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High & Low Blood Pressure

Nearly half of U.S. adults have high blood pressure, and most don’t have it under control. It usually causes no symptoms, so checking is the only way to know. Everyday habits and, for many people, medicine lower it — and a reading above 180/120 with symptoms is an emergency.

Call 911 now if your blood pressure is above 180/120 and you have any of these symptoms: chest pain, shortness of breath, back pain, numbness, weakness, a change in vision, or difficulty speaking. This is a hypertensive emergency. Don’t wait to see whether your blood pressure comes down on its own (American Heart Association). NHLBI also lists a sudden, severe headache and sudden, severe pain in the abdomen (NHLBI).

Above 180/120 with no symptoms? Wait at least a minute and measure again. If it is still that high and you have no symptoms, this is severe hypertension: contact your health care professional as soon as possible (AHA). Blood pressure this high can damage your organs (NHLBI).

Signs of a stroke — call 911 right away: sudden numbness or weakness in the face, arm or leg (especially on one side); sudden confusion, trouble speaking or understanding speech; sudden trouble seeing; sudden trouble walking, dizziness or loss of balance; or a sudden severe headache with no known cause. Note the time symptoms started, and call an ambulance rather than driving (CDC).

During or after pregnancy, call 911 for a severe headache, change in vision, abdominal pain, chest pain, significant swelling or shortness of breath with high blood pressure (AHA).

Low blood pressure: if someone faints (passes out), get help right away or call 911; if they aren’t breathing or have no pulse, begin CPR (MedlinePlus). Cold, sweaty skin, rapid breathing, a bluish skin tone or a weak, rapid pulse can be signs of shock — call 911 (NHLBI).

Never wait for a chiropractic, acupuncture or massage appointment for any of these signs.

What do the numbers mean?

Blood pressure is the force of blood pushing against the walls of your arteries. It is written as two numbers, such as 120/80 mm Hg (“120 over 80”). The first, systolic, number is the pressure when your heart pumps; the second, diastolic, number is the pressure between beats, when the heart is filling (NHLBI). Blood pressure changes throughout the day with your activities, so a diagnosis depends on readings that are consistently high (CDC).

Most U.S. health care professionals use categories from the American College of Cardiology (ACC) and American Heart Association (AHA) guidelines (CDC). The AHA’s current chart (AHA):

  • Normal: less than 120 and less than 80.
  • Elevated: 120–129 and less than 80.
  • Stage 1 hypertension: 130–139 or 80–89.
  • Stage 2 hypertension: 140 or higher or 90 or higher.
  • Severe hypertension: higher than 180 and/or higher than 120, without symptoms — call your health care professional.
  • Hypertensive emergency: higher than 180 and/or higher than 120, with symptoms — call 911.

NHLBI and MedlinePlus use the same first four categories and still call the top row “hypertensive crisis” (NHLBI, MedlinePlus). Only a doctor or other medical professional can confirm a diagnosis of high or low blood pressure (AHA). As people get older, systolic pressure usually rises as large arteries stiffen, and after age 50 the systolic number says more about heart disease risk (AHA).

The 2025 guideline update

In 2025 the AHA, ACC and eleven other professional groups (including the American Medical Association) published a new high blood pressure guideline that “retires and replaces” the 2017 ACC/AHA guideline (AHA/ACC guideline, 2025, ACC/AHA guideline, 2017). What it means in practice:

How common is it?

Very. Nearly half of U.S. adults (48.1%, about 119.9 million) have high blood pressure or take medicine for it, but only about 1 in 4 of them (22.5%) has it under control. In 2024 high blood pressure was a primary or contributing cause of 680,179 U.S. deaths (CDC). It is more common in men (50%) than women (42.1%) and in non-Hispanic Black adults (59.6%) than in Hispanic (44.9%), non-Hispanic white (44.8%) or non-Hispanic Asian (42.7%) adults (CDC). About 9 in 10 Americans will develop high blood pressure during their lifetime (CDC).

