Unlike some diseases and health conditions that present with symptoms early, high blood pressure is not as easy to recognize. That’s why knowing the most common high blood pressure causes—and anticipating a potential diagnosis—are so crucial to maintaining optimal heart health. “High blood pressure, in most cases, is asymptomatic,” said Lawrence Phillips, M.D., a cardiologist and associate professor of medicine at NYU Langone Health. “So people don’t feel that they have it, which is why regular screening is so important.”
Often referred to as a “silent killer,” about half of Americans have high blood pressure, per the American Heart Association (AHA). Left unaddressed, it can cause hardening of the arteries, stroke, kidney damage, and even early cognitive decline and dementia.
Before we go any further, what is blood pressure? In the simplest terms, blood pressure is the force of your blood against the walls of your blood vessels and arteries, and it is expressed as two numbers: The top number (systolic blood pressure) represents the pressure or force in the arteries when your heart beats, and the bottom number (diastolic blood pressure) is the pressure measured between heartbeats, explained Amnon Beniaminovitz, M.D., the founder and lead cardiologist at Vivify Medical in New York City.
Meet the experts: Lawrence Phillips, M.D., a cardiologist and associate professor of medicine at NYU Langone Health; Amnon Beniaminovitz, M.D., the founder and lead cardiologist at Vivify Medical in New York City.
While normal blood pressure is necessary for survival, high blood pressure is dangerous because it means your heart is working much harder to pump blood throughout your body. “You can sort of think of high blood pressure as your blood punching the walls of the heart and other organs over and over again,” said Dr. Phillips. “If that punching is at a high force, you’re going to develop thickening and damage over time.”
According to the AHA, anything above 120/80 mmHg is considered elevated blood pressure, while anything over 130/80 mmHg is considered high blood pressure. The good news: Elevated and high blood pressure can often (but not always) be addressed with diet and lifestyle modifications, said Dr. Phillips.
Here, cardiologists explain the lifestyle choices and health conditions that can increase your risk of developing high blood pressure, plus the alternative changes you can make to lower your blood pressure naturally and bring your numbers back down into a healthy range.
Common causes of high blood pressure
Eating too many processed foods
Excessive sodium intake has a direct impact on blood pressure. “More salt equals more sodium in the blood, which then pulls water from the surrounding tissues into your vessels and increases blood volume,” said Dr. Beniaminovitz. “More blood volume leads to higher blood pressure.”
But if you’re thinking, I don’t even use that much salt, it’s probably still hiding elsewhere in your diet. According to the Centers for Disease Control and Prevention (CDC), Americans are consuming an average of 3,400 milligrams (mg) of sodium per day, which is well beyond the recommended cap of 2,300 mg per day. And of that, more than 70% of a person’s sodium intake comes from processed and restaurant foods, including things like bread, breakfast cereal, chips, cookies, pizza, canned beans and veggies, canned soups, and pasta sauce—not the salt shaker itself.
Additionally, a diet heavy in processed foods can cause weight gain, and “when people are overweight, the body has to pump blood to more tissue, which can increase blood pressure,” said Dr. Phillips. “We see an extremely large amount of high blood pressure in obese patients.”
BP fix: Choose fresh, whole foods whenever you can.
Instead of eating processed foods, load up on whole foods rich in beneficial nutrients, like vegetables, fruits, whole grains, legumes, fish, nuts, seeds, and olive oil, suggested Dr. Beniaminovitz. Potassium and magnesium are both minerals that help blood vessels relax, which in turn can help lower blood pressure; and research links high-fiber diets to significant reductions in systolic blood pressure.
If you want to follow a specific dietary plan that’s been proven to lower blood pressure, Dr. Beniaminovitz recommended either the DASH (Dietary Approaches to Stop Hypertension) diet or a well-formulated Mediterranean Diet.
Regularly having more than one alcoholic drink per day
For people who already drink, moderate alcohol consumption (one drink a day for women, two a day for men) is often not a problem, and some research suggests it may even help prevent heart disease. However, heavier alcohol consumption—especially frequent binge drinking episodes—can lead to chronically elevated blood pressure, said Dr. Phillips.
BP fix: Sip in moderation.
Aim for just one drink at a time—that’s 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of spirits. And if it’s really more about the ritual than the alcohol itself, consider periodically swapping out your glass of cabernet for a kombucha or other non-alcoholic option.
Sitting too much
Leading a sedentary lifestyle can mess with just about every aspect of your health, and your cardiovascular health is no exception. “Being sedentary leads to elevated blood pressure, both indirectly and directly,” said Dr. Beniaminovitz. Sedentary people tend to be overweight or obese, and as mentioned above, weight is one of the main driving causes of high blood pressure.
Additionally, getting regular aerobic activity helps you maintain a healthy blood pressure by making blood vessels more compliant (or flexible) and less sensitive to hormonal influences, he explained—so a lack of such activity may accelerate arterial hardening, forcing the heart and blood vessels to work that much harder.
BP fix: Move your body.
A research analysis of nearly 400 studies suggests that regular exercise could be as effective as commonly prescribed blood pressure drugs. “In the pantheon of physical activity, aerobic exercising is the best for blood pressure,” said Dr. Beniaminovitz. The AHA recommends aiming for at least 150 minutes of moderate aerobic exercise per week (about 20 to 30 minutes a day), such as biking, brisk walking, swimming, a barre class, or even higher-speed varieties of yoga like vinyasa.
