How can I control my blood pressure?

How to Control Your Blood Pressure

Lifestyle modification is the cornerstone of blood pressure control and should be implemented immediately alongside medication when needed, as each intervention provides additive blood pressure reductions of 5–20 mmHg. 1

Lifestyle Changes That Lower Blood Pressure

Dietary Modifications

• Reduce sodium intake to less than 2 grams per day (approximately 5 grams of salt), which lowers systolic blood pressure by 5–10 mmHg and enhances the effectiveness of all blood pressure medications. 1

• Follow the DASH dietary pattern (high in fruits, vegetables, whole grains, and low-fat dairy products; low in saturated fat and cholesterol), which reduces blood pressure by approximately 11.4/5.5 mmHg (systolic/diastolic). 1, 2

• Eat 4–6 servings (400 grams) of fruits and vegetables daily to increase potassium intake, which has well-documented blood pressure-lowering effects. 1

Weight Management

• Achieve and maintain a healthy body weight (BMI 20–25 kg/m²), as losing approximately 10 kg reduces blood pressure by about 6.0/4.6 mmHg (systolic/diastolic). 1, 3

Physical Activity

• Engage in regular aerobic exercise for at least 30 minutes most days of the week (approximately 150 minutes per week of moderate-intensity activity), which lowers blood pressure by approximately 4/3 mmHg (systolic/diastolic). 1, 3

Alcohol Limitation

• Limit alcohol consumption to no more than 2 drinks per day for men and 1 drink per day for women (maximum 14 drinks per week for men, 9 per week for women), as excessive alcohol intake significantly interferes with blood pressure control. 1, 3

Smoking Cessation

• Stop smoking completely, as tobacco use has a particularly adverse effect on cardiovascular risk and can directly raise daytime blood pressure, especially in heavy smokers. 1

When Medication Is Needed

Indications for Drug Therapy

• Start medication immediately if your blood pressure is ≥160/100 mmHg (stage 2 hypertension), regardless of other risk factors. 1

• Start medication if your blood pressure is 140–159/90–99 mmHg (stage 1 hypertension) and you have any of the following: target organ damage, cardiovascular disease, diabetes, chronic kidney disease, or 10-year cardiovascular risk >15%. 1

• For blood pressure 140–159/90–99 mmHg without the above risk factors, try lifestyle modifications for 3–6 months first; if blood pressure remains elevated, add medication. 1

First-Line Medications

• Thiazide or thiazide-like diuretics (such as chlorthalidone or hydrochlorothiazide), beta-blockers, calcium channel blockers (such as amlodipine), ACE inhibitors, or angiotensin receptor blockers (ARBs) are all appropriate first-line options, as they significantly reduce cardiovascular morbidity and mortality. 1

• Most patients require 2 or more medications from different drug classes to achieve blood pressure control, as combination therapy is more effective than increasing the dose of a single medication. 1, 4, 5

Blood Pressure Targets

• Aim for blood pressure <140/90 mmHg at minimum, with an optimal target of <130/80 mmHg for most adults. 1

• For higher-risk patients (those with diabetes, chronic kidney disease, or established cardiovascular disease), target <130/80 mmHg. 1

Monitoring Your Progress

Home Blood Pressure Monitoring

• Use home blood pressure self-monitoring and telemonitoring, as these are effective tools for facilitating medication adjustments and achieving blood pressure goals. 1

• Home blood pressure ≥135/85 mmHg confirms true hypertension and indicates the need for treatment intensification. 1

Team-Based Care

• Work with a healthcare team that may include nurses, pharmacists, dietitians, and other professionals, as multilevel, multicomponent strategies including team-based care are the most effective methods for blood pressure control. 1

Common Pitfalls to Avoid

• Do not delay treatment intensification when blood pressure remains above goal, as prompt action within 2–4 weeks is required to reduce cardiovascular risk. 1

• Do not assume your blood pressure is controlled based on occasional readings; confirm with multiple measurements over time or home monitoring. 1

• Do not stop lifestyle modifications once you start medication, as lifestyle changes improve the effectiveness of drug therapy and may reduce the number or dose of medications needed. 1, 2

• Combining 2 or more lifestyle interventions produces additive effects, so implementing multiple changes simultaneously (such as sodium restriction plus weight loss plus exercise) provides greater blood pressure reduction than any single intervention alone. 1