Guide to managing hypertension

It is estimated about a third of adults in Australia and 1 in 5 adults in New Zealand, have high blood pressure. But if you recently learnt you’re in this group, you might be feeling a bit stunned. High blood pressure usually comes with zero symptoms, yet it’s considered a major warning sign of future health problems.

“High blood pressure is associated with an increased risk of stroke, heart attack, and heart failure,” says Donna K. Arnett, PhD, past president of the American Heart Association (AHA). The good news is there’s a lot people can do to lower their blood pressure—and those measures may prove helpful more quickly than many expect.

“There are many effective treatments that can manage or even help reverse the condition,” Dr. Arnett says. “Lifestyle interventions, such as diet, can result in reduced blood pressure in as little as three months.”

Read on as Dr. Arnett and other experts share their best advice for managing hypertension—the medical term for high blood pressure—and supporting your overall health.

What is high blood pressure?

Before we dive into advice on managing hypertension, let’s go over some basic info. Blood pressure is a measurement of how much force blood exerts on arteries. It’s expressed in millimetres of mercury (“mm HG”)—an old-time reference to the mercury used in blood-pressure gauges back in the day.

Blood pressure takes into account two types of force:

• Systolic: This is the top number in a blood-pressure reading, and it represents how much force blood exerts against artery walls when the heart beats.

• Diastolic: This is the bottom number in a blood-pressure reading, and it indicates the amount of force blood exerts against artery walls between beats.

Your blood pressure will fall into one of four categories:

One note about blood-pressure readings: Up to 30 per cent of people experience stress at medical appointments that causes their blood pressure to temporarily rise—a phenomenon known as white-coat hypertension. To help ensure this doesn’t influence your diagnosis, your healthcare provider ideally would wait a few minutes at the start of the appointment before measuring your blood pressure, Dr. Arnett says. And if your blood pressure is elevated, she adds, have a second measurement taken later in the appointment (when you’re hopefully a bit more relaxed.)

Lifestyle changes to reduce high blood pressure

While medication is often used to treat hypertension, it’s not always part of the initial treatment plan. “Lifestyle interventions are generally the first thing health care providers try to lower blood pressure,” Dr. Arnett says. “It’s possible that these changes can lower or even reverse hypertension.” Research shows that doing things like exercising more and eating a nutrient-rich diet (more on all of that in a bit) can help some people lower their blood pressure as much as a medication would. Ready to get started? Here are six lifestyle changes to consider:

1. Cutting back on sodium

While everyone’s body processes sodium differently, too much of the mineral can increase blood pressure. “When you eat too much sodium, your body holds onto water; that extra water increases your blood volume, which makes your heart work harder to push liquid through your blood vessels,” says Roxana Ehsani, a registered dietitian nutritionist and spokesperson for the American Academy of Nutrition and Dietetics. “Over time, this raises blood pressure.” That’s why the Australian and New Zealand governments recommend adults limit their sodium intake to 2,000 mg a day (the amount in 1 tsp of table salt).

Given that roughly 80 per cent of sodium in a typical diet comes from processed foods, simply prepping more of your own meals and snacks could help reduce salt intake. “Cooking lets you control the sodium,” Ehsani says. “Try replacing just one pre-made meal a week with one home-cooked meal.” And look for recipes that leverage add-ins like herbs and spices—instead of salt—to please your palate. For marinades and dressings, “use flavoured vinegars and citrus juices to add flavour,” Ehsani suggests.

2. Managing weight

Researchers are still working to fully understand how weight relates to blood pressure, Dr. Arnett says. So far, studies have shown that even modest weight loss is associated with healthier blood-pressure status. In one long-term study of volunteers with overweight, those who lost between 1.9 to 3.9 kilograms saw improvements in systolic blood pressure.

Many health experts suspect the link ties into hormones and body fat, Dr. Arnett says. For instance, higher amounts of body fat are associated with elevated levels of the hormone leptin, which in addition to affecting appetite may constrict blood vessels and raise blood pressure, Dr. Arnett says. Another hormonal effect—seen with elevated amounts of belly fat—may raise blood pressure by influencing how the body handles salt and water, she says.

And just a note on the science of healthy weight loss: Losing weight at a gradual, steady rate of up to 1 kilogram a week—with help from a variety of nutritious whole foods and regular physical activity—has been proven safer, more effective, and way more doable than restrictive fad diets and other “quick fixes.”

3. Eating more plants

Don’t be surprised if your healthcare provider recommends following what’s known as the DASH eating plan, short for Dietary Approaches to Stop Hypertension. Similar to the WeightWatchers approach, the DASH diet emphasises eating plenty of fruits and vegetables, as well as wholegrains. Research shows it can significantly lower blood pressure, likely in a few different ways.

“The dietary fibre found in these foods helps reduce blood pressure,” Ehsani says. Fibre helps decrease cholesterol levels in the blood, which may reduce the buildup in arteries that can contribute to high blood pressure. In addition, “many fruits and veggies—such as bananas, avocados, and leafy greens—are rich in potassium, a mineral that helps the body excrete excess sodium,” Ehsani continues. “Potassium also eases tension in the blood vessel walls, which helps lower blood pressure.” Consider these yet more reasons to bump up the plants in your diet.

4. Moving more often

You might wonder whether workouts are even advisable for people with high blood-pressure—could increasing your heart rate be dangerous? Rest assured, regular physical activity is considered safe and beneficial for most people, even those living with hypertension, Dr. Arnett says.

