How to Lower High Blood Pressure: Lifestyle Changes, Diet and Medicines

High blood pressure (hypertension) is often called a "silent killer" because it rarely causes symptoms until it has damaged the heart, brain, kidneys or eyes. It is a leading risk factor for stroke, heart attack, heart failure and kidney disease. The encouraging news is that blood pressure is one of the most treatable risk factors. Lifestyle changes alone can lower it by several points, and the right medicines lower the risk of stroke and heart attack substantially.

What counts as high blood pressure?

Blood pressure is written as two numbers, systolic over diastolic, in mmHg. As a general guide:

• Normal: below 120/80
• Elevated: 120-129 and below 80
• High (hypertension): 140/90 or above on repeated measurements; some guidelines use 130/80 for people at higher risk
• Crisis: 180/120 or above, especially with symptoms, needs urgent care

One high reading does not mean hypertension. Pressure rises with stress, pain, caffeine and rushing. Doctors diagnose it using several readings, often combined with home or 24-hour monitoring.

How to measure blood pressure correctly

Poor technique is a common reason for wrong readings.

1. Avoid caffeine, smoking and exercise for 30 minutes before.
2. Sit quietly for five minutes with your back supported, feet flat and arm resting at heart level.
3. Use an upper-arm cuff of the right size.
4. Take two readings, one minute apart, in the morning and evening for a week, and record the average to show your doctor.

Lifestyle changes that lower blood pressure

Reduce salt. Cutting salt can lower systolic pressure by roughly 5 mmHg or more. In Sri Lanka, much salt comes from curries, dried fish (karawala), salted fish, pickles, soy sauce, instant noodles, bakery items and processed meats. Taste food before adding salt, use lime, pepper, garlic, curry leaves and spices for flavour, and avoid putting extra salt on rice.

Lose excess weight. Each kilogram lost can reduce pressure by about 1 mmHg. Use our BMI calculator and waist measurement to guide your target.

Be active. Aim for at least 150 minutes a week of brisk walking, cycling or swimming. Regular exercise can lower systolic pressure by 4-9 mmHg.

Eat more potassium and fibre. Vegetables, fruit, pulses and whole grains help. The DASH eating pattern, which is rich in fruit, vegetables, low-fat dairy and whole grains and low in salt, can lower pressure significantly. People with kidney disease or those taking certain medicines should check with a doctor before increasing potassium.

Limit alcohol. Heavy drinking raises blood pressure. If you drink, keep it low or avoid it.

Stop smoking. Smoking does not directly cause long-term high readings, but it sharply raises heart and stroke risk and narrows arteries.

Manage stress and sleep. Aim for 7-8 hours of sleep. Loud snoring with daytime sleepiness may be sleep apnoea, which is an important and treatable cause of high pressure.

When medicines are needed

Many people need tablets alongside lifestyle change, especially if blood pressure is 160/100 or higher, or if they have diabetes, kidney disease or heart disease. Common medicine groups include ACE inhibitors, ARBs, calcium-channel blockers, diuretics and beta-blockers. Many people need two or more medicines.

Key points about treatment:

• Take tablets every day, at the same time, even when you feel well.
• Do not stop suddenly. Some medicines can cause rebound rises in pressure.
• Report side effects such as a persistent dry cough (ACE inhibitors), ankle swelling or dizziness. There are alternatives.
• Pregnant women and those planning pregnancy need specially chosen medicines.
• Avoid regular painkillers such as ibuprofen or diclofenac, and decongestants, unless advised. They can raise pressure.

Possible secondary causes

In younger people or those with very high or resistant hypertension, doctors look for causes such as kidney disease, hormone problems (for example primary aldosteronism or thyroid disease), sleep apnoea and medicines. Treating the cause can improve or resolve the problem.

Emergency warning signs

Get urgent medical help for very high readings with severe headache, chest pain, shortness of breath, confusion, vision changes, weakness or numbness on one side, or difficulty speaking. These can signal stroke, heart attack or hypertensive emergency.

A simple daily plan

• Walk briskly for 30 minutes on most days.
• Fill half your plate with vegetables, and keep dried fish and pickles occasional.
• Check your home pressure and record it.
• Take medicines at a fixed time and keep them where you will see them.
• Attend follow-up for blood tests, since some medicines affect kidney function and potassium.

When to see a doctor

See a doctor if your readings are repeatedly 140/90 or higher, if you have a family history of heart disease or diabetes, or if you are on medicines and have side effects. Everyone over about 30-40 should have their pressure checked at least yearly.

References

• World Health Organization: hypertension fact sheet and guideline on pharmacological treatment
• International Society of Hypertension: global practice guidelines
• NICE guideline NG136: hypertension in adults
• DASH trial, New England Journal of Medicine