Lowering your blood pressure
What you eat, how you move, and how you measure can lower your blood pressure as much as a pill. Here is the plan, step by step.
From Dr. Kenny Civello, cardiologist and electrophysiologist
Cutting salt alone can lower your top number by 6 to 8 points. That is about what one blood pressure pill does. Stack a few habits together and the effect grows. These changes work alongside your medicines, not instead of them.
Know your numbers
Blood pressure has two numbers. The top number (systolic) is the pressure when your heart beats. The bottom number (diastolic) is the pressure between beats.
| Category | Top number | Bottom number | |
|---|---|---|---|
| Normal | under 120 | and | under 80 |
| Elevated | 120 to 129 | and | under 80 |
| Stage 1 high blood pressure | 130 to 139 | or | 80 to 89 |
| Stage 2 high blood pressure | 140 or higher | or | 90 or higher |
Your goal
Under 130 on top and under 80 on the bottom. For many people, a top number under 120 is even better. We will set your goal together.
Why it matters
High blood pressure strains your heart, brain, kidneys, and blood vessels. Lowering it cuts your risk of stroke, heart attack, heart failure, kidney disease, and AFib.
Home beats the office
Readings at home, over several days, tell us more than one reading in the clinic. They are what we use to adjust your plan.
Measure it the right way at home
A wrong cuff size or bad position can throw a reading off by 10 points or more. These steps keep your numbers honest.
Use a good cuff
Pick an upper arm cuff that has been tested for accuracy. You can check your model at validatebp.org. Make sure the cuff fits your arm size.
Get ready
For 30 minutes before, skip caffeine, exercise, and smoking. Empty your bladder. Then sit quietly for 5 minutes.
Sit right
Back supported. Feet flat on the floor, legs not crossed. Arm resting on a table at heart level. Cuff on bare skin.
Stay still and quiet
Do not talk or look at your phone during the reading. Take a second reading 1 minute later.
The schedule before a visit
- Take 2 readings, 1 minute apart, in the morning before your medicines.
- Take 2 more readings in the evening.
- Do this for 7 days before your visit. If you cannot, do at least 3 days.
- That gives us at least 12 readings. Write them all down or use the log below.
Why so many readings?
Blood pressure changes all day. One high reading can come from stress, a full bladder, or a cup of coffee. The average of many readings shows your true blood pressure. Doctors call this home blood pressure monitoring, and the latest guidelines strongly recommend it.
Some people run high only in the office. Others run normal in the office but high at home. Home readings catch both.
Should I bring my cuff to my visit?
Yes, at least once a year. We will check it against our office readings. Up to 1 in 5 home cuffs read more than 10 points off for reasons that are hard to predict.
What about my smartwatch or ring?
Do not use a watch, ring, or phone app to manage your blood pressure yet. Devices without a cuff have not been proven accurate, and some read poorly at night or on darker skin. FDA clearance is not the same as proof of accuracy. Use a validated arm cuff for the numbers you send us.
What works, and how much
Each bar shows how many points the top number usually drops with that one change. Tap a row to mark the ones you will try.
Can I just add these up?
Not exactly. These numbers are averages from studies of people with high blood pressure. Your result may be bigger or smaller. Changes often work better together than alone. Cutting salt while eating the DASH way works better than either one by itself.
Salt down, potassium up
Sodium
That is the ideal. Stay under 2,300 mg at most. Most of the salt you eat is already in the food before it reaches your table.
Where the salt hides
- Bread and rolls
- Pizza
- Deli meat, bacon, sausage, ham
- Canned soup
- Restaurant and fast food
- Chips, crackers, pretzels
- Sauces, dressings, seasoning packets
Potassium
Potassium helps your body flush out sodium. Get it from food first: beans, potatoes, sweet potatoes, spinach, bananas, oranges, tomatoes, yogurt, and avocado.
Who should be careful
If you have kidney disease, or take spironolactone, eplerenone, amiloride, triamterene, or a potassium pill, ask us before you add potassium. Some blood pressure medicines (lisinopril, losartan, and others like them) also raise potassium.
Potassium salt substitutes (like NoSalt or Nu-Salt, or blends that replace part of the salt) lower blood pressure and lower the risk of stroke. They are not safe for everyone. Check with us first if you have kidney disease or take any of the medicines listed above.
