and yoga can help you manage stress. Triggering the relaxation response—the opposite of the fight-or-flight response—goes even further. “We recently demonstrated that the relaxation response activates genes associated with dilating the blood vessels and utilizing blood sugar, and inactivates genes associated with vascular inflammation and constriction,” says Dr. Zusman.

To practice the relaxation response, sit in a quiet place with your eyes closed; relax your muscles and silently repeat a word, phrase, sound, or short prayer of your choosing over and over; when stray thoughts interfere, let them come and go, and return to your word, phrase, or sound.

Monitor your blood pressure

Taking a daily blood pressure measurement will make you more likely to work at improving your numbers. The best times are early in the morning before you take any blood pressure medications, and again in the evening.

Quit smoking

The nicotine in tobacco constricts blood vessels and makes the heart work harder, leading to higher blood pressure. Quit-ting can lower your systolic blood pressure by two to eight points.

Treat sleep apnea

Obstructive sleep apnea (frequent pauses in breathing during sleep) sometimes causes high blood pressure. Treatment—such as continuous positive airway pressure or a dental appliance—may help lower blood pressure and reduce the harm to your heart.

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