The “silent killer”

High blood pressure is often called a “silent killer” because you can have it and not know it (FDA). It usually has no warning signs, and measuring is the only way to know (CDC); about 1 in 6 adults with high blood pressure is unaware of it (CDC). Over time it can damage the heart, brain, kidneys and eyes (CDC). Untreated, it can lead to heart attack, heart failure, stroke, aneurysm, chronic kidney disease, eye damage and vascular dementia (NHLBI), and it is the leading risk factor for stroke (AHA).

What causes it?

Most of the time no single cause is found; this is called essential (primary) hypertension (MedlinePlus). It usually develops over time (CDC).

Medicines and products that can raise blood pressure: some antidepressants, decongestants (for a stuffy nose), hormonal birth control pills and NSAID pain relievers such as aspirin or ibuprofen (NHLBI); diet pills, some cold medicines, migraine medicines, corticosteroids, some antipsychotics and certain cancer medicines (MedlinePlus). When another condition or a medicine causes high blood pressure (secondary hypertension), it may improve once the cause is treated or removed (NHLBI). Some supplements raise it too — see the herbal section below.

How it’s diagnosed

  • NHLBI advises that everyone age 3 or older have their blood pressure checked by a provider at least once a year (NHLBI); MedlinePlus says yearly checks are recommended from age 40, and some adults 18 to 39 may be checked less often (MedlinePlus). Ask your provider what is right for you.
  • A diagnosis needs two or more readings at separate appointments (NHLBI). Before confirming it, your provider should ask you to have your blood pressure measured outside the office — at home or a pharmacy (MedlinePlus).
  • White-coat and masked hypertension: some people read higher in the office than at home, and others read lower in the office than at home; comparing office and home readings helps find both (NHLBI). As many as 1 in 3 people with a high office reading may have normal readings outside it (CDC).
  • Your provider will ask about your eating, activity, sleep, weight, stress, smoking and family history, and may order tests for related conditions, such as cholesterol, diabetes, kidney and heart tests (NHLBI, MedlinePlus).

Measuring your blood pressure at home

The AHA recommends home monitoring for everyone with high blood pressure, to show whether treatment is working; it can also help confirm a diagnosis. It doesn’t replace doctor visits, and you shouldn’t stop a blood pressure medicine because of home readings without checking with your health care professional (AHA). Home monitoring plus support from your care team helps people with high blood pressure lower it (CDC, Million Hearts).

Choosing a monitor: use an automatic, upper-arm cuff monitor — wrist and finger monitors give less reliable readings. Choose one that has been validated, make sure the cuff fits your arm, and take it to your next appointment so your provider can check it against the office equipment (AHA). The U.S. Validated Device Listing at validatebp.org, run under American Medical Association governance, lists devices tested for clinical accuracy (validatebp.org, Million Hearts).

Getting an accurate reading (CDC, AHA):

  • For 30 minutes before: don’t smoke, exercise, or have caffeine or other food and drink. Empty your bladder.
  • Sit in a chair with your back supported, feet flat on the floor and legs uncrossed, and rest quietly for at least 5 minutes. Don’t talk or use your phone.
  • Rest your arm on a table so the cuff is at heart (chest) level. Put the cuff on bare skin, snug but not too tight.
  • Measure at the same time each day. Take two readings 1 to 2 minutes apart and write them down or use the monitor’s memory.

Crossing your legs or letting your arm hang down can make a reading higher (CDC). A single high reading isn’t a reason for alarm — measure again, record both, and check with your provider (AHA).

Low blood pressure (hypotension)

Low blood pressure is a reading lower than 90/60 mm Hg (NHLBI). For many people it is normal and harmless; it is a problem only if it causes dizziness, fainting or, in extreme cases, shock (MedlinePlus). A low reading is usually not harmful unless there are other concerning symptoms (AHA).