Reading a food label for salt
Look at the sodium line. 140 mg or less per serving is low. 600 mg or more in one item is a lot. Check the serving size. A can of soup often holds two servings, so double the number.
Rinse canned beans and vegetables. That washes away a good share of the salt. Choose "no salt added" when you can.
For a full eating plan built around DASH and Mediterranean eating, see Eating for your heart.
Move most days
All three kinds of exercise lower blood pressure. Pick what you will actually do.
Aerobic
90 to 150 minutes a week. Brisk walking, cycling, swimming. You should breathe harder but still talk. That is 30 minutes, 3 to 5 days a week.
Strength
2 to 3 days a week. Six exercises, 3 sets of 10. Use weights, bands, or your body weight. Pick a load you can lift 10 times with good form.
Handgrip
3 days a week, about 12 minutes. Squeeze a handgrip at a light to medium effort for 2 minutes. Rest 1 minute. Repeat 4 times.
Why does a handgrip lower blood pressure?
Holding a steady squeeze is called isometric exercise. Over weeks, it helps your blood vessels relax. In studies it lowered the top number by 5 to 10 points. It is cheap, quick, and you can do it sitting down. Use about a third of your hardest squeeze. Do not hold your breath.
Is exercise safe for me?
For most people, yes. Start slow and build up over a few weeks. If your blood pressure is 180 or higher on top, or you get chest pain, unusual shortness of breath, or dizziness with exercise, stop and call us before you continue.
Weight and alcohol
Weight
If you carry extra weight, losing even a little helps. Expect about 1 point lower on top for every 2 pounds you lose. For someone who weighs 200 pounds, 5% is 10 pounds.
What about weight loss shots?
Medicines like Wegovy and Zepbound help with weight and also lower blood pressure. They are not first choice blood pressure medicines. Ask us if one might fit your plan.
Alcohol
Alcohol raises blood pressure. If you drink, cut back by more than half. Stay at 2 drinks a day or fewer for men, 1 or fewer for women.
What counts as one drink?
12 ounces of beer, 5 ounces of wine, or 1.5 ounces of liquor. Many bar pours and craft beers are bigger than one drink.
Stress and sleep
Slow your breathing
Breathe slowly, fewer than 10 breaths a minute, for 15 minutes a day. Try in for 4 counts, out for 6. A breathing app or guide helps.
Meditate
Two 20 minute sessions a day, seated with eyes closed. Learn from a teacher or a good app.
Sleep 7 to 9 hours
Short or poor sleep raises blood pressure. See Sleeping well for a 12 week plan.
Snoring? Tell us.
Loud snoring, gasping at night, or daytime sleepiness can mean sleep apnea. Treating it can help bring blood pressure down.
How strong is the evidence?
Breathing and meditation lowered the top number by about 5 to 7 points in studies. Those studies were smaller and shorter than the ones on salt, diet, and exercise. They are worth doing, but do them alongside the bigger changes, not instead of them.
Your home reading log
Type each reading as top/bottom, like 132/84. Your readings stay on this device. Once you have 12, you will see your average.
This week
Pick a few. Check off what you did. Your progress saves on this device.
When to call us
Call 911 if your blood pressure is 180 or higher on top, or 120 or higher on the bottom, and you have chest pain, shortness of breath, weakness or numbness, trouble speaking, vision changes, confusion, or a severe headache.
Call our office the same day if:
- You read 180 or higher on top (or 120 or higher on the bottom) without symptoms. Rest 5 minutes and recheck first.
- Your top number is under 90, or you feel dizzy or faint when you stand.
- Your home average stays above your goal for 2 weeks.
- You have side effects from a medicine.
Other guides
Lowering your AFib riskEating for your heartSleeping wellLiving with POTSMy watch says I have AFibGetting ready for your ablationLiving with a pacemaker or ICDThis page is general education for my patients. It does not replace advice from your own doctor. Do not stop or change a medicine without talking with us. Ask us before using a salt substitute or potassium supplement.
Based on: Jones DW, et al. 2025 AHA/ACC/Multisociety Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. And: Davis LL, Yang E, et al. Optimizing Blood Pressure Care in Patients With Resistant Hypertension: 2026 ACC Expert Consensus Decision Pathway. JACC. 2026. Read the pathway.