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Understanding your blood pressure ― and how to lower it

Maureen Shelly By Maureen Shelly

In the 1980s, Sema Stein was juggling raising three children with a high-pressure job in an assisted living facility in Massachussetts. When she started feeling ill one day, she asked one of the nurses to take her blood pressure. “It was raging,” Sema remembers.

With her doctor’s blessing, she developed a plan to manage her stress through meditation and exercise. Today, at 81, Sema is enjoying the rewards of being proactive about her health. When we spoke with her, she was packing for a trip to Amsterdam with friends. “My doctors are very happy with my numbers: blood pressure, cholesterol and weight,” she says. “They tell me, ‘Whatever you’re doing, keep doing it.’ It’s wonderful to hear.”

One in three Americans has high blood pressure, also called hypertension. Without treatment, they are three times more likely to contract heart disease, and four times more like to have a stroke. If you’re concerned about your blood pressure, read on to learn simple ways to lower it and protect your heart.

What is blood pressure?

For many people, the concept of blood pressure is abstract and puzzling. “Pressure is what makes your blood flow,” explains Bradley Artel, MD, FACC, FASE, a cardiologist and Aetna medical director. “The heart is a muscle. When it beats, it squeezes blood out the aorta, the largest artery. That pushes the blood forward throughout the body, from larger vessels to smaller, and from smaller vessels to the tiny capillaries that feed our organs and tissues.”

Two numbers make up a blood pressure reading: Less than 120/80 (pronounced “120 over 80”) is considered normal. The top number measures the force when your heart muscle is squeezing and actively pushing blood throughout your body. That’s called your “systolic” pressure. The bottom number, or “diastolic” pressure, measures the lesser force when your heart is relaxed.

It’s normal for blood pressure to rise and fall throughout the day. Blood pressure naturally goes up in response to physical effort or emotional stress. Your pressure drops when you relax. If one or both numbers are consistently high over time, that’s a sign that something is wrong.

High Blood Pressure Facts

  • A blood pressure cuff is called a sphygmomanometer 
  • Normal blood pressure is under 120/80
  • High blood pressure is above 130/80
  • 1 in 3 Americans is affected by high blood pressure
  • High blood pressure is the 2nd major risk factor for heart disease after smoking
  • Lowering your blood pressure extends your life by 5 years

Why is high blood pressure bad?

High blood pressure doesn’t cause any noticeable symptoms at first. So why is it a problem? “The lining of your blood vessels is only one cell thick,” Dr. Artel explains. “High blood pressure damages that thin lining, and cholesterol collects at the damaged spots.” As deposits build up and narrow vessels, your blood can’t deliver enough oxygen and nutrients to your body. If the process isn’t caught early, it can lead to many serious problems, including:

  • Blindness
  • Kidney disease
  • Leg pain and difficulty walking from peripheral artery disease
  • Heart attack
  • Stroke  

New guidelines define high blood pressure as 130/80 and above. That used to be considered not so bad. “But as we’ve followed more people over the years, we’ve seen that lower is better,” Dr. Artel explains. “This is especially true for patients with medical conditions like diabetes, for whom high blood pressure is more dangerous.” That’s because people with diabetes are already at greater risk for heart disease.

Learn more about cholesterol and how to manage it.

What causes high blood pressure?

The good news is that many causes of high blood pressure are within our control. Unhealthy habits tend to spike our pressure. In fact, some habits are considered unhealthy largely because they raise blood pressure. And we can reduce the effects that sleep apnea and stress have, even if we can’t avoid them entirely. The biggest risk factors are:

  • Poor diet / obesity
  • Lack of exercise
  • Heavy drinking
  • Smoking
  • Sleep apnea
  • Stress hormones 

High blood pressure can also be caused by genetics, certain medical conditions and medications. If you have a family history of high blood pressure or heart disease, it’s important to get yours checked. And don’t wait till middle age; hypertension can show up as early as your 20s. You should also watch your blood pressure if you have diabetes, thyroid problems or you’re planning to become pregnant. One out of three Americans with high blood pressure doesn’t know they have it.