  • Symptoms: dizziness or lightheadedness, fainting, confusion, blurry vision, feeling tired or weak, headache, neck or back pain, nausea, and heart palpitations (NHLBI).
  • Common causes: dehydration; blood loss; diabetes; heart problems such as an irregular or very slow heartbeat, valve problems or heart failure; pregnancy; prolonged bed rest or standing; Parkinson’s disease; an underactive thyroid or Addison’s disease; and anemia from low vitamin B12 or folic acid (NHLBI, AHA).
  • Medicines and alcohol: diuretics and other blood pressure medicines, some heart medicines, anti-anxiety medicines, some antidepressants, Parkinson’s medicines, painkillers, erectile dysfunction medicines (especially with nitroglycerin) and alcohol (MedlinePlus, AHA). Older adults are more likely to get low blood pressure as a side effect of blood pressure medicines (NHLBI).
  • Orthostatic (postural) hypotension is a drop in blood pressure when you sit up or stand. It can cause dizziness, feeling faint, blurry vision or a fall, especially when you get up suddenly, in the morning, after a large meal or alcohol, or when you are ill (CDC STEADI). It is linked to high blood pressure itself, diabetes, heart failure, hardening of the arteries, Parkinson’s disease, dehydration and some diuretics, antidepressants and blood pressure medicines (CDC STEADI). When it happens after eating, it is called postprandial hypotension (MedlinePlus).

What helps: if you feel faint, sit or lie down right away and raise your feet above heart level (MedlinePlus). Get up slowly — sit up first, then sit on the side of the bed before standing; move your feet and hands before you stand; hold on to something; don’t walk while dizzy; and avoid very hot baths and showers (CDC STEADI). Your provider may suggest more fluids (unless you have been told to limit them), compression stockings, or adjusting a medicine that lowers your blood pressure (NHLBI, CDC STEADI). Don’t stop any medicine before talking to your provider (MedlinePlus). Falls from low blood pressure can break a hip or spine in older adults (MedlinePlus) — see our balance and falls guide.

When to see a doctor: if your home readings stay high (MedlinePlus); if you think you have high blood pressure, or have it but it isn’t under control (CDC); or if low blood pressure makes you dizzy, nauseous or faint (AHA). With low blood pressure, call your provider right away if you have chest pain, dizziness or lightheadedness, fainting, an irregular heartbeat, shortness of breath, black or maroon stools, or a fever over 101°F (MedlinePlus).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Lifestyle changes for everyone; medicine (most often ACE inhibitors, ARBs, calcium channel blockers or thiazide-type diuretics, often two together) when lifestyle alone isn’t enough or risk is high. Regular checks and home monitoring. Medicare’s yearly Wellness visit includes a blood pressure check, and its cardiovascular behavioral therapy visit includes one too — $0 if your provider accepts assignment. Prescription costs: being researched. Most high blood pressure can be controlled with medicine and lifestyle changes. Many people need two or more medicines. Take them every day, even when you feel fine; never stop without your doctor.
Chiropractic Upper-neck (atlas) or full-spine adjustment has been promoted for blood pressure. Useful mainly for back and neck pain alongside medical care. About $50–$200 a visit without insurance; first evaluations $100–$250. Medicare Part B covers spinal adjustment for subluxation only (20% coinsurance). A 2007 pilot study reported large drops, but a 2016 sham-controlled trial found no effect and reviews find no reliable evidence. Neck manipulation carries a small, debated stroke risk.
Acupuncture Needle treatments, sometimes alongside blood pressure medicine. About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. Medicare covers acupuncture only for chronic low back pain. A Cochrane review found no evidence of a lasting blood pressure drop; short-term effects are uncertain. Newer reviews are mixed. Not a replacement for medicine.
Herbal medicine Garlic, hibiscus tea and beetroot (nitrate) have small studies. Several products raise blood pressure: licorice, bitter orange, ephedra, yohimbe, and decongestants. Cost estimate being researched. Garlic, hibiscus and beetroot show modest, uncertain drops in small trials, with no proof they prevent heart attack or stroke. Licorice can raise blood pressure even in small amounts. Check every product for interactions.
Massage therapy Relaxing, gentle massage as a comfort and stress-relief measure. About $60–$120 for 45–60 minutes with a private therapist, or $50–$90 at clinics, gyms and spas. Medicare doesn’t cover massage ordered by a chiropractor. Low-quality studies suggest small effects at most; a 2024 review found only a minimal reduction. Fine for relaxation, not as treatment.
MBHA Wellness Coach DASH-style eating, less sodium, more potassium-rich foods (if safe for your kidneys), activity, weight, alcohol limits, quitting smoking, sleep, stress and home monitoring with a log to share with your doctor. Coaching: being researched. Validated upper-arm home monitors were about $40–$65 in a 2023 report. Supports — never replaces — medical care. The DASH plan with less salt can lower blood pressure as much as medicine; aerobic exercise has stronger evidence than other alternative approaches.

