Lifestyle Interventions to Lower Blood Pressure

If you are diagnosed with hypertension, your physician may choose to start you on blood pressure medication. There are many types, with different mechanisms of action.

Thankfully, in addition to this treatment, there are numerous lifestyle choices that can play a key role in helping to lower blood pressure.

Ideal blood pressure is less than 120 over 80, according to the American Heart Association; any blood pressure higher than 130 over 80 is considered hypertension. Even small changes in these readings can significantly impact the chance of having a cardiac event down the road, so it’s important to catch elevated blood pressure early and notice changes over time.

“Patients who know their blood pressure readings have a much better prognosis,” says Dr. Jaime Burkle, a top preventive cardiologist and Chair of Cardiology at Atria. “People who know their numbers tend to grow older stroke-free compared to their counterparts who don't know their blood pressure numbers.”

Dr. Burkle recommends that all patients with hypertension have a blood pressure cuff in their home and check their pressure around midday, at least three days per week.

A doctor’s advice for checking your blood pressure at home:

• If your cuff is more than three years old, invest in a new one—most cuffs lose accuracy over time
• Make sure you’re using fresh batteries; low batteries can inhibit accurate readings
• Bring your blood pressure cuff into your doctor’s office to check its accuracy against a professional instrument
• Keep a log daily, or at minimum, three days a week

• Anyone with hypertension needs to understand their salt intake. “Americans eat 3 to 4 grams of sodium per day,” says Dr. Burkle. “That's way too much. And, especially if you eat out, then those foods are loaded with salt. Salt restriction is among the first things you need to pay attention to.” Cooking food at home is a good way to monitor salt intake—remember, it doesn’t need to be eliminated entirely, and it is possible to get too little sodium.
• “We always recommend a Mediterranean diet with plenty of fruits, vegetables, fish, and chicken, with lots of legumes and grains and good oils,” says Dr. Burkle. “Cashews and peanuts are the best cardiac snacks.”
• “Caffeine and alcohol intake, especially alcohol, is associated with elevated blood pressure readings,” says Dr. Benjamin Lewis, a leading cardiologist and Director of Research at Atria. Minimizing both can help.
• Watching your weight is also important, says Dr. Lewis, because “the bigger the volume of weight, the bigger the volume of blood that has to be circulated. And if it goes through stiff pipes, your heart has to work harder to deliver the blood flow.”

The literature connecting poor sleep to hypertension is clear. “People who get less than 6 hours of sleep per night are at a significant risk of hypertension,” says Dr. Lewis. Another reason to be careful about alcohol and caffeine intake is because both can also affect sleep quality, which is crucial for getting blood pressure under control.

Emotional stress and anxiety contribute to hypertension as well, and there are many strategies that have been proven to get both in check. It’s important to find out what works for you. One option is meditation, which the American College of Cardiology endorses as an effective way to lower your heart rate and blood pressure. Working with a therapist and regular acupuncture have also been proven to help with stress management, as has regular physical exercise.

“The biggest impact that stress has, apart from the obvious ones, is that people lose their healthy routines,” says Dr. Lewis. “They stop exercising, they eat more indiscriminately, they drink more coffee and alcohol, and that disrupts their sleep.” All these factors compound to elevate blood pressure.

Atria physicians recommend 30 to 45 minutes of exercise—a combination of aerobic and weight training—four days a week.

"If you practice regular cardiovascular exercise, over time, that will lower your heart rate, and that constant stretching of arteries during exercise may prevent some of the loss of flexibility,” says Dr. Lewis.

Lifestyle changes are necessary for any person with hypertension, but they often won’t go far enough alone. “Medication should not be resisted, but rather celebrated,” says Dr. Lewis, “because 100 years ago, we didn’t have these things. Not treating something efficiently leaves you open to the natural history of the disease, which is generally a downward spiral over time.” If you are on medication and have concerns about side effects or the cost of the medication, that’s a perfect opportunity to have a conversation with your physician. There are more treatment options than ever, and getting on the right medication is key.

Dr. Lewis suggests if you have any trepidation about medication to let that be your incentive to get serious about lifestyle changes: “If we start medications to close the gap on your blood pressure and you make lifestyle changes that are so positive that your numbers improve to the point where we will consider reducing or discontinuing medication, that can be a powerful motivator.”