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Allow me to be direct: if you have lifestyle caused high blood pressure, you are not just gambling with your arteries and life, you are playing Russian roulette. 

Every single day that your blood pressure reading stays above 130/80 mmHg*, you are accelerating the wear-and-tear on your heart, brain, kidneys and eyes. (* mmHg = millimetres of mercury on a sphygmomanometer, the name of the blood pressure measuring device. The first of the two figures refers to systolic pressure, the pressure your heart exerts with each beat.  The second figure refers to the diastolic pressure, the pressure between heart beats.) 

The good news, and it is spectacularly good news, is that the majority of people can drop their blood pressure by 10, 15, even 20 mmHg in a mere 4–12 weeks, by taking simple actions involving liquid, food, movement, sleep and a few effective behavioural tweaks. That is without any extra prescriptions, and with no side-effects. Just action.

What follows is the straight-talking essence of what actually works, in the real world, drawn from the largest, longest and most rigorous trials ever conducted into blood pressure, BP, and how to return it to a healthy level.

First, it would be useful to understand the system for classifying hypertension (high BP). 

• Stage 1: 140/90 to 159/99 (clinic) or 135/85 to 149/94 (home)
• Stage 2: 160/100 to 179/119 (clinic) or 150/95 or higher (home)
• Stage 3 (Severe Hypertension): 180/120 or higher (clinic).

You might reasonably ask, what is the difference between home and clinic readings. The answer? The white coat effect. People are stressed when a medical professional measures their BP. When they are relaxed at home the measures are lower.

Blood pressure is measured when a person is not engaged in any form of activity. Ideally, when they have been relaxed for some time. When people are exercising or engaged in sport, at the peak of exercise systolic BP can reach over 200 mmHg, with diastolic BP only slightly raised.

What causes high blood pressure?

Broadly speaking, there are two risk factors, those that can be modified, and those that cannot.

Modifiable risk factors of high blood pressure

These factors are often related to lifestyle habits and can be managed to help prevent or lower high blood pressure.

• An unhealthy diet. Eating too much salt is especially harmful, it disrupts the natural sodium balance in the body, leading to fluid retention and therefore increased blood pressure. A diet low in potassium also affects this balance.
• Being overweight or obese. Excess body weight puts extra strain on the heart and the 60,000+ miles of the circulatory system, causing changes in blood vessels and kidneys, which in turn often increase blood pressure.
• Lack of physical activity. Inactivity, surprisingly, makes the heart work harder in the long-term. How? A sedentary lifestyle gradually weakens the heart muscle, slows blood flow, and causes plaque buildup and stiffening in the arteries. That forces the heart to pump against greater resistance in order to deliver oxygen and nutrients. That in turn increases the strain on the heart and the risk of high blood pressure, and can and does lead to heart disease. Inactivity can also cause weight gain, both of which increase the risk of high blood pressure.
• Excess alcohol consumption. Regular, heavy alcohol use can cause significant problems, including heart failure, stroke, and an increase in blood pressure. How does alcohol raise blood pressure? Alcohol stimulates the nervous system, it constricts blood vessels, and can disrupt the brain’s blood pressure regulation system, turning temporary peaks of bp into chronic, potentially lethal hypertension. Even moderate or low alcohol intake, (one drink daily), can progressively increase blood pressure.
• Smoking and vaping. Smoking or vaping immediately raises blood pressure for a short time and in so doing damages artery walls, every time, speeding up the process of hardening of the arteries (atherosclerosis).
• Chronic stress. High levels of persistent stress can lead to temporary blood pressure peaks. Chronic stress raises blood pressure by repeatedly triggering the body’s “fight-or-flight” response, which floods the body with adrenaline and cortisol. That infusion of “danger chemicals” constricts blood vessels, and speeds the heart rate. Unhealthy coping mechanisms for dealing with stress, such as a poor diet, smoking, or drinking alcohol can lead to sustained high blood pressure.
• Lack of quality sleep. Sleep deprivation or having disturbed sleep (one cause of which is sleep apnea) can and does affect how the body regulates blood pressure. How? Sleep apnoea Raises blood pressure as a result of the repeated dropping of oxygen levels which triggers stress responses, adrenaline surges, which in turn constrict blood vessels, activates the nervous system, and releases hormones, leading to chronic vessel stiffening and elevated blood pressure even during the day.  Lack of sleep and disrupted sleep also activate the sympathetic nervous system, increasing heart rate and blood pressure, while poor sleep can elevate stress hormones, all contributing to hypertension.
• Some medications and health conditions. Some medicines, such as decongestants, some pain killers, some anti-inflammatories, and hormonal birth control pills, and underlying medical conditions, such as chronic kidney disease, diabetes, or thyroid problems, can and do raise blood pressure. Physicians all over the world face a daily dilemma: how to treat one disease knowing that the treatment may or will cause another. Often physicians have to treat something now, with a treatment that they know will cause damage over time. Why? In many cases it is the only option.
• Pain, short-term and chronic. Pain can and does increase blood pressure. Chronic pain sits somewhere between a modifiable and non-modifiable cause of high blood pressure. how does pain increase blood pressure? Through the following routes: pain chronically stimulates the “fight-or-flight” response, which releases catecholamines throughout the body (adrenaline, nor adrenaline). They, in turn, raise heart rate and constrict blood vessels, thus raising blood pressure. Pain causes stress and elevated cortisol and other stress hormones over months/years, which increase blood pressure. Sleep disturbance and inflammation are common with chronic pain conditions. Each independently raises blood pressure. reduced physical activity, as a result of the pain leads to weight gain and worsening cardiovascular fitness, and thus higher blood pressure. Medication effects, such as ibuprofen, and naproxen frequently used for chronic pain can raise blood pressure, especially for people already at risk.