Approach 1 of 6

Conventional medicine (AMA)

In the U.S., doctors follow the 2025 AHA/ACC high blood pressure guideline, written with the American Medical Association and other groups (AHA/ACC guideline, 2025). For most people, treatment combines heart-healthy lifestyle changes with medicine when needed, and your provider may use a risk calculator to estimate your chance of heart attack or stroke and guide the choice (NHLBI). You and your provider should set a blood pressure goal together, based on your age, other conditions and medicines (MedlinePlus).

1. What treatment usually looks like at each stage

2. Lifestyle first — and always

Every guideline strongly emphasizes lifestyle changes for everyone, whatever their blood pressure: less sodium, more physical activity and weight loss for people with excess weight are all top-level recommendations (ERBP commentary, 2026). NHLBI-funded research showed that the DASH eating plan combined with a low-salt diet can be as effective as medicine in lowering high blood pressure (NHLBI). Keep these habits up even after you start medicine (NHLBI). The details are in the MBHA Wellness Coach and DASH eating plan sections below.

3. Medicines

Blood pressure medicines work in different ways: helping the body get rid of extra water and salt, relaxing blood vessels, making the heart beat with less force, or blocking nerve signals that tighten blood vessels (CDC). The main groups (NHLBI, CDC):

  • ACE inhibitors and angiotensin II receptor blockers (ARBs) keep blood vessels from narrowing as much.
  • Calcium channel blockers let blood vessels relax.
  • Diuretics (“water pills”) remove extra water and sodium; the main type for high blood pressure is the thiazide diuretic, often combined with another medicine in one pill.
  • Others include beta-blockers, alpha blockers, centrally acting medicines, renin inhibitors and vasodilators.

The first choices in current guidelines are ACE inhibitors or ARBs, long-acting calcium channel blockers and thiazide-type diuretics; guidelines recommend starting many people on a once-daily single pill that combines two medicines, to make it easier to take them consistently — except for people who are frail or have symptoms of low blood pressure on standing (ERBP commentary, 2026). Many people need two or more medicines (NHLBI). If you are pregnant or planning a pregnancy, talk with your provider — not all blood pressure medicines are safe in pregnancy, but some are (NHLBI).

We don’t list doses; your doctor or pharmacist will choose the medicine and amount for you.

4. Taking medicine consistently

  • Take your blood pressure medicine every day — even when your numbers come down and you feel fine — and don’t stop until your provider says it’s OK (FDA). Stopping without talking to your health care team could have serious consequences (CDC).
  • Most of the time these medicines cause no side effects; some people have mild dizziness, headaches, swelling in the legs or feet, or stomach problems (CDC). Common side effects often ease after the first few weeks; if they don’t, tell your provider (FDA), who can change the dose or try another medicine (NHLBI).
  • Some over-the-counter medicines, such as nasal decongestants, can raise blood pressure and interact with blood pressure medicines — tell your doctor about every medicine and supplement you take (CDC).
  • Ask your provider or pharmacist about apps and text reminders for taking medicine and refilling prescriptions (NHLBI).

5. Regular checks

Keep up regular follow-up visits and tests, tell your provider about new conditions or medicines, and share your home readings (NHLBI, CDC). Your provider may need to change or add medicines over time (NHLBI).

Who treats high blood pressure

Your primary care provider usually leads, and may involve a nutritionist or dietitian, a pharmacist, and specialists for other conditions you have, such as heart conditions (NHLBI).

