How to lower blood pressure

The cutoffs come from the ACC/AHA chart, and the and/or logic in them is the part people miss. All figures are in mm Hg (AHA):

• Normal: less than 120 and less than 80
• Elevated: 120 to 129 and less than 80
• Stage 1 hypertension: 130 to 139 or 80 to 89
• Stage 2 hypertension: 140 or higher or 90 or higher
• Severe hypertension: higher than 180 and/or higher than 120, with no symptoms, which means call your healthcare professional
• Hypertensive emergency: higher than 180 and/or higher than 120 with symptoms, which means call 911

Because stage 1 is 130 to 139 or 80 to 89, either number alone puts you there. A reading of 128/86 is stage 1 on the bottom number by itself. The 2025 guideline kept all of it: the blood pressure criteria remain the same as the 2017 guideline, with normal below 120/80, elevated at 120 to 129 and below 80, stage 1 at 130 to 139 or 80 to 89, and stage 2 at 140 or above or 90 or above (2025 ACC/AHA guideline). The CDC states the same cutoffs in two buckets, calling 130 or higher systolic or 80 or higher diastolic high blood pressure (CDC).

Nothing about this announces itself. High blood pressure usually has no warning signs or symptoms, and many people do not know they have it (CDC), which is why the AHA calls it a silent killer (AHA). It affects nearly half, 46.7%, of all adults in the U.S. and is the leading cause of death in the U.S. and around the world (AHA news release, August 2025). One caveat sits under the AHA's own chart and belongs under this one too: only a doctor or other medical professional can confirm a high blood pressure diagnosis (AHA).

The number most people are given is below 130/80 mm Hg, and the 2025 guideline says that for many people with high blood pressure, especially those who have Type 2 diabetes, obesity or kidney disease, more than one medication may be needed to reach it (2025 ACC/AHA guideline). The same guideline states a separate systolic goal of below 130 mm Hg for adults with high blood pressure to prevent cognitive impairment and dementia (2025 ACC/AHA guideline).

Your own number is set for you rather than off a chart. The guideline asks clinicians to use the PREVENT risk calculator, which estimates 10-year and 30-year risk of cardiovascular disease in people ages 30 to 79 using age, sex, blood pressure, cholesterol levels and other health indicators, including zip code as a proxy for social drivers of health, on the reasoning that more precise risk estimates can help guide treatment decisions personalized for each individual (2025 ACC/AHA guideline). If blood pressure stays high after one medication, clinicians may individualize treatment to either increase the dose or add a second medication from a different class (2025 ACC/AHA guideline).

What happens at each stage follows from that. In stage 1 your healthcare professional should prescribe lifestyle changes, and may consider adding medication based on your risk of heart disease or stroke, and should add medication if you have other conditions such as diabetes, heart failure and kidney disease. In stage 2 your healthcare professional should prescribe blood pressure medication and lifestyle changes (AHA). At 140/90 or higher the guideline maintains the recommendation to begin treatment with two medications at once, preferably in a single combination pill (2025 ACC/AHA guideline).

UK readers work from different numbers and they should not be blended with the US ones. The NHS says you have high blood pressure if your reading is 140/90 or higher when checked by a healthcare professional, or 135/85 or higher when checked at home (NHS).

Home monitoring is recommended for all people with high blood pressure to help their healthcare professional know if treatments are working, and it can also be used to confirm the diagnosis, though it does not replace regular doctor visits (AHA). The 2025 guideline says the same, recommending home blood pressure monitoring to help confirm office diagnosis and to monitor, track progress and tailor care as part of an integrated care plan (2025 ACC/AHA guideline).

Doing it right is a short list, and every step is here (AHA):

• The machine. Use an automatic, cuff-style, upper arm monitor. Wrist and finger monitors are not recommended, because they give less reliable readings. Choose one that has been validated, measure around your upper arm, and get the correct cuff size.
• The 30 minutes before. Don't smoke, drink caffeinated beverages or exercise within 30 minutes before taking your blood pressure, and empty your bladder. The CDC adds not eating or drinking anything for those 30 minutes (CDC).
• Bare arm. Don't take the measurement over clothes. Remove the clothing over the arm being used.
• Five minutes still. Allow at least five minutes of quiet rest before measuring, and don't talk or use the phone. The CDC's version is to sit in a comfortable chair with your back supported for at least 5 minutes, both feet flat on the ground and legs uncrossed (CDC).
• Position. Support your arm on a flat surface at heart level, with the middle of the cuff on the upper arm at heart level and the bottom of the cuff directly above the bend of the elbow on bare skin.
• Two readings. Each time you measure, take two readings one minute apart, and record the results. The CDC says at least two readings, 1 or 2 minutes apart (CDC).
• Same time daily. Take the readings at the same time each day, and talk with your healthcare professional about how often to take them.
• Once a year, check the machine. Bring your monitor in so your healthcare professional can see that you are using it correctly and getting the same results as the equipment in the office.