Non-modifiable risk factors of high blood pressure

There are factors that none of us can change. They are, none-the-less important to be aware of in managing our overall risk of high BP.

• Age: Our risk of high blood pressure increases as we get older because blood vessels naturally become stiffer and less elastic with time.
• Genes: High blood pressure often runs in families, suggesting a genetic predisposition to hypertension.
• Race/ethnicity: People of Black African or Black Caribbean descent are at a higher risk of developing high blood pressure, often at an earlier age, compared to other ethnic groups, especially when part of an ethnic minority.  When dark-skinned people are the majority in their country race does not seem to be a factor, indicating that the result of social injustice and racial prejudice is stress induced high blood pressure.
• Detecting high blood pressure: The standard advice is that regularly checking your blood pressure is the only way to know if it is high, because it often has no symptoms. Yet, some people can detect it; they can feel the pressure in their head. Others have ongoing headaches. Some report feeling their heart beating where previously they did not.

There are a large number of reported symptoms. None of them are accurate indicators on their own and, therefore regular testing is the best option.

What can you do?

The single most powerful dietary approach to high BP: DASH 

The Dietary Approaches to Stop Hypertension (DASH) are the benchmark standard. When researchers put people suffering from Stage 1 Hypertension** on the full DASH diet, the average blood pressure drop was 11.4/5.5 mmHg in just eight weeks. 

That result is better than many medications, without the side effects of the medications. Add the low-sodium version of DASH and even greater drops are witnessed: 15–20 mmHg. 

What is the best Version of DASH?

• 7–10 portions of vegetables and fruit daily (especially leafy greens, berries, beetroot and citrus)
• 2–3 portions of nuts, seeds or legumes
• Whole grains (oats, barley, quinoa, brown rice)
• Fatty fish twice a week (salmon, mackerel, sardines)
• Ensure you obtain the minerals known as the ‘non-negotiable trio,’ calcium-magnesium-potassium, by eating foods know to contain them, such as, leafy greens, pumpkin seeds, avocados, salmon, nuts. 
• Use olive oil as your primary added fat

The most up to date version of DASH is the Mediterranean-DASH hybrid (sometimes called the MIND diet). A recent meta-analysis study (collating the results of multiple studies) showed that an additional 4–6 mmHg drop was possible when people emphasise extra-virgin olive oil, more berries, and green leafy vegetables every day.

The salt demon

The average Brit consumes 8.4 g of salt a day; the scientific target is less than or equal to 5 g (World Health Organisation) or ideally less than 3g for best blood-pressure reduction results. Another review confirmed that cutting sodium by just 3 g/day lowers systolic blood pressure by 6–9 mmHg in people with high BP, and even more for those the 60% of people who are salt sensitive. 

