How To Lower High Blood Pressure: Science-Backed Methods That Can Help

An estimated 1 in 3¹ American adults has high blood pressure (hypertension), with most sufferers in their late thirties or older. People with high blood pressure face medical costs of almost $2,000² higher than their non-hypertensive counterparts, and it costs the US population an extra $131bn every year.

Thankfully, researchers have worked extensively to discover ways to treat and manage high blood pressure, and most people can control it with some effort. Screening is vital, as high blood pressure has no symptoms until it’s done a lot of damage to the person's organs.

How is high blood pressure diagnosed?

As there are no symptoms, doctors diagnose high blood pressure (hypertension) through routine screening. Normal blood pressure is 120/80 mm Hg or less. The top number (120) is systolic blood pressure, and the bottom (80) is diastolic. It's normal for blood pressure to increase for short periods under certain conditions, such as anxiety or dehydration.

You’re at risk of developing high blood pressure if multiple readings are between 120/80 and 139/89. This is called prehypertension. Above this, you’ll be diagnosed with hypertension.

Typically, you will use a home monitor to monitor your blood pressure over 24 hours to eliminate transitory spikes. Some people have momentary high blood pressure because they are anxious about a trip to the doctor, a condition called “white coat syndrome.”

How is high blood pressure treated?

Doctors typically treat high blood pressure with a two-pronged approach of medication and lifestyle changes. In some cases, lifestyle changes alone can keep hypertension under control.

Many different medications treat high blood pressure. In some cases, multiple drugs may be prescribed, which work together to control hypertension. Currently, only 24%³ of people in the US with high blood pressure properly manage their condition: Many don’t take their medication correctly or change their lifestyle.

Lifestyle changes to treat high blood pressure

Doctors typically recommend lifestyle changes as the first approach, and sometimes they can be sufficient. Medications can have side effects, so the more you can control your high blood pressure with lifestyle changes, the better. Lifestyle changes include:

Maintaining a healthy weight

Being overweight puts more pressure on your heart, increasing the risk of high blood pressure. It's a good idea to get a referral to a nutritionist rather than relying on a fad diet. Many weight-loss diets don't work and result in more weight gain in the long run.

Eating a balanced diet

Most people with hypertension follow the DASH (Dietary Approaches to Stop Hypertension) diet, which is a low-salt diet including lots of fruit and vegetables.

Cutting down on sodium and increasing potassium

A lot of food has sodium in it, including things you wouldn’t expect. If you like eating packaged food, always read the labels.

It's also a good idea to cut down on unnecessary added sugars. Eating foods with more potassium is a good idea for most people. However, as some blood pressure medications can increase potassium, check with your doctor so you don't end up with too much in your blood.

Reducing alcohol consumption 

If you are on medication, your doctor may tell you to stop drinking altogether,⁴ especially if you are over 65. Some blood pressure medications interact with alcohol to cause drowsiness and dizziness. You should avoid heavy drinking if you are on diuretics, as alcohol is also a diuretic.

Quitting smoking or vaping

Vaping⁵ also increases high blood pressure so, while it is generally healthier for people who are unable to quit smoking, you should still avoid it if possible. If you have been diagnosed with high blood pressure, talk to your doctor about a plan to stop smoking.

Increasing physical activity

Exercise is one of the best ways to control your blood pressure. Try to aim for at least 150 minutes of moderate activity a week. Taking up an active hobby is ideal for most people, but you should talk to your doctor and possibly a physical therapist if you have other health concerns.

Improving sleep habits

Going to bed at the same time every day and avoiding screens and reading before sleeping is great ways to improve your sleep. Many people with high blood pressure might also have sleep apnea. If you snore and wake up feeling unrefreshed, talk to your doctor about a sleep study.

Reducing stress and managing anger

Getting mad raises your blood pressure. Meditation and mindfulness can reduce stress and bring your blood pressure under control. Therapy can also really help if you have issues controlling stress, and your doctor might recommend anger management counseling if you feel you struggle to manage your temper.

Cutting caffeine

Caffeine can increase blood pressure, but only in some people. For many people, it is entirely safe to continue to drink caffeinated beverages.