The reason for all the fuss is in one line from the same page: one blood pressure measurement is like a snapshot, and a record of readings taken over time provides a more complete picture (AHA). It is also why a bad afternoon is not a verdict. A single high reading is not an immediate cause for alarm; take it a second time, write down both, and check with your healthcare professional to see if there's a health concern or whether there may be problems with your monitor (AHA).

The 2025 guideline names six of them, and it puts a number on most. Its blood pressure guidance is to limit sodium to less than 2,300 mg per day, moving toward an ideal limit of 1,500 mg per day by checking food labels; ideally consume no alcohol, or for those who choose to drink, no more than two drinks per day for men and no more than one per day for women; manage stress with exercise and techniques like meditation, breathing control or yoga; maintain or achieve a healthy weight, with a goal of at least a 5% reduction in body weight in adults who have overweight or obesity; follow a heart healthy eating pattern such as the DASH eating plan; and increase physical activity to at least 75 to 150 minutes each week including aerobic exercise and/or resistance training (2025 ACC/AHA guideline).

What the whole list buys is more than the reading. By adopting a heart-healthy lifestyle you can reduce your blood pressure, prevent or delay the development of high blood pressure, improve how well blood pressure medications work, lower your risk of high blood glucose and high cholesterol, lower your risk of heart attack, stroke, heart failure, kidney damage, vision loss and sexual dysfunction, and lower risk of dementia (AHA).

The AHA recommends no more than 2,300 milligrams of sodium a day, with an ideal limit of no more than 1,500 for most adults, especially those with high blood pressure, and it says cutting out just 1,000 milligrams a day can improve blood pressure and heart health (AHA). For scale, one teaspoon of salt is 2,300 mg of sodium, half a teaspoon is 1,150 mg, and a quarter teaspoon is 575 mg (AHA).

The saltshaker is mostly innocent. More than 70% of the sodium Americans eat comes from packaged, prepared and restaurant foods, and the average intake runs over 3,100 milligrams daily (AHA). The categories the AHA names as the usual sources are burgers; burritos and tacos; deli meat sandwiches; egg dishes and omelets; pasta mixed dishes; pizza; poultry; savory snacks such as chips, crackers and popcorn; and soups (AHA). That list is what makes label reading the actual work.

If you are trying to prevent or treat high blood pressure, the AHA recommends 3,500 mg to 5,000 mg of potassium daily, ideally from diet (AHA). The mechanism is worth knowing, because potassium can reduce the effects of sodium: the more potassium you eat, the more sodium you lose through urine, and potassium also helps to ease tension in your blood vessel walls (AHA). A medium banana has about 451 milligrams and half a cup of plain cooked sweet potatoes has 286 mg (AHA).

The caveat travels with the number. Potassium can be harmful in people with kidney disease, any condition that affects how the body handles potassium, and people on certain medications, so check with a health care professional before taking an over-the-counter potassium supplement, and ask before trying salt substitutes (AHA).

DASH stands for Dietary Approaches to Stop Hypertension, and NHLBI describes it as a flexible and balanced eating plan that helps create a heart-healthy eating style for life (NHLBI). Its sodium level is 2,300 mg a day, with the note that 1,500 mg lowers blood pressure even further (NHLBI). On a 2,000-calorie plan the daily servings are 6 to 8 grains, 4 to 5 vegetables, 4 to 5 fruit, 2 to 3 low-fat or fat-free dairy, and 6 or fewer of meats, poultry and fish, plus 2 to 3 fats and oils; weekly it is 4 to 5 servings of nuts, seeds, dry beans and peas, and 5 or fewer sweets (NHLBI).

The AHA's verdict on it is short: the DASH eating plan is easy to follow, delicious and varied, and it is proven to help lower blood pressure (AHA). None of the sources on this page state how many points it takes off a reading, so this page doesn't either.

For blood pressure specifically, the guideline's number is at least 75 to 150 minutes each week including aerobic exercise such as cardio and/or resistance training such as weight training (2025 ACC/AHA guideline). The AHA's general fitness recommendation is framed differently: at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous activity, or a combination, preferably spread throughout the week, plus moderate- to high-intensity muscle-strengthening activity on at least 2 days per week, with even more benefit at 300 minutes a week (AHA).