High levels of stress
From an evolutionary standpoint, stress hormones like cortisol and adrenaline are released into the blood to help us escape danger (to fight or flee). They increase heart rate, elevate blood pressure, constrict blood vessels, and enlarge our pupils to help us think and move fast, explained Dr. Beniaminovitz.
In the past, the stressful event was typically over pretty quickly—but today, relentless work demands, overbooked schedules, challenging relationships, and even social media have led to an epidemic of chronic stress, which triggers the same release of stress hormones. But unlike our ancestral past, there’s often no reprieve—and thus, blood pressure may remain elevated.
BP fix: Find your happy place.
Physical activity is one of the most effective ways to reduce levels of stress hormones and minimize their impact on blood pressure, said Dr. Beniaminovitz. Mindfulness practices like deep breathing, meditation, and yoga, or even reading a book or listening to your favorite music, can also keep stress hormones in check.
You may also need to cut out certain activities, like checking those work emails at all hours. “People have to get to know themselves and their triggers, and how they may be able to remove themselves from situations that increase stress and anxiety,” said Dr. Phillips.
Loneliness or social isolation
You may not necessarily feel stressed when you experience loneliness or social isolation, but these feelings—when they persist—can trigger the same dangerous release of stress hormones that spike blood pressure, said Dr. Beniaminovitz. Not to mention, chronic loneliness is associated with depression, and research has shown a correlation between depression and the subsequent development of high blood pressure.
BP fix: Make plans to socialize.
“We are social beings and we need a certain amount of social interaction to function optimally,” said Dr. Beniaminovitz. But if the idea of putting yourself out there seems impossible, start small. Send a friend a quick DM to say you’re thinking of them and see where things go. Combine physical activity and social time by committing to a weekly Saturday morning yoga class with a pal. Want to make new friends? Try volunteering to meet like-minded people.
Sleep apnea or poor sleep quality
In general, inadequate sleep may lead to high blood pressure by increasing stress hormones or by increasing your cravings for junk food and thus contributing to weight gain, said Dr. Beniaminovitz. But the biggest sleep-related cause of hypertension is obstructive sleep apnea (OSA)—a disorder that causes someone to stop breathing for brief periods of time while sleeping due to an obstruction of their upper airway.
“With higher obesity rates, more and more people are developing OSA,” said Dr. Phillips. “This leads to broken sleep and decreased oxygen levels in the body, and part of the body’s response is to increase blood pressure.” In fact, it’s estimated that half of people with hypertension also suffer from OSA. Some signs you may have sleep apnea? Your partner says you snore or gasp in your sleep and you’re always tired despite going to bed at a reasonable hour.
BP fix: See a sleep doctor.
If you suspect OSA, see your doctor ASAP so they can conduct a sleep study in which your oxygen levels will be measured throughout the night, suggested Dr. Phillips. If you are diagnosed, you will likely be prescribed a CPAP (continuous positive airway pressure) machine to wear over your mouth and nose at night to help you breathe.
Certain health conditions and medications
If you do have high blood pressure, your doctor will likely take into consideration the range of other diseases and disorders that, when poorly managed, cause your blood pressure to become elevated. These include thyroid problems, renovascular disease, Cushing’s syndrome, and a number of others. “The key to all these conditions is the correct diagnosis,” said Dr. Beniaminovitz. “When the proper diagnosis is made, working with your doctor to reverse and/or treat these conditions often cures high blood pressure.”
Additionally, a number of common medications can increase blood pressure such as antidepressants, decongestants, St. John’s Wort, oral contraceptives, NSAIDs, and prednisone, per the Mayo Clinic.
BP fix: Monitor your symptoms.
If your doc says your BP is high, bring up any strange symptoms that could indicate an underlying cause (for example, if you’re experiencing weight gain, exhaustion, and hair loss, these are all subtle symptoms of a thyroid problem), and always provide them with a list of your current medications and supplements.
If your meds are the issue, “ideally they would be discontinued or changed to ones that have no or less effect on blood pressure,” said Dr. Beniaminovitz. “If a change in medication is not possible, often your doctor will prescribe optimal lifestyle and blood pressure medication to combat the effects.”
A family history of hypertension
Genes do play some role in high blood pressure, which is why younger people in seemingly great health can still be diagnosed with hypertension, said Dr. Phillips. However, more often than not, it’s also likely that people with a family history of high blood pressure share common environments (similar diets, similar sedentary lifestyles, etc.) that increase their risk—and these are very much modifiable.
“Our genes also interact with the environment and we can influence them by the choices we make,” said Dr. Beniaminovitz. “While lifestyle changes may not help you in never developing high blood pressure if you have a strong family history, optimal lifestyle will aid in delaying the onset and the need for early medications. Instead of developing high blood pressure in your 30s or 40s, with optimal diet and lifestyle you may delay the onset of high blood pressure to your late 60s or 70s.”
BP fix: Make the changes above.
There’s no magic bullet, but if you have a strong family history, that’s even more reason to implement all of the dietary and lifestyle recommendations above—eat whole foods, move your body more, manage stress—and get your blood pressure checked regularly.
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