Hypertension can be effectively treated with lifestyle modifications, medications, and natural remedies. Most people with hypertension experience improvement with prescription treatment such as diuretics, ACE inhibitors, beta-blockers, or other options, and some may require more than one prescription medication to reach optimal blood pressure. If your hypertension has a medical cause (secondary hypertension), you may also need treatment for medical issues that are contributing to your high blood pressure.
Home Remedies and Lifestyle
Often, hypertension can improve with lifestyle changes. In some cases, high blood pressure can go down to normal levels with only lifestyle modifications, particularly if you have stage 1 hypertension (systolic blood pressure of 130 mmHg to 159 mmHg, or diastolic blood pressure 80 mmHg to 99 mmHg), or if you have elevated blood pressure (systolic blood of 120 mmHg to 129 mmHg and diastolic less than 80 mmHg).
If you have extremely high blood pressure, lifestyle modifications can reduce your blood pressure, though likely not to optimal levels.
Smoking is one of the leading factors that causes and worsens hypertension. If you smoke and have hypertension, you may experience a substantial improvement in your blood pressure if you quit.
If you are overweight, losing weight can help reduce your blood pressure. With some persistence, most people can do so using a combination of diet and exercise. Bariatric surgery, which may be necessary for some individuals, has also been shown to improve hypertension.
Foods that are high in water content, such as fresh fruits and vegetables, help maintain fluid and electrolyte balance, which can help keep blood pressure at ideal levels. Fruits and veggies also contain antioxidants, which help prevent damage to your blood vessels and related vascular disease, which often presents with hypertension.
The Dietary Approaches to Stop Hypertension (DASH) diet is low in saturated fat, cholesterol, red meat, and sugar, and is considered to be a good dietary approach to maintaining your optimal blood pressure. This diet emphasizes vegetables, fruits, low-fat dairy, whole grains, lean protein, nuts, and legumes.
Regular physical activity can help maintain optimal blood pressure, even if you do not need to exercise for weight loss. The cardiovascular, hormonal, and cholesterol changes that result from exercise are all believed to contribute to maintaining a healthy blood pressure.
A diet that is low in sodium can help lower your blood pressure. Excess salt has been shown to increase blood pressure for some people, but not for everyone.
It’s best to get advice from a dietician regarding your salt intake. Some people need to have a moderate salt intake, while some need to consume a very low-salt diet to keep blood pressure from getting too high.
There are many prescription medications used for the treatment of hypertension. These medications fall into categories based on their different mechanisms of action.
According to the American College of Cardiology and the American Heart Association, the goal of blood pressure treatment is to attain a blood pressure reading that’s less than 130/80 mmHg systolic and less than 80mmHg diastolic. In general, if you have hypertension, it is likely that you will need to be treated for the duration of your life to maintain this target blood pressure.
Diuretics also referred to as water pills, increase the amount of fluid excreted in the urine. They are believed to lower blood pressure by reducing the volume of fluid circulating in the blood vessels.
Side effects include low potassium levels, frequent urination, and worsening of gout. Examples of these drugs include:
- Diamox (acetazolamide)
- Thalidone, Tenoretic, and Clorpres (chlorthalidone)
- HydroDiuril, Microzide, and Esidrix (hydrochlorothiazide)
- Lozol (indapamide)
- Zaroxolyn, Mykrox (metolazone)
Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure by dilating (widening) the arteries. Side effects include cough, decreased sense of taste, and elevated potassium levels. Examples of ACE inhibitors include:
- Lotensin (benazepril)
- Capoten (captopril)
- Vasotec, Vaseretic (enalapril)
- Monopril (fosinopril)
- Prinivil, Zestril (lisinopril)
- Univasc (moexipril)
- Accupril (quinapril)
- Altace (ramipril)
- Mavik (trandolapril)
Calcium channel blockers reduce blood pressure by dilating the arteries and reducing the force of the heart’s contractions. Side effects include constipation, leg swelling, and headaches. Examples include:
- Norvasc, Caduet, and Lotrel (amlodipine)
- Cardizem, Dilacor, and Tiazac (diltiazem)
- Plendil (felodipine)
- DynaCirc (isradipine)
- Cardene (nicardipine)
- Procardia XL, Adalat (nifedipine)
- Sular (nisoldipine)
- Isoptin, Calan, Verelan, and Covera (verapamil hydrochloride)
Beta blockers decrease the effect of adrenaline on the cardiovascular system, slow the heart rate, and reduce stress on the heart and the arteries. Side effects include worsening shortness of breath if you have chronic obstructive pulmonary disease or asthma; sexual dysfunction; fatigue; depression; and worsening of symptoms if you have peripheral artery disease. Beta-blocker examples include:
- Sectral (acebutolol)
- Tenormin (atenolol)
- Kerlone (betaxolol)
- Zebeta, Ziac (bisoprolol)
- Cartrol (carteolol)
- Coreg (carvedilol)
- Normodyne, Trandate (labetalol)
- Lopressor, Toprol (metoprolol)
- Corgard (nadolol)
- Levatol (penbutolol)
- Inderal, Inderal LA (propranolol)
- Blocadren (timolol)
Angiotensin II receptor blockers (ARBs) reduce blood pressure by dilating the arteries. Side effects include allergic reactions, dizziness, and high potassium levels. ARBs include:
- Atacand (candesartan)
- Avapro (irbesartan)
- Cozaar (losartan)
- Micardis (telmisartan)
- Diovan (valsartan)
Lotensin (minoxidil) is a vasodilator. It works by causing blood vessels to relax and widen, which lowers the pressure necessary to push blood through them. Minoxidil doesn’t act directly on the blood vessels. It stimulates the action of an enzyme to produce chemicals that facilitate the relaxation of blood vessels.
