High blood pressure, or hypertension, often goes unnoticed because it typically doesn’t cause immediate symptoms. Yet, it quietly affects nearly half of all adults in the U.S., and that number is expected to rise to at least 60 percent by 2050.
Age and excess weight are risk factors for high blood pressure. As the U.S. population gets older and heavier, more people are facing hypertension and its complications, says UNC Health nephrologist and certified hypertension specialist Raven Voora, MD.
“Hypertension is called the silent killer because there are no symptoms,” Dr. Voora says. “It puts you at increased risk for heart disease, stroke, kidney disease and cognitive impairment.”
Fortunately, you can take action to reduce your blood pressure and risk of these related health conditions. Start here.
Monitor Your Blood Pressure at Home
Blood pressure is a measure of the force at which blood goes through your arteries, represented by two numbers. Systolic pressure, the top number, is the force when the heart contracts, or beats, and diastolic pressure, the bottom number, is the pressure when the heart relaxes, between the beats. A systolic pressure above 130 and a diastolic pressure above 80 meets the definition for hypertension, but you won’t typically know that your blood pressure is high without measuring it.
The blood pressure reading taken at your doctor’s office is a snapshot of a particular moment, but to get the complete picture of your blood pressure over time, you should monitor it at home. Having more data can help your provider determine the best treatment for you.
The number of monitors available in stores and online can be overwhelming, so Dr. Voora recommends asking your provider or pharmacist which one they recommend, or choosing one listed on the website validatebp.org, as these have been validated for accuracy.
Once you’ve selected your device, your provider can show you how to use it correctly and explain when and how to share readings.
“I recommend two blood pressure measurements in the morning, before you’ve taken any medications, and two measurements in the evening, before dinner, three times a week,” Dr. Voora says. “The week before you see your provider, take measurements every day.”
How you take the measurement is important: Abstain from exercise, caffeine and smoking in the 30 minutes before taking a reading. Sit with your feet flat on the floor, your back supported and your arm supported at heart level for at least five minutes before taking your first reading, and then sit for another minute before taking your second reading. Changes in this position, such as having your feet dangling or reclining your body, will affect the measurement.
Some devices will create a log of your readings, but if not, make sure you record the date and time of each reading so that your provider can review. Unless your provider advises otherwise, try not to become fixated on one day’s numbers, because it’s normal for blood pressure to fluctuate from day to day and even throughout the day. Ask your provider what numbers signal an emergency.
As you take other steps to address your blood pressure, it can be empowering and reassuring to see your numbers reach a normal range.
Make Lifestyle Modifications
You can lower your blood pressure—and decrease your risk for future hypertension—by building a healthy lifestyle.
Dr. Voora recommends the DASH (Dietary Approaches to Stop Hypertension) eating plan, which has been proven to reduce blood pressure. DASH emphasizes fruits and vegetables, whole grains, poultry, fish, seeds and nuts while reducing sodium, red meat and saturated and trans fats.
A diet overhaul is daunting, so start with small changes, such as reducing sodium intake by avoiding processed foods and going out to eat a bit less, Dr. Voora says. Homecooked meals tend to be healthier than restaurant food.
Aim for 150 minutes of moderate intensity exercise every week. If you have found it difficult to lose weight with diet and exercise, talk to your doctor about whether weight loss medications are a good option for you.
You should also stop smoking, find ways to manage stress and prioritize quality sleep. The American Heart Association recommends seven to nine hours of continuous sleep every night to reduce the risk of hypertension and cardiovascular disease.
Dr. Voora acknowledges that making these changes can be difficult.
“These are easy for me to talk about, but they can be hard to do,” she says. “Changes don’t occur overnight, so don’t expect that you can stop and change everything. Start slow, and pick one step to making a change that will work best for you.”
There is support available for making these changes. Your health care provider can connect you with dietitians, lifestyle educators, weight loss or specialty hypertension clinics, support groups or classes, so that you can get a personalized plan or resources for cooking healthier meals and exercise options.
You might change your eating habits or exercise more often only to see your blood pressure measurements remain high week after week. Try to be patient, Dr. Voora says.
“If you don’t see changes, continue on. You’re still improving your health in other ways that you may not be able to measure or appreciate,” she says.
Talk to Your Doctor About Medications
Medication can effectively lower blood pressure. Your provider will make a recommendation for medication that’s individualized for your needs, taking your age, health history and other conditions into account.
There are three commonly used classes of medications:
- Diuretics, which help the body get rid of excess salt and water.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), which widen the blood vessels by affecting the hormone angiotensin, which narrows them.
- Calcium channel blockers, which lower the amount of calcium in the heart and blood, allowing the blood to flow more easily.
You may need more than one medication to control your blood pressure.
These medications do have side effects; diuretics can affect kidney function and cause increased urination, so people need to be attentive to symptoms of dehydration, such as dizziness. ACE inhibitors can cause a dry cough and rarely swelling of the face and throat. Calcium channel blockers can cause fluid retention, leading to swelling in the ankles.
“Most of the side effects aren’t permanent, and they can get better by reducing the dose or changing to another medication,” Dr. Voora says. “If you’re having side effects, discuss them with your provider before stopping the medication on your own.”
It’s important to take your medications every day at the dosage prescribed by your doctor, but know that you may not have to be on them forever.
“If lifestyle modifications are successful, you can usually reduce the dosages or stop the medications, in consultation with your health care provider,” Dr. Voora says. “That can be a motivation for patients to work on lifestyle changes.”
About 8 to 15 percent of adults in the U.S. may have resistant hypertension, which means that their blood pressure stays high despite being on three medications at a reasonable dose, Dr. Voora says. Some of these people may have another condition that affects their blood pressure, such as chronic kidney disease or a hormonal disorder. In 2023, the FDA approved a minimally invasive procedure called renal denervation, which reduces activity in nerves in the kidneys that can affect blood pressure, for people with resistant hypertension.
Dr. Voora says that there may be other new treatments for hypertension available in the coming years.
“There are novel medications being actively studied,” she says. “The potential to have these therapies in the coming years to treat hypertension is exciting.”
If you have questions about your blood pressure, talk to your doctor. If you need a doctor, find one near you.