What can I do to lower my blood pressure without medicine?

The 2017 American College of Cardiology (ACC) and American Heart Association (AHA) hypertension guidelines state that doctors should promote nonpharmacological therapy to everyone with elevated blood pressure or diagnosed hypertension.¹ Nonpharmacological therapy includes healthy diet,^1-4 weight loss,^1,5 sodium reduction,^1,6-8 exercise,^1,9-20 enhanced intake of dietary potassium,^1,21-25 smoking cessation,^1,26-28 and moderating alcohol consumption.^1,29-34  Doctors should reassess blood pressure in three to six months for people just adopting healthy habits. People adopting healthy habits and started on antihypertensive medication should be assessed in one month.

Evidence shows that lowering blood pressure decreases the risk of adverse cardiovascular outcomes such as heart disease, stroke, and death.^35-38 It may also slow the progression of kidney damage in people with chronic kidney disease.³⁹ Further, meta-analyses as well as national and international guidelines suggest that lowering blood pressure decreases risk of these outcomes regardless of which hypertensive-lowering method is used. ^35-38

A summary of blood pressure reduction for each nonpharmacological modality is given below. The details of systematic reviews, meta-analyses, clinical guidelines, and studies cited to support the recommendation for each therapy are explained in depth in the specific PALS article dedicated to that lifestyle recommendation.

Healthy Diet

The 2017 ACC/AHA guidelines recommend a heart-healthy diet as it will help people with elevated or high blood pressure (>120/80 mm Hg) meet their weight goals. [Strong Recommendation (Level A)].¹ Adopting a healthy diet can result in a significant blood pressure reduction.^1-3 In normotensive patients, systolic blood pressure is reduced by about 3 mm Hg and in hypertensives by about 11 mm Hg.

Weight Loss

In the 2017 ACC/AHA guidelines, weight loss is specifically recommended for adults with elevated or high blood pressure who are overweight or obese [Strong Recommendation (Level A)].¹ The best goal is an individual’s ideal body weight which is a body mass index (BMI) between 18.5 and 25. But recognizing this is unrealistic for many overweight and obese people, they recommend most overweight adults should aim to lower body weight by at least 1 kg (2.2 lbs). People can expect about 1 mm Hg reduction for every 1 kg (2.2 lbs) of weight loss.

Sodium Reduction

Adults should ultimately aim for less than 1500 mg/day of sodium in their diet but at a minimum should reduce their intake by at least 1000 mg/day.¹ Reducing dietary sodium can result in about a 5 mm Hg reduction in systolic blood pressure.^1,6-8

Potassium Increase

Increasing dietary potassium to between 3500 to 5000 mg/day can lower systolic blood pressure by about 4 – 5 mm Hg.^1,21

Alcohol in Moderation

According to the 2017 ACC/AHA Hypertension Guidelines alcohol is a substance that has the potential to impair blood pressure control.¹ They recommend limiting alcohol to ≤1 drink daily for women and ≤2 drinks for men. In the United States, 1 “standard” drink contains roughly 14 g of pure alcohol, which is typically found in 12 oz of regular beer (usually about 5% alcohol), 5 oz of wine (usually about 12% alcohol), and 1.5 oz of distilled spirits (usually about 40% alcohol).^1,29,30 Evidence reviewed by the panel shows that for heavy drinkers, reducing alcohol intake to this amount may result in a reduction of blood pressure by 4 mm Hg systolic and 3mm Hg diastolic or more, regardless of other interventions.^1,31-34

Exercise

Increased physical activity that includes a structured program of exercise is recommended for adults with elevated blood pressure or hypertension.¹ Studies show that aerobic exercise for 90 – 150 minutes a week can result in a blood pressure reduction of 5/8 mm Hg in hypertensive people.^17,18 All studies included were a minimum of four weeks duration. Dynamic resistance exercise for 90 – 150 minutes a week can result in a systolic blood pressure reduction of 4 mm Hg.¹⁷ Isometric resistance exercise can result in a 5 mm Hg systolic blood pressure reduction in about eight to ten weeks.^19,20

Smoking Cessation

Cigarette smoking is known to increase the risk of heart attacks and stroke.^40,41 It raises blood pressure acutely, an effect that lasts 15 minutes or more.²⁶ It damages the endothelial lining of the blood vessels over time causing vascular stiffening, inflammation, and the development of atherosclerotic plaque which leads to cardiovascular events.^41,42 It is not clear if smoking increases the risk of hypertension. Some studies have shown a positive association between smoking and hypertension^5,6 while others have failed to show an association.^43,44

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