You may not need medication for your borderline-high blood pressure just yet. But if it’s left unchecked, you soon might.

The good news: “There are several lifestyle modifications that could help keep blood pressure within the normal range,” says Vicken Zeitjian, MD, a cardiovascular disease fellow at the University of Texas Health Science Center in San Antonio. “They should always be the first step, especially if borderline. Medication is always considered the second line in blood pressure management.”
Your blood pressure is measured in 2 numbers:

Systolic blood pressure (the first number) tells you how much pressure your blood exerts against your artery walls when your heart beats.

Diastolic blood pressure (the second) tells you how much pressure your blood exerts against your artery walls when your heart is resting between beats.

According to the American Heart Association, either an elevated systolic or an elevated diastolic blood pressure reading can be used to diagnose high blood pressure. Recent studies have shown that for people ages 40 to 89, the risk of death from ischemic heart disease and stroke doubles with every 20 mm Hg systolic increase or 10 mm Hg diastolic increase.

These are blood pressure ranges from the American Heart Association:

  • Normal blood pressure is less than 120 mm Hg systolic and less than 80 mm Hg diastolic
  • Elevated blood pressure is 120-129 and less than 80 mm Hg
  • Stage 1 hypertension is 130-139/80-89 (if either number is elevated)
  • Stage 2 hypertension is 140 or higher/90 or higher.

Even if your blood pressure numbers are in the elevated range and not the hypertension stage, it’s important to act now — before it becomes a serious problem. (While you’re at it, you can save some money, too. Download the Optum Perks app for instant coupons on thousands of medications.)

How to lower blood pressure naturally

“Staying healthy doesn’t have to be boring,” says Erkeda DeRouen, MD, who is based near Washington, D.C. She’s double board-certified in family medicine and lifestyle medicine, and the host of the podcast The Prospective Doctor. There are plenty of fun lifestyle changes that can significantly lower your blood pressure. Here are some ideas:

Upload dance videos to TikTok. Getting plenty of exercise can keep borderline-high blood pressure in check. Aim for 2.5 hours of aerobic and resistance exercise per week, Dr. Zeitjian says. “This can include, but is not limited to, dancing on TikTok, doing some spring cleaning around the house or joining an online Pilates class,” he says. “Anything to get you moving.”

Bake banana bread. Incorporating potassium into your diet is key. “A banana a day keeps hypertension away, so maybe it’s time to bring back that quarantine banana bread recipe,” Dr. Zeitjian says.

Count your steps. “You don’t have to be a pro athlete to hit the streets or trails with a daily run,” Dr. DeRouen says. “If you can’t run, then walk. Steps count too!”

José Morey, MD, chief medical officer at Liberty Biosecurity, an Eisenhower Fellow and an adviser to NASA, MIT and the White House, adds: “Sometimes just increasing activity alone can reduce BP by as much as some standard medications.”

Trade salt for other seasonings. “We’ve all heard this one before: Limiting salt as much as possible is a sure way to keep blood pressure down,” Dr. Zeitjian says. The ideal limit: Stay under 1,500 mg of sodium per day.

To make the transition easier, “skip adding salt to 1 meal a day and try some fun alternatives instead,” says Dr. Morey, who’s based in Newport News, Virginia. You can compensate for the lack of salt in foods by adding other seasonings and flavors, such as lemon juice, crushed red peppers or a salt-free seasoning blend.

Treat yourself to some self-pampering. “People who look good feel good,” Dr. DeRouen says. “This lowers your levels of the hormone cortisol, which induces stress and raises blood pressure. Doll yourself up, get that haircut, paint those nails and throw on that eyeshadow to walk your way into confidence and health.”

Limit alcohol consumption. According to Dr. Zeitjian, women should consume no more than 1 alcoholic beverage per day, and men should consume no more than 2 per day. Drinking more than that can temporarily raise blood pressure, and regular binge drinking can lead to long-term increases, according to the Mayo Clinic.

Play with your kids or pets. “If you have pets or young kids, increase active playtime with them,” Dr. Morey says. It’s a fun way to stay active, which can help keep borderline-high blood pressure in check. Bonus: “Movement is healthy for the entire family,” he says.

Follow the DASH diet. The DASH diet (dietary approaches to stop hypertension) is rich in fish, poultry, whole grains, fruits, vegetables and nuts. And it’s low in red meat, sweets and sweetened beverages, according to Dr. Zeitjian. This diet has been proven to reduce your blood pressure in a matter of weeks, according to Dr. Morey: “You can even reach low-2-digit reductions in some cases,” he says.