While lifestyle changes are not always easy, they’re good for your health, and they can lower your blood pressure. Exercise can improve your heart health and mood, and quitting smoking is hugely beneficial to your lungs. Additionally, all of these changes can prevent high blood pressure in the first place, which is always better than having to treat it.

Medications for high blood pressure

Most people with high blood pressure have to take one or more medications.⁶ Multiple medications are more common for adults with high systolic blood pressure (the top number) but normal diastolic blood pressure (the bottom number). Your doctor may try you on several different medications or combinations of medications before settling on a regimen.

Medication is long-term; there is no "cure" for high blood pressure, and you should not stop taking medication unless your doctor tells you to. Many people have difficulty remembering to take their medication, especially since they often do not suffer from any symptoms. Your doctor may give you a combination of blood pressure medication or once-daily medications to make this easier.

Blood pressure medication typically starts working in a matter of days. Your doctor may give you a home monitor to check if they are working: If they aren’t, your doctor may add a medication, alter dosages, or change things completely.

As we’re all unique, drugs affect us differently, so another medication may work better for you. Unfortunately, your doctor will not know what works without trying it.

First-line treatments⁷ include thiazide diuretics, ACE inhibitors, angiotensin II receptor blockers, and calcium channel blockers.

Here are the common types of high blood pressure medicine:

Diuretics

Diuretics, or "water pills," specifically thiazide diuretics, are often the first medication doctors prescribe. As elevated levels of sodium cause high blood pressure, diuretics cause your kidneys to release more sodium into your urine.

There are three types of diuretics: thiazide, loop, and potassium-sparing.  Thiazide diuretics such as indapamide or chlorothiazide are first-line treatments for high blood pressure.

Potential side effects

They are generally safe, but they can increase how much you urinate. Thiazide diuretics can lower potassium levels, which means you may need to take supplements or eat more potassium-rich food to compensate. On the other hand, potassium-sparing diuretics can cause you to have too much potassium.

Other side effects include erectile dysfunction (impotence), dehydration, headaches, muscle cramps, joint disorders, and dizziness. It is particularly important to stay hydrated if you are on diuretics. Avoid excessive consumption of alcohol or caffeine, both of which can have an additional diuretic effect.

Beta-blockers

Doctors typically use beta-blockers when other medications don't work. They block the effects of epinephrine, also known as adrenaline, which makes the heartbeat slower and with less force, lowering blood pressure. They also widen veins and arteries.

Beta-blockers are not the first choice because they work poorly in older people and don’t work as well in Black people.

However, your doctor may put you on beta-blockers if you also have heart issues, angina, or migraines, as they can help with these conditions. They’re often used to treat irregular heartbeats caused by conditions like atrial fibrillation, and doctors prescribe them to people who have had heart attacks and heart failure.

Beta-blockers are not used in people with asthma because they can trigger attacks.

People with diabetes⁸ (especially those on insulin) need to carefully monitor their blood sugar levels. Beta-blockers cause low blood sugar by inhibiting liver glucose production, and they also mask the symptoms of rapid heart rate. That’s usually a warning sign for people suffering from low blood sugar.

Potential side effects

A common side effect of non-selective beta-blockers is weight gain, which can reduce their effectiveness by increasing blood pressure. Other side effects include cold hands or feet, fatigue, or more rarely depression, shortness of breath, and trouble sleeping.

Calcium channel blockers

Calcium channel blockers treat high blood pressure, chest pain, and irregular heartbeat. They selectively prevent calcium from entering the cells of your heart and arteries, which causes your blood vessels to relax and open. They may also slow your heart rate.

Typically, your doctor will prescribe a long-acting calcium channel blocker for high blood pressure. These medications include Norvasc, Procardia, and Verelan. Calcium channel blockers work better in Black people and older individuals.

Potential side effects

Side effects include heart palpitations, fatigue, flushing, headache, nausea, rash, swelling in the feet, dizziness, and constipation.

Grapefruit can interact with certain calcium channel blockers and statins. Check with your doctor or pharmacist to see if you should avoid grapefruit products.

