New Thinking on How to Lower Your Blood Pressure

It remains important to eat right and exercise, though some specific advice for both has changed a bit. And it’s still important to use prescribed blood pressure medication consistently and correctly.

The AHA has long advised that all adults consume less than 2,300 mg of sodium each day. But the new guidelines advise less than 1,500 mg (the amount in about ⅔ teaspoon). "On average, we see systolic (top) blood pressure drop about 3 points in people with normal blood pressure and 7 points in people with high blood pressure when they stick to a low-sodium diet," says Jones.

The easiest way to limit sodium is to focus on fresh, unprocessed foods. "Most salt in our diets comes from consuming packaged, processed food and eating out at restaurants," Jones says. When you cook, try using a potassium-based salt substitute, not table salt. Research suggests that can lower blood pressure by up to 5 points.

If you have high blood pressure, Jones also recommends following the DASH diet, which is rich in fruits, vegetables, low-fat or nonfat dairy, and whole grains. "It’s the most effective eating pattern to lower blood pressure," he says. Research shows it can lower blood pressure (both systolic and diastolic, the bottom number) by up to 10 points. Everyone should limit alcohol, too. Newer research suggests that over time, consuming any amount will raise blood pressure.

To reduce stress, which contributes to high blood pressure, the new guidelines recommend a technique called transcendental meditation. With TM, you repeat a word or phrase like "om" in your head to quiet your mind.

But any mindfulness-based activity, like yoga or deep breathing, should help, says Nieca Goldberg, MD, a cardiologist at NYU Langone Health in New York City. "The key is to find something that works for you," she says.

All physical activity helps lower blood pressure, according to the new guidelines. For instance, brisk walking reduces systolic blood pressure by about 4 points, and more in people with hypertension. If possible, aim for 150 minutes of such moderate activity weekly. That’s the amount needed for the largest reduction in blood pressure, according to the guidelines.

Strength training, which the AHA recommends doing twice a week, is important too, for people with and without hypertension. The guidelines found that isometrics, where you tighten a specific muscle or group of muscles (think planks and wall sits), have the largest effect on blood pressure of any strength exercise. A 2023 review published in the British Journal of Sports Medicine found that isometrics can lower systolic blood pressure by about 8 points.

About 10 percent of adults with hypertension have secondary hypertension, or high blood pressure caused by another medical condition. "We often suspect secondary hypertension if your blood pressure doesn’t get better with treatment, or if we see diastolic hypertension in older adults, which is when the bottom number of your blood pressure reading is consistently high, even with medication," says Sarraju.

If your doctor has tried several different medications and your blood pressure isn’t improving, Sarraju advises asking about the possibility of secondary hypertension and potential causes (sleep apnea is the most common; chronic kidney disease can hike blood pressure, too). The guidelines also now recommend that everyone with hypertension that doesn’t respond to treatment be tested for primary aldosteronism, where you produce too much of the hormone aldosterone—which can affect your blood pressure.

Medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) are approved to treat conditions like obesity and type 2 diabetes. But they may help lower blood pressure, too.

In a 2024 study in the journal Heart, overweight adults who took tirzepatide for 18 months saw their systolic (top) blood pressure drop by 7 points, on average, compared with 4 points for those who took a placebo. "About 70 percent of that was explained by weight loss, but 30 percent was independent," says study co-author Harlan Krumholz, MD, a cardiologist at Yale New Haven Hospital in Connecticut.

If you are overweight and have high blood pressure, you may want to ask your doctor whether such a drug would be beneficial, says Krumholz. "For people with both obesity and hypertension, treating obesity first may actually be the best strategy," he says. Just keep in mind that these drugs aren’t usually covered by Medicare solely for weight loss.

Doctors may use risk calculators to assess patients’ 10- or 30-year likelihood of heart disease and cardiac events like heart attacks. In the past, the online tools sometimes overestimated risks or failed to factor in the effects of poor healthcare.

Enter the American Heart Association’s PREVENT calculator. "It’s based on the data of 3 million people vs. just several hundred thousand in past calculators," says Jones. "It reflects a much more diverse group."

To use PREVENT, you and your doctor enter your age, cholesterol levels, blood pressure, BMI, kidney function, and if you’d like, details like your hemoglobin A1c. The calculator scores your risk of several cardiovascular diseases. Results can help determine how to treat risk factors like hypertension.