“Exercise helps relax blood vessels so blood flows more easily,” Dr. Arnett says. “It also makes muscles better equipped to use glucose,” she explains—a potentially helpful counter effect for the insulin resistance often seen with high blood pressure.

A review of more than 70 studies published in Preventive Cardiology found that aerobic exercise (like walking, cycling, and swimming) significantly lowers blood pressure in people with hypertension. On average, study participants exercised for 40 minutes three days a week.

Echoing the latest government guidelines which recommends adults working their way up to 150 minutes of moderate-intensity physical activity (such as brisk walking) or 85 minutes of vigorous activity (like jogging) a week, along with muscle-strengthening exercise twice a week. If you’ve been diagnosed with high blood pressure, ask your healthcare provider for personalised exercise advice.

5. Allowing space to relax

There’s a reason many of us feel physically on edge in tense moments: “When you’re under stress, you get a surge of sympathetic nervous system hormones”—such as adrenaline and cortisol—“which constricts blood vessels, increasing your heart rate and blood pressure,” Dr. Arnett explains. Over time, she continues, the effects of chronic stress may damage blood vessels, impacting blood pressure even in non-stressful situations.

To be clear: Managing stress doesn’t mean pretending life is perfect; it’s about coping with challenging circumstances in a healthy way. Figuring out what works for you might take some exploration. Some people benefit from journaling; others find stress relief in listening to music, spending time outside, taking a break from screens or meeting up with friends for a weekly catch up. Increasing your activity level may also help—in addition to reducing blood pressure, exercise is linked to reduced stress. A good stress reliever is one that helps you feel less overwhelmed—and better equipped to face life’s challenges.

6. Limiting alcohol

In general, sipping a glass of wine with dinner isn’t likely to send your blood pressure soaring. That said, there is a link between hypertension and higher alcohol intake—as in, three or more drinks per day. “Like stress, [high alcohol consumption] increases activity in the sympathetic nervous system, which can increase blood pressure,” Dr. Arnett says. Guidelines recommend limiting alcoholic drinks to one per day for women and two per day for men.

Many people find simple measures effective in cutting back on drinking. Mapping out when and how much to drink ahead of time is one approach. “Instead of having a glass of wine or a beer every evening, plan which days you’ll have one,” Ehsani says. Another quick idea: Dial down the strength of mixed drinks. “Instead of using 60ml of liquor, try 30ml and add more soda water and citrus,” Ehsani suggests. If you are struggling in your efforts to reduce drinking, professional support might be helpful.

Another good idea: Quitting smoking

Cigarette smoking falls into an in-between category because the habit itself is not a proven cause of hypertension. Still, puffing on a cigarette can temporarily raise blood pressure and injure blood vessel walls. Smoking is also risky when combined with hypertension because both are dominant risk factors for cardiovascular disease and stroke, Dr. Arnett says. Research shows that smokers with hypertension have a significantly higher risk of experiencing stroke than nonsmokers living with hypertension.

Try not to be discouraged if you’ve tried to quit smoking in the past and weren’t successful. Reflecting on what worked—and what didn’t—can help guide you in coming up with more effective strategies going forward. Options include nicotine-replacement therapy and behavioural counselling. Chat with your healthcare provider about a plan.

Medication for treating high blood pressure

Healthcare providers will generally consider prescribing antihypertensive drugs if a person has repeated blood pressure readings of higher than 140/90 mm Hg, or if lifestyle modifications don’t seem to be lowering blood pressure, Dr. Arnett says. Here’s some of the most commonly prescribed hypertension medications:

• Diuretics: Sometimes referred to as “water tablets,” these medications help remove excess sodium and water from the blood through urination. This lowers blood volume, reducing the pressure exerted on artery walls. Diuretics are often used in combination with other medications.
• Angiotensin-converting enzyme (ACE) inhibitors: ACE inhibitors reduce the body’s production of angiotensin, a chemical that causes arteries to constrict. In doing so, blood vessels relax, which reduces blood pressure.
• Angiotensin II receptor blockers (ARBs): ARBs are sometimes prescribed if a person has an adverse reaction to an ACE inhibitor. These drugs help block the effects of angiotensin, so like ACE inhibitors they prevent the arteries from constricting. By keeping the blood vessels more open, blood pressure lowers.
• Calcium channel blockers (CCBs): When calcium enters the muscle cells of the heart and arteries, it triggers a stronger heart contraction. CCBs help prevent calcium from going into these cells, keeping blood pressure lower.
• Beta-blockers: These medications reduce the heart rate, the heart’s workload, and the heart’s output of blood; together, these factors lower blood pressure.

Monitoring high blood pressure

Your treatment plan for hypertension may consist only of lifestyle modifications, or a combo of DIY adjustments and medication. Either way, your healthcare provider will likely suggest that you periodically check your blood pressure on your own. Monitoring blood pressure is key to gauging how hypertension treatments are working, Dr. Arnett says. You can often find a blood-pressure monitor at your local pharmacy, but for convenience you may want to purchase one for your home. It is a good idea to keep a log of blood-pressure readings to share with your healthcare provider at your follow-up visits.

This content is for informational purposes only and does not constitute medical advice, diagnosis or treatment. It should not be regarded as a substitute for guidance from your healthcare provider.