What it costs

  • Medicare yearly “Wellness” visit: includes routine measurements such as blood pressure and a review of your prescriptions. You pay nothing if your provider accepts assignment; it is covered once every 12 months (Medicare.gov).
  • Medicare cardiovascular behavioral therapy: a primary care visit in which your doctor may check your blood pressure and give you diet and exercise tips. You pay nothing if your primary care provider accepts assignment (Medicare.gov).
  • Home monitor: see the MBHA Wellness Coach section.
  • Prescription medicines: MBHA cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Some chiropractors — especially those who focus on the top bone of the neck (the atlas, or “upper cervical” care) — have promoted adjustments as a way to lower blood pressure. Here is what the research actually shows.

What the research says

  • The 2007 pilot study: 50 people with stage 1 high blood pressure, not taking medicine, received either a National Upper Cervical Chiropractic (NUCCA) atlas correction or a sham procedure. After 8 weeks, systolic pressure fell an average of 17 mm Hg in the NUCCA group versus 3 mm Hg with the sham, and the authors reported large, sustained reductions (Bakris et al., 2007). It was a small, single-center pilot.
  • The 2016 sham-controlled trial: 51 people with mildly high blood pressure had a different upper-neck technique (toggle recoil) or a sham procedure twice a week for 6 weeks. The adjustment did not lower systolic or diastolic blood pressure compared with the sham, and the researchers said their results did not support a larger trial (Goertz et al., 2016).
  • Reviews: a 2012 systematic review of 10 studies found a lack of low-bias evidence for spinal manipulation as a treatment for high blood pressure; the studies at higher risk of bias showed the bigger effects (Mangum et al., 2012). A 2021 review found only 6 good-quality studies of spinal manipulation for non-musculoskeletal conditions such as high blood pressure, and none showed a clear benefit (NCCIH).

In plain terms: one small early study looked promising, but a better-controlled trial did not confirm it, and there is no reliable evidence that chiropractic care lowers blood pressure. Chiropractic care may still help back or neck pain — see our back pain guide — but it should not replace blood pressure monitoring or prescribed medicine.

Safety

  • Mild, short-lived side effects — more pain or discomfort, stiffness or headache — are common and usually gone within 24 hours. Serious problems are very rare, and the risk may be higher in people with other health problems (NCCIH).
  • Neck manipulation and stroke: neck manipulation has been linked to small tears in the neck arteries (cervical artery dissection), which are rare but can cause a stroke. Experts disagree about whether manipulation actually causes these tears (NCCIH). Because upper-neck techniques are the ones promoted for blood pressure, ask about the risks and alternatives first.

As a precaution, MBHA suggests telling your chiropractor about your blood pressure and medicines, and never using an adjustment in place of care for the emergency signs above.

Medicare coverage

Medicare Part B covers only adjustments of the spine by a chiropractor to correct a subluxation, done by hand or with an “activator” device. It doesn’t cover other services or tests a chiropractor orders, such as X-rays, massage or acupuncture. You pay 20% of the Medicare-approved amount after the deductible (Medicare.gov).

What it costs

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Approach 3 of 6

Acupuncture

According to Traditional Chinese Medicine theory, acupuncture has the potential to lower blood pressure, and it has been tested in a number of trials (Cochrane review, 2018). The results are limited and mixed.

What the research says

  • Cochrane review, 2018: 22 randomized trials (1,744 people) found no evidence of a sustained blood-pressure-lowering effect — the one trial that looked found no effect at three and six months. Four sham-controlled trials gave very low-quality evidence of a small effect lasting 1 to 24 hours. Trials claiming acupuncture beat blood pressure medicines were at very high risk of bias, and the authors judged that result most likely reflected bias, not a true effect (Cochrane review, 2018).
  • American Heart Association, 2013: its review of alternative approaches gave acupuncture its lowest rating (Class III), behind device-guided breathing and well behind exercise (AHA scientific statement, 2013).
  • Newer reviews: a 2019 review of systematic reviews rated the evidence for most non-drug therapies as low quality, but gave a stronger recommendation for acupuncture added to blood pressure medicine (Niu et al., 2019). A 2026 meta-analysis of 15 randomized studies found a lower office systolic pressure at the end of treatment but no clear effect on diastolic pressure, with little data on 24-hour readings (Zhong et al., 2026).