Side effects include swelling, low blood pressure, dizziness, nausea, loss of appetite, and unwanted hair growth.
Monotherapy and Combination Therapy
Use of a single antihypertensive medication is referred to as monotherapy. If one medication is not effective or if it causes intolerable side effects, your doctor may switch to another monotherapy, and then to a third, if necessary.
If three or more attempts at monotherapy do not lower your blood pressure without causing adverse side effects, the next step is combination therapy with two or more prescription antihypertensives. Sometimes, combining medications that have a different mechanism of action can enhance the therapeutic effects without exacerbating the side effects.
Resistant hypertension is defined as blood pressure that remains well above the target goals despite the use of optimal, three-drug therapy.
There are a few things that can cause resistant hypertension:
- Not taking medications as prescribed
- Secondary hypertension
- Fluid retention, often the result of kidney failure
If you have resistant hypertension, your doctor will ask about whether you are taking your medications as prescribed; options and/or doses may be adjusted.
You may also or instead need medical treatment for another condition that could be causing your high blood pressure, such as sleep apnea, chronic kidney disease, or aldosteronism (excess hormone production in the adrenal glands).
Complementary Medicine (CAM)
There are some natural remedies that may lower blood pressure, particularly if you have pre-hypertension.
- Garlic: Garlic has long been thought to reduce hypertension. Studies show that garlic extract can lower blood pressure, although the optimal dose, frequency, and form are not well established. Garlic may produce this effect by acting directly on the kidneys to eliminate excess salt. It is considered a safe spice to consume, although it can cause some stomach upset.
- Magnesium: Magnesium, which is present in nuts, seeds, avocado, and green leafy vegetables, has also been proposed as a natural way to reduce blood pressure. Supplements are also available in pill form. Studies show that higher levels of magnesium are associated with lower blood pressure, but it is still not completely clear whether there is a cause-and-effect relationship.
- Fish oil: Eating fish regularly is associated with lower high blood pressure. The use of fish oil pills has also been studied, and it is not clear whether consuming pills has the same effect as consuming fish.
- Stress control and relaxation: Stress and anxiety raise blood pressure temporarily. Methods of stress control are believed to lower blood pressure in the short-term, and studies suggest that this effect may also work to reduce hypertension in the long-term as well.
While some of the numerous herbal remedies out there may reduce blood pressure, some can raise it. If you are using herbal remedies, be sure to familiarize yourself with side effects and medication interactions and discuss them with your doctor.
Hypertension Doctor Discussion Guide
Get our printable guide for your next doctor’s appointment to help you ask the right questions.
There are no over-the-counter medications for lowering your blood pressure. However, there are a number of options that can actually cause high blood pressure as a side effect. Though this doesn’t happen to everyone who uses these medications, this may be a concern for you, especially if you are taking a drug for the first time.
The most common types of OTC medications that can cause high blood pressure include:
- Non-steroidal anti-inflammatories (NSAIDs): Medications such as Ibuprofen and aspirin can raise blood pressure for some people.
- Decongestants: Some decongestants contain pseudoephedrine or phenylephrine, stimulants that raise blood pressure.
- Weight loss supplements/appetite suppressants: Many of these over-the-counter products contain stimulants and/or caffeine, both of which raise blood pressure.
- Caffeine-containing stimulants/energy pills: Pills used to maintain alertness or to stay awake typically contain caffeine as the active ingredient.