Embrace garlic breath. “Include garlic in your diet several times per week,” Dr. Zeitjian says. Studies show it’s been proven to reduce hypertension, according to a research review published in Experimental and Therapeutic Medicine.

Relax. “Get in touch with your inner zen!” Dr. DeRouen says. “Meditation, yoga, journaling or prayer may calm and relax not only your mind but have positive effects on your heart health.” Try the popular meditation app Headspace or watch a guided yoga video on YouTube.

Explore your neighborhood. “Try walking around your neighborhood 15 to 20 minutes per day,” Dr. Morey suggests. It’s the ideal no-excuses exercise, since you can simply lace up your sneakers and head out the door. Take a different route each time to keep it fresh. If you get bored and have time, drive to a different neighborhood and stroll there.

Double up on fruits and veggies. “An apple a day may actually keep the doctor away,” Dr. DeRouen says. “Plants aren’t only for animals. Studies show that people who practice plant-based diets have a significantly lower rate of high blood pressure.”

Take the stairs. “When at work, take the stairs instead of the elevator,” Dr. Morey says. It’s just another easy way to incorporate more movement into your daily routine. Start with just 1 flight and work up to more with each passing week.

Record yourself sleeping. Why? You might have obstructive sleep apnea. “Untreated OSA is associated with a lack of normal blood pressure reduction during sleep, among other [heart problems],” says Dr. Zeitjian. Apps such as Sleep Cycle and SnoreLab can record your movements and sounds while you sleep. Or just ask your partner, who will likely know if you snore or have frequent pauses during your breathing while asleep, he says.

Measure your neck. While it might sound odd, a neck circumference greater than 16 inches (40 cm) in women and 17 inches (43 cm) in men could be another sign that you have obstructive sleep apnea — which is a common indicator of high blood pressure, according to Dr. Zeitjian.

Do a 5-minute workout. “Doing a few morning or midday squats is a quick and easy way to get the heart pumping,” Dr. Morey says. “You can set a timer for every hour or few hours to take small exercise breaks for 5 minutes,” he says, which can really add up.

Following these tips is 1 way to avoid developing high blood pressure as you get older. Learn more strategies that can help.

Medications to reduce blood pressure

Sometimes your body still needs an assist. Here are some of the medications your doctor might recommend if lifestyle changes alone aren’t enough:

Diuretics. Diuretics reduce the sodium content in the body. “A doctor might consider starting you on a medication called hydrochlorothiazide or chlorthalidone,” Dr. DeRouen says. They work on the kidneys to help you urinate it out. These medications are also often called water pills because they help reduce excess fluid in the body. (Get coupons instantly for hydrochlorothiazide and chlorthalidone. Just click the links.)

ACE inhibitors, ARBs or calcium blockers. In addition to a diuretic, ACE inhibitors, ARBs and calcium channel blockers are commonly prescribed because they help relax the blood vessels. Lisinopril and captopril are commonly prescribed ACE inhibitors, Dr. Morey says. “These reduce angiotensin — a compound your body produces to make the vessels smaller in diameter.  When this happens, the pressure increases,” he explains. “By reducing angiotensin, the vessels increase in diameter, so the pressure drops.”

ARBs (such as candesartan and losartan) do not reduce angiotensin, but they do stop it from making the vessels smaller. Calcium channel blockers (amlodipine or diltiazem) relax the muscles of the blood vessels, making them wider. Read more about diltiazem.

Beta blockers. “These are the drug (names) that tend to end in o-l-o-l,” says Dr. Morey. “They act on the heart itself. They reduce the workload of the heart, which decreases vascular pressure,” he explains. They’re usually added as an additional therapy if you’re not able to reach your blood pressure goals with other medication.

“You can think of the vascular system like a plumbing system,” Dr. Morey explains. “Reduce the amount of liquid in the system (diuretics), pressure drops; increase the pipe diameter (ACE inhibitors, ARBs and calcium channel blockers), pressure drops; reduce the pumping source power (beta blockers), pressure drops.”

If you need medication to manage your blood pressure at some point, your doctor will work with you to find the right combination.

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Additional sources
Blood pressure basics: National Heart, Lung, and Blood Institute
Blood pressure readings: American Heart Association
Garlic study: Experimental and Therapeutic Medicine. (2020). Garlic lowers blood pressure in hypertensive subjects, improves arterial stiffness and gut microbiota: A review and meta-analysis.”
Plant-based diet: Journal of Geriatric Cardiology. (2017). “A plant-based diet and hypertension.”