In short: acupuncture has not been shown to lower blood pressure over the long term. If you try it, use it alongside — never instead of — your prescribed treatment, and keep checking your blood pressure.

Safety

Relatively few complications have been reported; problems have come from non-sterile needles and poor technique. The FDA requires acupuncture needles to be sterile and single-use, and most states license acupuncturists (NCCIH). In the Cochrane review, safety couldn’t be fully judged because only 8 of the trials reported side effects (Cochrane review, 2018). MBHA suggests telling your acupuncturist if you take a blood thinner.

Medicare coverage

Medicare covers acupuncture only for chronic low back pain, not for high blood pressure (Medicare.gov).

What it costs

Published cash prices run about $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90 a visit (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

Several foods and herbs have been studied for blood pressure. The effects found so far are modest and uncertain, the studies are small, and none has been shown to prevent heart attacks or strokes. Just as important: some herbs and supplements raise blood pressure or interact with blood pressure medicines.

What the research says

  • Garlic: limited evidence suggests garlic supplements may lower blood pressure to a small extent in people with high blood pressure (NCCIH). A Cochrane review found only two small trials, and not enough evidence to know whether garlic lowers the risk of heart attack, stroke or death in people with high blood pressure (Cochrane review, 2012). Garlic supplements may not be safe in pregnancy or breastfeeding in more than food amounts; talk with your provider first if you take a blood thinner, aspirin or any other medicine (NCCIH).
  • Hibiscus (sour tea): a 2022 meta-analysis of 17 trials found hibiscus lowered systolic pressure more than placebo, but the results varied widely between trials, and the authors said more research is needed on how much and for how long (Ellis et al., 2022).
  • Beetroot juice (dietary nitrate): a 2022 meta-analysis of 7 small trials (218 people with high blood pressure) found a modest drop in systolic but not diastolic pressure (Benjamim et al., 2022).
  • Coenzyme Q10: the small amount of evidence suggests it probably doesn’t have a meaningful effect on blood pressure, and it may interact with warfarin and insulin (NCCIH).
  • Hawthorn: promoted for the heart, but there is little or no quality evidence for most uses, and the FDA has warned that some “tejocote root” (Mexican hawthorn) products actually contained toxic yellow oleander (NCCIH).

Products that can raise blood pressure

  • Licorice root: its glycyrrhizin can cause serious effects such as an irregular heartbeat and cardiac arrest, and even small amounts have been linked to severe effects in people with high blood pressure, heart or kidney conditions, or a high-salt diet (NCCIH). A review of 18 studies found regular licorice intake raised blood pressure and lowered potassium (Penninkilampi et al., 2017), and a 2024 trial in healthy volunteers found home blood pressure rose even with a modest daily amount (af Geijerstam et al., 2024).
  • Ephedra (ma huang): the FDA banned dietary supplements containing ephedrine alkaloids in 2004; ephedra has been linked to high blood pressure, heart attack, seizure and stroke, even in low doses and short-term use (NCCIH).
  • Bitter orange (synephrine): often found in weight-loss products; some studies show it raises blood pressure and heart rate and others don’t, and heart attacks and strokes have been reported in people taking multi-ingredient products that contained it (NCCIH).
  • Yohimbe: linked to irregular heartbeat, blood pressure problems, heart attacks and seizures, and to high blood pressure in poison-center reports (NCCIH).
  • Decongestants and other medicines: nasal decongestants, NSAID pain relievers and diet pills can raise blood pressure (NHLBI, MedlinePlus). MBHA suggests asking a pharmacist before using cold and allergy products.
  • Interactions: there are uncertainties about whether ginseng interacts with calcium channel blockers and other blood pressure medicines (NCCIH).

Before you take any herb or supplement, show it to your doctor or pharmacist — especially if you take blood pressure medicine, a blood thinner, or several prescriptions, have kidney or heart disease, are pregnant or breastfeeding, or are planning surgery. “Natural” doesn’t always mean safe, and supplements may interact with medicines (NCCIH). We don’t list doses here. Never stop or reduce a prescribed blood pressure medicine in favor of an herb.