"We can’t avoid all causes of high blood pressure, but we can reduce the effects they have."

How to lower your blood pressure

You already know that you should exercise, quit smoking and cut back on alcohol. Besides those healthy moves, here are five other strategies proven to lower your blood pressure…a lot.

1.     Improve your diet / lose weight. If you’re carrying around extra pounds, dropping them will lower your blood pressure. But even people who are at a healthy weight can stand to improve their diet. The DASH eating plan was developed just for people with high blood pressure: DASH stands for Dietary Approaches to Stop Hypertension. The flexible diet recommends more vegetables and whole grains and fewer fatty and sweetened foods. (Learn more at Consider probiotics as well; some studies suggest that gut bacteria influence blood pressure.

Online health coaching can help you lower your blood pressure, lose weight and more. Some Aetna members, for instance, have free access to the Simpler Steps to a Healthier Life program, which offers online sessions that make attaining health goals easy and fun.

2.     Relax / manage stress. Blood pressure rises in response to stress. Stress management techniques help fight high blood pressure. That can mean yoga, meditation, listening to music, spending time in nature ― whatever is most effective for you. One recent study found that people who enjoy saunas 4 to 7 times a week had 50% lower blood pressure than non-sauna users.

Learn simple ways to reduce your stress level in 10 minutes or less.

3.     Take your medication. For some people, healthy habits are not enough: Their genes hardwire them for high blood pressure. So taking prescriptions exactly as the doctor recommends is essential. “I do take blood pressure medication now,” Sema says. “I’m a very good patient. The doctors tell me what to do, and I do it. And so far, it’s keeping me around.”

4.     See your doctor twice a year. If that sounds excessive, consider this: People who see their doctor at least twice a year are 3.2 times more likely to keep their blood pressure under control, according to the American Heart Association. Make sure to discuss with your doctor all the prescription and over-the-counter medications you take. Many drugs and natural remedies can contribute to high blood pressure when taken regularly, including asthma rescue inhalers, pain relievers, decongestants, gingko and even licorice.

Find out how to make the most of your next doctor’s visit.

5.     Check your blood pressure at home too. People who monitor their blood pressure at home ― in addition to regular doctor visits ― tend to lower their blood pressure more than patients who rely on doctor visits alone. The connection isn’t clear, but it may reflect a greater commitment to improving health or a better understanding of how personal habits influence blood pressure. Make sure to invest in a highly rated blood pressure cuff; the Consumer Reports site has a thorough buying guide. Then bring the device to your doctor to ensure it’s calibrated correctly and get tips on self-monitoring.

What about salt?

In conversations about blood pressure, salt or sodium is often singled out as the bad guy. But for most people, salt intake has no long-term negative effects . And focusing on salt alone can mean you overlook other ingredients that can contribute to high blood pressure.

“We as humans eat too much salt,” Dr. Artel admits. “But I’ll tell you a secret that most people don’t know. Salt is everywhere. The more you eat, the more salt you’ll naturally take in. But the opposite is also true: The less you eat in general, the less salt you’ll take in. And you won’t have to look at labels. It’s simple: To control your blood pressure, just eat less.”

If label reading comes naturally, though, here are two other ingredients to keep an eye on: sweeteners (sugar or the artificial kind) and caffeine. Both can cause blood pressure spikes. One study found that having just one less sweetened beverage a day significantly lowered blood pressure in adults .

The bottom line on blood pressure

Blood pressure can be confusing. But it’s also an amazing predictor of your future heart health. Get familiar with your blood pressure numbers. Know them as well as you know your weight. Then listen to your doctor’s recommendations. If your doctor prescribes medication, don’t put off taking it because you think you can fix the problem through diet and exercise. For some people, lifestyle changes alone aren’t enough.

Sema continues to follow the same routine she initiated 30 years ago. In the morning, she spends 20 minutes meditating followed by 30 minutes on the treadmill. In the evening, she’s back on the treadmill for another 30 minutes. “When I go to the doctor now,” she says. “I’m happy to tell him, ‘I’m doing all that I can. Now it’s up to you.’”


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About the author

Maureen Shelly is a health and science geek living in New York City.

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