Angiotensin-converting enzyme inhibitors

These are typically called “ACE inhibitors,” which is much easier to pronounce. ACE inhibitors (ACEIs) stop your body from producing a substance called angiotensin II, which narrows blood vessels.

There are many ACEIs available, including Lotensin and Fosinopril, and they’re good if you also suffer from migraines, diabetes, or chronic kidney disease.

Potential side effects

Side effects can include dry cough, increased potassium, fatigue, dizziness, headaches, loss of taste, and swelling on rare occasions. If you’re pregnant, you should not take ACEIs.

You shouldn’t mix them with NSAIDs such as ibuprofen, which can decrease renal function.⁹ Talk to your doctor or pharmacist about safe over-the-counter painkiller options if you are on ACE inhibitors.

Peripherally acting alpha-adrenergic blockers

These are also called alpha-blockers. They reduce the contraction of smooth muscles. Doctors don’t usually prescribe alpha-blockers on their own, and long-term therapy with them can cause issues. Nonselective alpha-blockers can cause blood pressure to drop too low.¹⁰

Alpha-blockers used to treat high blood pressure include Cardura and Minipress.

Potential side effects

You should take your first dose at bedtime because it is very common for the first dose to induce postural hypotension, meaning you may feel faint when you stand up.  Other side effects include weakness, headache, dizziness, and pounding heartbeat.

Long-term use of one specific medication, doxazosin,¹¹ can increase the risk of heart failure, so your doctor will carefully monitor your heart. Doctors may not prescribe this drug to patients with other issues that put them at higher risk for heart problems.

Angiotensin II receptor blockers

ARBs also affect angiotensin II, like ACE inhibitors. Instead of inhibiting the production of the substance, they block its action. Angiotensin II receptor blockers also widen and relax your blood vessels, and they include Edarbi and Benicar.

Potential side effects

Side effects include high potassium levels, swelling of the skin, and dizziness. Intestinal problems are rare, but they can be serious. Talk to your doctor immediately if you have unexplained weight loss or you’re experiencing severe diarrhea.

You should not take these drugs while pregnant. If you get pregnant or are trying to conceive, talk to your doctor about alternative medications. It’s essential to keep blood pressure down through your pregnancy.

Renin inhibitors

Only one renin inhibitor¹² (Aliskiren) is approved by the FDA. It inhibits renin, another chemical that causes a tightening of the blood vessels. It may be more tolerated in some patients than ACE inhibitors, and it rarely causes an increase in potassium. However, patients often take it with a thiazide diuretic and ACE inhibitors or angiotensin II receptor blockers.

Researchers are still looking into renin inhibitors, so it’s likely that more of these drugs will reach the market soon. If you are struggling to control your blood pressure, your doctor may add a renin inhibitor as they are relatively new.

Vasodilators

Vasodilators open blood vessels differently. Direct vasodilators affect the vessel walls themselves, with two approved: Hydralazine and minoxidil. They’re strong medications, and doctors only prescribe them when other drugs have failed.

Potential side effects

They have significant side effects, including heart palpitations, rapid heartbeat, fluid retention, nausea, headache, excessive hair growth, and joint and chest pain. If you take vasodilators, you may need medication to deal with any side effects.

As you can see, other than diuretics, a common theme of blood pressure medications is that the majority enlarge blood vessels. This helps your blood flow more smoothly, and your heart doesn't have to work as hard. One of the major causes of high blood pressure is your blood vessels hardening with age, and these medications help compensate for that.

Ways to remember to take your blood pressure medication

Remembering to take your medications can be challenging, but it’s important you discover a way to stay on top of them. With high blood pressure, no symptoms creep up on you if you forget to take a dose, but the damage still occurs. A reminder system is vital for older adults who might be developing memory issues.

Some suggestions:

1. Set an alarm to remind you to take your medication. You can set most alarms to ring at the same time every day, so you won’t need to remember to keep setting it. 

2. Always take your medication at the same time every day.

3. If you don’t need to take your medication on an empty stomach, it is often easier to remember to take it with a meal. 

4. If you take your medication at night, keep it with your toothbrush, so you remember to take it before bed.

5. Keep your medication in a convenient location. Consider keeping a couple of doses in a bag or purse that you routinely take with you so that you don't miss a dose while you’re out.