Approach 5 of 6

Massage therapy

Massage can feel relaxing, and some people use it to unwind. Its effect on blood pressure itself is small and uncertain.

What the research says

  • A 2015 review of 24 trials found some encouraging results — including when massage was added to blood pressure medicine — but most trials were of low quality, so the evidence remained weak, and safety was unclear (Xiong et al., 2015).
  • A 2019 review of systematic reviews gave massage one of its stronger recommendations among non-drug therapies, while rating the overall quality of evidence as generally low (Niu et al., 2019).
  • A 2024 meta-analysis of 6 studies (290 people) found only a minimal, uncertain reduction in blood pressure and called for more trials (Vijayakumar et al., 2024).

In short: enjoy massage for relaxation and muscle tension, but don’t count on it to treat high blood pressure.

Safety

The risk of harm appears low, but rare serious problems — a blood clot, nerve injury or broken bone — have been reported, sometimes with vigorous deep-tissue massage or in older adults (NCCIH). MBHA suggests telling your therapist about your blood pressure, any blood thinner, and any dizziness when you stand up, and getting up slowly from the table.

What it costs

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Daily habits make a real difference to blood pressure, and many people can bring it into a healthy range, or keep it there, with lifestyle changes (CDC). An MBHA Wellness Coach can help you build these habits one at a time — alongside, never instead of, your medical care. NHLBI suggests making one change at a time and adding another when you feel comfortable (NHLBI).

Eat the DASH way and cut sodium

  • The DASH eating plan has a proven record of helping people lower their blood pressure (CDC) — see the DASH eating plan section below.
  • Sodium limits: the federal recommendation for teens and adults is less than 2,300 mg of sodium a day, but Americans average more than 3,300 mg (CDC). The AHA says adults should have 2,300 mg or less, moving toward an ideal limit of less than 1,500 mg (AHA); MedlinePlus advises people with high blood pressure to aim for less than 1,500 mg (MedlinePlus). One teaspoon of table salt has about 2,400 mg of sodium (CDC).
  • Where it hides: over 70% of the sodium Americans eat comes from packaged and prepared foods, not the salt shaker (FDA). Top sources include deli meat sandwiches, pizza, soups, savory snacks, breads and rolls, and cheese (CDC).
  • Read labels: the Daily Value for sodium is less than 2,300 mg; 5% Daily Value or less per serving is low and 20% or more is high (FDA).

Potassium-rich foods — with a kidney caution

Potassium helps blunt the effects of sodium, and a diet too low in potassium can raise blood pressure (AHA, CDC). Fruits, vegetables, beans, potatoes and yogurt are good sources (CDC, AHA). But extra potassium can be harmful if you have kidney disease, a condition that affects how your body handles potassium, or take certain medicines. Ask your health care professional before eating a lot more potassium, taking a potassium supplement or using a potassium-based salt substitute (AHA).

Move more, sit less

Weight, alcohol and smoking

Sleep and sleep apnea

Not getting enough sleep regularly is linked to a higher risk of high blood pressure (CDC). Adults are advised to get 7 to 9 hours, with regular sleep and wake times, a calming bedtime routine and a cool, dark bedroom (NHLBI). Sleep apnea can cause high blood pressure (NHLBI, MedlinePlus) — if you snore loudly or are very sleepy in the day, ask your provider about it (AHA).

Stress

Stress raises blood pressure for a short time, and the links between long-term stress and blood pressure are still being studied; stress does feed habits such as poor eating and drinking too much (AHA). Long-lasting depression, anxiety, stress or PTSD can contribute to high blood pressure (CDC). Helpful habits include meditation, controlled breathing, yoga, regular exercise, at least 7 hours of sleep and staying connected with others (AHA) — see the Meditation, breathing, tai chi & yoga section below for the evidence.

