High blood pressure is a silent but serious medical condition that affects an estimated 1.28 billion adults aged 30-79 worldwide, with two-thirds living in low-and middle-income countries (WHO, 2021). Without adequate management, it can cause significant and irreversible damage.

This article describes practical ways to lower your blood pressure.

What is blood pressure?

Blood pressure, measured in millimetres of mercury (mmHg), is the force of blood pushing against the walls of the arteries (Shahoud, 2022). It is written as two numbers – a systolic or top number over a diastolic or bottom number. The top number illustrates the pressure of blood being pumped out of the heart into the arteries, and the bottom number demonstrates the pressure created as the heart rests between heartbeats. Ideally, we should all have a blood pressure reading between less than 120/80 mmHg (Whelton et al., 2022).

Symptoms and diagnosis of high blood pressure

High blood pressure, also known as hypertension, is when the force of blood pushing against the walls of the arteries is consistently too high, making the heart work harder to pump blood (Shahoud, 2022). It is dangerous because it makes the heart work too hard and contributes to atherosclerosis or the hardening of the arteries.

Almost half of American adults, about a third of adults in the UK and two-thirds in Nigeria have it, but many are unaware because it has no symptoms. When symptoms occur, they can include early morning headaches, nosebleeds, irregular heartbeats, and vision changes. High blood pressure can cause fatigue, nausea, vomiting, chest pain, anxiety and muscle tremors (WHO, 2021).

In the United States, doctors will diagnose high blood pressure if your readings are consistently 130/80 mmHg or higher over several weeks (Whelton et al., 2022). The threshold in the UK and Nigeria is 140/90 mmHg (Jones et al., 2020; Kadiri et al., 2020). You will also be diagnosed with high blood pressure if just one of the numbers is higher than normal, i.e., if the top number is over 139 mmHg or the bottom is over 89 mmHg.

Blood Pressure Category	Systolic mmHg (Top number)		Diastolic mmHg (Bottom number)
Normal	Less than 120	and	Less than 80
Elevated	120-129	and	Less than 80
Stage 1 high blood pressure	130-139	or	80-89
Stage 2 high blood pressure	140 or higher	or	90 or higher
Stage 3 hypertensive crisis	Higher than 180	and/or	Higher than 120

Aim to keep your blood pressure below 140/80 mmHg if you have diabetes or below 130/80 if you have diabetes with kidney or eye disease (de Boer et al., 2017).

What are the consequences of uncontrolled high blood pressure

Uncontrolled high blood pressure can harden the arteries, reducing blood flow and oxygen to the heart, which can cause angina, heart attacks, heart failure, stroke, blindness and kidney disease (Shahoud et al., 2022).

Check your blood pressure at least every two to five years if your blood pressure is normal and you have no high blood pressure risk factors. However, if you have diabetes, or are at least 40 years old or younger with risk factors for high blood pressure, check it annually (de Boer et al., 2017). You may need to check your blood pressure more frequently with a home monitor if you’ve been diagnosed with high blood pressure.

What factors increase high blood pressure risk?

High blood pressure can occur sporadically (essential hypertension) or secondary to underlying conditions such as obstructive sleep apnoea, kidney failure, thyroid disease and use of certain medications (Charles, Triscott & Dobbs, 2017).

Several factors increase the risk of high blood pressure and include (NICE, 2022):

• Age – blood pressure tends to rise with increasing age.
• Anxiety and emotional stress – may raise blood pressure due to increased adrenaline and cortisol levels
• Co-existing diabetes or kidney disease
• Sex – females tend to have lower blood pressure than men up to age 65. However, women seem to have a higher blood pressure than men between ages 65 and 74.
• Genetic factors – a family history of hypertension increases the risk
• Ethnicity – people of African descent have higher rates of high blood pressure than other races
• Lifestyle – smoking, physical inactivity, and an unhealthy diet with excessive intakes of alcohol, salt and saturated fat increase the risk
• Social deprivation – people from the most deprived areas are more likely than those from the least deprived areas to have high blood pressure

Ways to lower your blood pressure

Lifestyle changes are the cornerstone to lowering your blood pressure. You may need medication if your blood pressure is very high, and you have other risk factors or co-existing conditions.

1 | Eat a healthy diet

A healthy diet is rich in whole foods such as fruits, vegetables, unprocessed meats and poultry, fish, legumes, wholegrains, nuts and seeds. The DASH diet is a healthy diet clinically proven to lower blood pressure.