6. Set up automatic refills with your pharmacy if possible to ensure you don't run out. If you’re traveling, count your doses before you leave and get a refill early if needed.

7. If you have multiple medications, weekly pill boxes are your friend. You can get these at most pharmacies, and you just put each day's pills in the box. It’s also really easy to see if you’ve taken them with this system.

8. Enlist a friend or family member to remind you to take your medication.

If you miss a dose, take it as soon as you realize, unless it's close to the time you will be taking your next dose. Don't take two doses at once, or you may overdose and end up with your blood pressure dropping too low.

Are there any non-drug treatments for high blood pressure?

Other than the lifestyle changes above, there are currently no non-drug treatments such as devices to lower blood pressure. Researchers have conducted clinical trials¹³ for BAT (baroreflex activation therapy), which uses a stimulating electrode attached to the carotid sinus and an implantable pulse generator, somewhat like a pacemaker. However, the FDA hasn’t approved such devices, and trials indicate mixed results.

Another device, the Symplicity catheter system, which causes renal denervation, shows promising results¹⁴ in trials. While it’s not yet approved, it might be an option for people whose high blood pressure does not respond to any available medications.

As these devices require surgery, they are likely to be reserved for patients resistant to drug therapy. However, they do have the advantage of not needing to remember to take multiple medications. They may be useful for older patients who have difficulty complying with a complicated medication regimen.

When should you see a doctor for high blood pressure?

Most high blood pressure diagnoses occur during routine visits for other matters. High blood pressure is not diagnosed based on a single reading, as many factors can cause a transitory spike. Typically, at least two high readings are required.

Some people need close monitoring for high blood pressure. Risk factors include:

• Obesity

• Race: If you’re Black, you’re more likely to develop hypertension

• High levels of stress or anxiety

• Heavy drinking

• Smoking

• Diabetes

• Family history

Most cases of high blood pressure don’t have links to another condition, but it can be caused by:

• Certain thyroid conditions

• Medicines that elevate your blood pressure, including birth control pills, some cold remedies, migraine medicines, corticosteroids, and certain antipsychotics

• A congenital narrowing of the artery that supplies blood to the kidney

• Chronic kidney disease

• Sleep apnea

• Pregnancy

Gestational hypertension usually goes away after the child is born. Still, it’s a warning sign for a highly dangerous condition called preeclampsia, which can be fatal for both mother and baby. If you have high blood pressure and get pregnant, you will need to work with your doctor, as some blood pressure medications are unsafe during pregnancy.

Untreated hypertension increases your risk of a heart attack or stroke and can damage your heart, brain, kidneys, and eyes. It can also cause erectile dysfunction.

Because of this, everyone should get their blood pressure checked regularly, especially as they get older. In the case of pregnancy, medical professionals should carefully monitor the mother’s blood pressure to avoid serious complications for both mother and baby.

When high blood pressure is an emergency

Rarely, blood pressure can rise very quickly, causing a medical emergency.

Symptoms to look out for include:

• Severe headaches

• Dizziness

• Visual disturbances

• Shortness of breath

• Memory loss

• Personality changes¹⁵

• Trouble concentrating

• Irritability

• Progressive loss of consciousness

• Chest pain

• Blindness

These crises can cause a heart attack or a stroke, typically resulting in immediate hospitalization. Fortunately, they are relatively rare. In most cases, high blood pressure is a chronic disease that causes problems and damage over time.

The lowdown

Hypertension is a serious problem facing the US and its population. Lifestyle changes can reduce high blood pressure naturally, but you may require medication if these changes aren’t successful. Generally, it’s better to attack high blood pressure by changing things like your activity level and diet, rather than relying on medication which can have unpleasant side effects,

While it may be hard to give up smoking or reduce your alcohol intake, support groups are available to help. Uncontrolled high blood pressure has serious consequences for the body, including heart issues, stroke, and other organ damage. If lifestyle changes fail, you need to take your blood pressure medication as your doctor prescribes. Skipping doses is unwise, and it’s dangerous to leave your condition unmanaged. If the side effects are too difficult for you to deal with, speak to your doctor as they’ll be able to suggest an alternative.