Home monitoring and keeping a log

  • Measure correctly (see the checklist above), at the same time each day, and record two readings each time (AHA, CDC). A record over time gives a more complete picture than a single reading (AHA).
  • Bring your log — or the monitor’s memory — to appointments (AHA). Your provider uses readings over time to decide whether you need medicine (CDC).
  • Self-measured blood pressure (SMBP) programs: strong evidence shows that SMBP plus clinical support — one-on-one counseling, web or phone support, or classes — helps people with high blood pressure lower it (Million Hearts). Ask your clinic whether it offers one. A coach can help you stick with the routine and spot patterns to discuss with your doctor — but only your care team should change your treatment.

What it costs

Another approach

The DASH eating plan

DASH (Dietary Approaches to Stop Hypertension) is a flexible, balanced eating plan that needs no special foods (NHLBI). NHLBI-funded research showed that DASH combined with a low-salt eating plan can be as effective as medicine in lowering high blood pressure (NHLBI).

What it looks like

  • Eat vegetables, fruits and whole grains.
  • Include fat-free or low-fat dairy, fish, poultry, beans, nuts and vegetable oils.
  • Limit foods high in saturated fat, such as fatty meats, full-fat dairy and tropical oils (coconut, palm kernel and palm oils), and limit sugar-sweetened drinks and sweets.
  • Choose foods rich in potassium, calcium, magnesium, fiber and protein, and lower in sodium (NHLBI).

For a 2,000-calorie day, NHLBI’s example targets are 6–8 servings of grains, 4–5 of vegetables, 4–5 of fruit, 2–3 of low-fat or fat-free dairy, 6 or fewer of meat, poultry and fish, and 2–3 of fats and oils, plus 4–5 servings of nuts, seeds, dry beans and peas and no more than 5 of sweets a week. Sodium is kept to 2,300 mg a day, and 1,500 mg lowers blood pressure even further (NHLBI). Your own servings depend on your calorie needs (NHLBI).

The Mediterranean eating pattern and the Dietary Guidelines for Americans are other heart-healthy options your provider may suggest (NHLBI). If you have kidney disease, ask your provider or a dietitian before following a high-potassium plan (AHA).

What it costs

Cost estimate being researched.

Another approach

Meditation, breathing, tai chi & yoga

Mind-and-body practices are low-risk and can help with stress, but their effect on blood pressure is modest and the evidence is mixed. In 2013 the American Heart Association concluded it is reasonable for people with blood pressure above 120/80 to try such approaches alongside standard care when clinically appropriate (AHA scientific statement, 2013). If you have high blood pressure, keep following the treatment plan your provider prescribed (NCCIH).

What the research says

  • Meditation and mindfulness: few high-quality studies exist; meditation may have a possible benefit, but its specific effects on blood pressure haven’t been determined. A 2020 review of 14 studies linked mindfulness-based stress reduction with lower blood pressure in people with conditions such as hypertension (NCCIH). In the 2013 AHA review, Transcendental Meditation received a weak positive rating and other meditation techniques did not (AHA scientific statement, 2013).
  • Slow breathing and relaxation: a 2019 review of 17 studies found slow breathing exercises led to a modest reduction in blood pressure, though the studies were short and at high risk of bias (NCCIH). The AHA rated device-guided slow breathing higher than most other alternative approaches (AHA scientific statement, 2013). A Cochrane review of relaxation therapies found small reductions overall, but the evidence was weak and the effect largely disappeared in better-blinded trials (Cochrane review, 2008).
  • Tai chi: a 2020 review of 28 studies (2,937 people) found tai chi lowered systolic and diastolic blood pressure more than education or no treatment, but the studies were of poor quality and differed a lot (NCCIH).
  • Yoga: the 2013 AHA review did not find enough consistent evidence to recommend yoga for lowering blood pressure (AHA scientific statement, 2013). The AHA still lists yoga, meditation and breathing control among helpful ways to manage stress (AHA).

Safety

People with severe high blood pressure may need to avoid or modify some yoga poses and practices — talk with your provider and the instructor first (NCCIH). If you get dizzy when you stand, rise slowly from the floor or mat (CDC STEADI).

What it costs

Cost estimate being researched.

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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