Hypertension, or high blood pressure, is usually the result of many factors. Some, such as family history and genetics, are out of a person’s control, but there are lifestyle changes any person with hypertension can make to maintain a healthier blood pressure.
While medication is a common tool many people need to control their hypertension, “many people might not ever need medication,” says Vivek Bhalla, MD, founder and director of the Stanford Hypertension Center at Stanford University School of Medicine in California.
“If your blood pressure is more than 140/90 [millimeters of mercury] mmHg, regardless of age or other risk factors, you will probably need medication,” Dr. Bhalla says. “Once you get it below 140/90 mmHg, then diet and lifestyle can be used to get it closer to 120/80 mmHg, which is the end goal. But what we use to get there depends on the person.”
Maintaining a healthy blood pressure for life will require multiple steps, he adds. Here are five ways you can treat hypertension with lifestyle changes, whether or not you’re taking medication.
1. Watch Your Salt Intake
Sodium, or salt, increases blood pressure by causing the body to retain fluid, which puts strain on the heart and blood vessels, according to the American Heart Association (AHA).
Wanpen Vongpatanasin, MD, director of the Hypertension Fellowship Program at the University of Texas Southwestern Medical Center in Dallas, says salt is the number one thing people should be aware of when trying to lower their blood pressure.
“The first thing we always go over with patients is sodium intake,” he says. “Sodium is the most important factor in hypertension, and it’s high in most processed food.”
Most Americans are also eating too much of it.
Federal guidelines recommend people get no more than 2,300 milligrams (mg) of sodium daily — and to aim for around 1,500 mg — but the average American eats 3,400 mg of salt every day, according to the Centers for Disease Control and Prevention (CDC).
Not adding salt to your food usually isn’t enough to make a significant difference in your salt intake, Dr. Vongpatanasin says.
“The U.S. population gets most of its salt from processed foods, even things like bread and pasta,” he says. “So if people don’t add salt, that’s not enough. We only get about 20 percent from table salt, and 80 percent is already in foods.”
According to the CDC, 40 percent of the salt Americans eat comes from just 10 sources, bread being No. 1, followed by pizza, sandwiches, cold cuts and cured meats, soups, and burritos and tacos.
Not everyone reacts to salt in the same way, but “everybody has some rise in their blood pressure when they eat salt,” says Bhalla.
Some people are naturally more salt sensitive, and people who have obesity are typically more sensitive to the blood pressure effects of salt, he says.
The best way to think about your daily salt intake is like an allowance, Vongpatanasin says, advising people to read food labels to better understand how much sodium is in different foods.
“We eat about 10 servings of things per day. If we don’t consume 140 mg of sodium in a sitting, we don’t usually go over 1,500 mg per day,” he says.
2. Improve Your Sleep
Sleep hygiene is a sometimes less obvious, but important factor in a person’s risk of hypertension.
A study published in The International Journal of Environmental Research and Public Health used National Health and Nutrition Examination Survey sleep and health data from more than 12,000 adults in the United States. The researchers found that not sleeping enough was associated with an increased risk of high blood pressure, and that for each hour of sleep, a person’s risk of hypertension decreased by about 0.4 percent. People who reported having trouble sleeping and those with a sleep disorder, such as sleep apnea, were also at higher risk for hypertension.
Like salt, different amounts of sleep will impact people differently based on many factors, including their unique physiology, says Virend Somers, MD, PhD, director of the cardiovascular sleep facility at Mayo Clinic in Rochester, Minnesota.
“Some people are completely rested and have no issue sleeping five hours per night. Other people need up to nine hours. It’s up to what the individual needs,” Dr. Somers says. “And the way to know you got enough sleep is that you wake up without an alarm.”
He recommends most adults get between seven and eight hours of sleep per night, and notes that a person’s chronotype — their natural preference for when they’re asleep and when they’re feeling awake — will determine if they’re a night owl or an early bird.
“We need to find a way to reconcile our chronotype with our job; that can be a tricky business. If you have to wake up at a certain time in the morning, I would absolutely recommend adjusting your schedule,” Somers says.