The CDC's general recommendation reads as a calendar you can keep: at least 2 hours and 30 minutes of moderate-intensity exercise, such as brisk walking or bicycling, every week, which is about 30 minutes a day, 5 days a week (CDC).

The AHA recommends no more than two drinks per day for men and one drink per day for women for people who choose to drink, and one drink means a 12-ounce beer at 5% alcohol, an 8-ounce malt liquor at 7%, a 5-ounce glass of wine at 12%, or 1.5 ounces of 80-proof liquor (AHA). The CDC states the same limits (CDC), and the NHS uses a weekly cap instead, at no more than 14 units of alcohol a week (NHS).

The guideline's own framing starts one step earlier, asking ideally for no alcohol (2025 ACC/AHA guideline), and the AHA adds the line that saves anyone from starting a habit for their heart: if you don't drink, don't start (AHA).

The guideline's number is at least a 5% reduction in body weight in adults who have overweight or obesity (2025 ACC/AHA guideline). The AHA's consumer page puts it in pounds, saying you might gain health benefits from losing as few as 10 pounds, and that even a small weight loss can help manage or prevent high blood pressure (AHA).

No source on this page converts pounds into points off a reading, so neither does this page.

Sleep is not one of the six levers named in the 2025 guideline's blood pressure guidance, and it is worth a paragraph anyway. The AHA counts getting 7 to 9 hours of sleep each night among Life's Essential 8 for heart health, up there with eating healthy, being active, and not smoking (AHA). The CDC connects it to this number directly, saying that not getting enough sleep on a regular basis is linked to an increased risk of heart disease, high blood pressure, and stroke (CDC).

The first-line classes the 2025 guideline names are angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, long-acting dihydropyridine calcium channel blockers, and thiazide-type diuretics (2025 ACC/AHA guideline).

The instruction attached to all of them is blunt. Never stop taking a medication or change your dose or frequency without checking with your healthcare professional (AHA). The home-monitoring page repeats it for the people who bargain with their own numbers: do not stop taking blood pressure medication without checking with your healthcare professional regardless of your readings during home monitoring (AHA). The CDC spells out the consequence. It says it is important to take your blood pressure medicine exactly as your doctor tells you to, that you should not stop your current medicine without talking to your doctor or pharmacist first, and that stopping without first talking to your health care team could lead to serious health consequences (CDC). The AHA's framing is that there is no cure, but using medications as prescribed and making lifestyle changes can improve your quality of life and control your blood pressure (AHA).

Cost is a reason to talk rather than to skip. If medication cost is an issue, let your doctor, pharmacist or other healthcare team member know, because they may suggest a medication that costs less, and there are patient assistance programs to ask about (AHA).

• Don't stop a blood pressure medicine, or change the dose or frequency, without checking with your healthcare professional (AHA, CDC).
• Don't swap the prescription for a supplement. There are no special pills, vitamins or drinks that can replace prescription medications and lifestyle changes, herbal remedies have not been tested for your safety, some may affect how other medications work, and some can even raise your blood pressure (AHA).
• Don't start a potassium supplement or a salt substitute on your own, since both can raise potassium too much in people with some health conditions and on some medications (AHA).
• Don't read one number as a diagnosis, and don't assume the machine is right. Check with your healthcare professional to see if there's a health concern or whether there may be problems with your monitor (AHA).
• Don't drop the appointments because you are measuring at home, because home monitoring does not replace regular doctor visits (AHA).
• If pregnancy is anywhere in the picture, this is a prescriber conversation. Women taking blood pressure medication should check with their healthcare professional before becoming pregnant, and talk to them as soon as possible on discovering a pregnancy, because some blood pressure medications can be dangerous to both mother and baby (AHA).

I never touch a prescription, never diagnose, and never set your target. What I do is take the readings with you the way the AHA describes, two a minute apart at the same time each day, keep them with their dates, ask every day about the one lever your clinician named, and read the record back before the visit so the appointment starts with what actually happened. If a reading lands above 180/120 I tell you what the AHA says to do with it, including calling 911 when the symptoms are there, and those records are the kind that provide valuable information to the medical team in an emergency (AHA).

No clinician reviewed this page. It restates the AHA pages, AHA's release on the 2025 AHA/ACC guideline, the CDC, NHLBI, and the NHS linked below, and those are the documents to trust over anything here.