2 | Maintain a healthy weight

Your blood pressure rises as your body weight increases. Losing just three to five per cent of your weight can improve your blood pressure if you’re overweight.

The body mass index (BMI) and waist circumference are key metrics used to determine whether a person is overweight or obese. Although BMI is a poor measure because it doesn’t account for muscle mass or fluid retention, it is a reasonable indicator of overweight or obesity if you don’t have water retention, aren’t a bodybuilder, or are an older person with extensive muscle loss. The WHO classifies overweight as a BMI of 25 and over in Caucasians and Blacks, and over 23 in Asians.

The waist circumference indicates how much fat you carry around your abdomen and by proxy, around your organs. Of note, excess abdominal fat increases the risk of high blood pressure, diabetes and high cholesterol.  A waist measurement of more than 35 inches (89 cm) in women and more than 40 inches (102 cm) in men is considered high.

Consider keeping your waist circumference below 94 cm if you’re a Caucasian, African, Eastern Mediterranean or Middle Eastern man and below 80cm if you’re a woman. Asian (South Asian, Chinese and Japanese) men should maintain a waist circumference below 90cm, and women should keep below 80cm (IDF, 2016).

3 | Exercise regularly

Being physically active is one of the best ways to prevent or control high blood pressure and reduce heart disease risk.

All you need is 30 minutes of moderate-intensity exercise five times a week. Exercise can include brisk walking, cycling, swimming, dancing, gyming, weight-lifting, jumping rope or playing sports.

4 | Eat less salt

Most people eat more salt and sodium than they need. People of African descent and the elderly are particularly sensitive to salt and must be careful of how much they consume. In these people, excess salt leads to fluid retention by the kidney and a corresponding increase in blood volume, resulting in increased blood pressure. Guidelines recommend eating less than 2300 mg of sodium or one teaspoon of salt daily.

Use herbs, spices and salt-free seasoning blends to add flavour instead of salt. Speak with a doctor or your registered nutritionist before trying (potassium-rich) salt substitutes, especially if you take certain medications or have kidney disease.

Lifestyle Change	What to do	Estimated drop in systolic blood pressure
Lose weight if you’re overweight	Maintain a healthy body weight (BMI 18.5-24.9; waist circumference <94 cm for men; <80 cm for women)	5 – 20 mmHg per 10 kg weight loss
Adopt a DASH eating plan	Eat a low-saturated fat diet rich in fruits, vegetables and low-fat dairy products	8 – 14 mmHg
Limit salt	Eat no more than 2.4 g of sodium or one teaspoon of table salt	2 – 8 mmHg
Exercise regularly	Engage in moderate-intensity exercise at least 30 per day, most days of the week	4 – 9 mmHg
Drink alcohol in moderation	Limit alcohol to one drink per day if you’re a woman and two drinks if you’re a man	2 – 4 mmHg
Quit smoking	Get support to quit smoking	–

5 | Drink alcohol moderately

As well as raising your blood pressure, excess alcohol can add extra calories to your diet leading to weight gain that also increases your blood pressure. If you choose to drink alcohol, have a moderate amount – no more than a drink daily for women and two for men.

6 | Use caffeine sparingly

Drinking coffee increases blood pressure temporarily. A review study found that people with high blood pressure who drank two to three cups of coffee daily increased their systolic blood pressure by 3-14 mmHg and diastolic blood pressure by 4-13 mmHg (Nurminen et al., 1999). Compared to older adults who never or rarely drank caffeine, daily coffee intake increased systolic blood pressure by a mean of 8.63 mmHg in healthy, older adults (Kujawska et al., 2021).

7 | Stop smoking

Smoking may not directly increase your blood pressure, but it significantly raises your risk of heart disease and stroke because it causes your arteries to narrow (Primatesta et al., 2001, Gallucci et al., 2020). Get help to quit smoking.

7 | Take your medication

You may need medication to control your blood pressure. If your doctor has prescribed medication, keep taking them while improving your lifestyle. Don’t stop taking your medication without consulting your doctor first.

8 | Manage stress

Stress can increase your blood pressure and encourage your body to store more fat. Relaxing activities, meditation, yoga or support from a therapist can help you manage stress.

The Takeaway

High blood pressure is a ‘silent’ killer because it doesn’t cause symptoms. If you have risk factors for high blood pressure, check your blood pressure frequently either at your doctor’s office or with a home monitor. Remember that lifestyle changes are fundamental to blood pressure management and you must always incorporate them even if your doctor has prescribed medication.

If you need help developing a personalised diet plan to manage your blood pressure, schedule a free consultation with me here.

REFERENCES

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