He also stresses the importance of getting screened for a sleep disorder, especially sleep apnea, if you have hypertension. If a person has sleep apnea, getting that treated with a continuous positive airway pressure (CPAP) machine alone can lower blood pressure, he says.
According to the AHA, chronic stress, when a person is constantly under stress that they cannot control, can lead to high blood pressure.
People often don’t have control over stressors in their lives, but sleep plays an important stress-reducing role in the body, which is another way sleep may lower blood pressure, Somers adds.
3. Up Your Potassium and Magnesium Intake
While salt raises blood pressure, other minerals, namely potassium and magnesium, can lower it.
Potassium slows the impact salt has on the cardiovascular system, so getting more potassium into your diet can help lower blood pressure, says Vongpatanasin. In 2022, the U.S. Food and Drug Administration (FDA) added lowering high blood pressure as a bonafide health claim for magnesium supplements.
A study published in Kidney Medicine included more than 2,000 people enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT). They found that people who had higher magnesium levels in their blood had a lower overall risk of cardiovascular disease, including high blood pressure.
Although supplements can deliver nutrients, Vongpatanasin always recommends getting potassium and magnesium from food rather than a pill. Eating healthy whole foods, especially fruits, nuts, vegetables, and beans, can deliver doses of hypertension-fighting potassium, magnesium, and fiber into your diet, she says. Bananas are a great source of all three, per the U.S. Department of Agriculture — Vongpatanasin just says to keep in mind how much sugar fruit has if you also have diabetes, and maybe opt for another food instead.
4. Get 30 Minutes of Exercise 5 Days a Week
According to Mayo Clinic, regular exercise strengthens the heart, which allows it to pump blood with less effort, which lowers blood pressure.
Getting your heart rate up regularly can also help with weight loss — having obesity is another common factor in hypertension.
“If you are not overweight to begin with, it’s unrealistic to think that losing a couple pounds is going to help you manage your hypertension,” says Vongpatanasin. “But for people who are obese, this can really help.”
Vongpatanasin says to aim for about 150 minutes of moderate to intense exercise per week that gets your heart rate up 50 to 60 percent higher than your resting heart rate. People can divide this in a way that works for them, but 150 minutes equals about 30 minutes per day, five days per week.
For people who are taking multiple blood pressure drugs, adding in a regular exercise routine may be able to help cut down on the number of medications a person needs, Vongpatanasin says.
The key is consistency, Bhalla says. “It’s better to walk every day for 30 minutes and work up a sweat than it is to do something once or twice and not come back to it because you didn’t have the time,” he says.
Bhalla also emphasizes diet as the most important factor in hypertension, and that getting regular exercise can amplify the benefits of eating a healthy, low-sodium diet.
5. Build on Your Good Habits
Bhalla says people can’t expect to overhaul their lifestyle and be able to stick to healthy habits long term.
“Any diet and lifestyle change is super easy for a provider to say, but it’s super hard to implement,” Bhalla adds. “Diet and exercise and lifestyle changes are way harder for a patient to implement than medication.”
Instead, “I go very slowly and try to get patients to focus on just one thing,” he says. “Maybe that’s don’t eat outside the home on Monday if you eat out seven days a week. Try for the next month to only eat fresh ingredients at home on Monday. If you can do that for a month, try to also do Tuesday and build on that.”
The same goes for exercise. If a person doesn’t exercise at all, they may need to work up to at least 150 minutes per week. Studies, including one published in the International Journal of Environmental Research and Public Health, have found that bundling exercise with being in nature or practicing mindfulness can have an added stress-lowering effect.
The Japanese practice of shinrin-yoku, or forest bathing, has been widely studied as a way of reducing depression, anxiety, and stress and increasing mindfulness. Practices like yoga also combine exercise with mindfulness, which can both relieve stress that can worsen hypertension.
The most important thing is to build healthy habits over time in a way that makes them stick as a permanent part of your lifestyle.
“It’s for a lifetime, so there’s no hurry for most people,” Bhalla says. “In my clinical experience, patients are much more open to going slow than they are to overhauling anything.”