Here are some of the best approaches you can act on immediately:

• Bin your salt shaker.
• Stop eating so many processed foods. 75 % of many people’s salt intake is hidden in processed food.
• Read food labels and eliminate anything that has more than 1.5 g salt (0.6 g sodium) per 100 g.
• Use potassium chloride salt substitutes. The research indicates that can give you an extra 4–7 mmHg drop in BP.
• If you like your food to have a tangy taste, cook with herbs, garlic, lemon zest, smoked paprika and chilli instead of salt.

4 Foods that seem to act like blood pressure medicine

• Beetroot juice. Around 250 ml daily (about one large beetroot) drops systolic BP by about 8–10 mmHg within hours due to nitrate (nitric oxide conversion)
• Hibiscus tea. Taking 2–3 cups/day seems to cause a 7–13 mmHg drop in BP.
• Dark chocolate. If the dark chocolate contains more than 85 % cocoa, around 15–30 g/day provides the flavanols that can give a 3–4 mmHg reduction.
• Ground flaxseed. Around 30 g/day has been found to give a 10–15 mmHg BP falls in some responders.

BP reduction by exercise 

• Only 90–150 minutes a week of exercise can reduce BP, dramatically. The single most effective exercise approach for high blood pressure is isometric exercise. 
• Wall sits or handgrip squeezing 3×2 minutes, three times a week can lower systolic BP by 8–10 mmHg.
• Traditional aerobic exercise (brisk walking, cycling) for 150 min/week can gives you a 5–8 mmHg reduction in BP.
• Dynamic resistance training (weights) 3× week could give you another 4–6 mmHg reduction in BP
• Combining exercise approaches can be best. 

For instance, 30 minutes brisk walking each day and three short isometric sessions per week can lead to a 15–20 mmHg drop for many people. Exercise alone can take people with high BP from Stage 2, to normal levels.

Sleep is the most underrated high blood-pressure treatment

Every hour of lost sleep raises your next-day systolic blood pressure by around 3 mmHg. Habitually sleeping less than 6 hours a day is associated with 30%–40 % higher risk of sustained hypertension.

What sleep approaches work? 

• 7–9 hours every night are essential.
• Go to bed and get up at the same time, every day or night, plus or minus 30 mins. 
• Ensure your bedroom temperature is less than 18 °C, and is pitch black, and do not use electronic or TV screens for around 60 minutes pre-bed time.
• Low doses (0.3–0.5 mg) of melatonin, in the short-term, if you are over 55 have been shown to lower nocturnal BP by 6–10 mmHg.

Break the stress-blood-pressure chain

Chronic stress keeps your arteries constricted. A recent meta-analysis  found that slow diaphragmatic breathing (6 breaths/min) for 10–15 minutes daily lowers systolic BP by 9 mmHg on average. Add mindfulness or progressive muscle relaxation to slow breathing routines and the reduction is even better.  

Lose the pounds, lose the pressure

For every 1 kg of body-fat you lose, it produces roughly a 1 mmHg drop in systolic pressure. A 5–10 kg sustainable loss (most people can achieve this in 12–20 weeks) can give you a 5–15 mmHg drop without any other change.

4-week “drop 10–20 points” plan to consider adopting

Week 1 

• Cut visible salt, swap to herbs 
• Start 30 min brisk walking 5× week 
• Drink 250 ml beetroot juice or 2 hibiscus teas daily

Week 2 

• Add 30 g ground flaxseed to breakfast 
• Begin 3×2 min wall sits, 3× week 
• Set phone reminder for 10 min slow breathing twice daily

Week 3 

• Make the DASH/Mediterranean your full shopping list 
• Switch to potassium salt substitute 
• Fix your bedroom sleep hygiene

Week 4 

• Weigh-in, celebrate your 3–7 kg loss
• Re-measure BP – expect 10–20 mmHg lower

Takeaway

High blood pressure is not a life sentence; for most people it is a reversible lifestyle syndrome. The science is certain: combine low sodium, nitrate- and potassium-rich plants, isometrics, better sleep and stress management and the majority of people can achieve a BP of 120/80 or close without needing a single pill.

Start today. Your arteries will thank you within days, and your future self will thank you for decades.

***

Please seek medical advice if you have high blood pressure before changing any aspect of your healthcare.

Professor Nigel MacLennan runs the performance coaching practice PsyPerform.