How do you lower diastolic blood pressure?
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Losing weight, eating less sodium, drinking less alcohol and exercising regularly lower both numbers, but diastolic (the bottom number) usually drops less than systolic (the top number). If your diastolic averages 80 or higher over a home week, that’s a reason to see a doctor.
What the trials found for diastolic pressure
These are average changes in mmHg from trials. Your own result will be different, and you can’t just add the rows together.
| What changed | Diastolic | Systolic | Group studied |
|---|---|---|---|
| Isometric training, such as wall sits | 4.0 lower | 8.2 lower | 270 exercise trials |
| Dynamic resistance training | 3.0 lower | 4.6 lower | Same |
| Combined aerobic and resistance training | 2.5 lower | 6.0 lower | Same |
| Aerobic training | 2.5 lower | 4.5 lower | Same |
| High-intensity intervals | 2.5 lower | 4.1 lower | Same |
| Weight loss, per kg lost | 0.9 lower | 1.05 lower | 25 weight trials pooled |
| DASH eating pattern, 8 weeks | 5.5 lower | 11.4 lower | People with hypertension |
| Low-sodium week against high-sodium week | 3 lower | 8 lower | 213 middle-aged and older adults |
| Cutting alcohol by about half | 4.0 lower | 5.5 lower | People who had 6 or more drinks a day |
Weight loss lowers diastolic almost as much as systolic, kg for kg. In the exercise review, running ranked first of the specific types for diastolic, and wall squats ranked first for systolic. Most trials didn’t test these types against each other directly, so the rankings are partly worked out from indirect comparisons. Pick the exercise you’ll keep doing.
Age changes which number predicts risk
In the Framingham study, diastolic was the strongest predictor of heart disease risk in people under 50. As people get older, systolic takes over (see systolic and diastolic for why).
A high diastolic with a normal systolic is called isolated diastolic hypertension. In a large 2020 analysis using the 2017 US definition, researchers found no significant rise in cardiovascular risk from this pattern alone. But that’s an average across groups, so it doesn’t mean any one person is in the clear. If your home average is high, you should still see a doctor.
What a doctor may check
If your average stays high, ask your doctor about causes that need their own treatment. One is untreated sleep apnea, so bring it up if you snore or wake up tired. In one long study, people with moderate or worse sleep-disordered breathing had 2.89 times the odds of getting hypertension later. Doctors may also check for thyroid, kidney and adrenal causes.
Next step
Take a home week, change one thing from the how-to, then repeat the week and compare. Keep taking any prescribed medication as directed.
If you have chest pain, shortness of breath, back pain, weakness, numbness, vision change or trouble speaking, call emergency services, whatever your number is.
9 sources
- Edwards JJ et al., exercise training and resting blood pressure, British Journal of Sports Medicine, 2023pubmed.ncbi.nlm.nih.gov
- Neter JE et al., weight reduction and blood pressure, Hypertension, 2003pubmed.ncbi.nlm.nih.gov
- Appel LJ et al., DASH trial, New England Journal of Medicine, 1997pubmed.ncbi.nlm.nih.gov
- Gupta DK et al., Effect of Dietary Sodium on Blood Pressure, JAMA, 2023jamanetwork.com
- Roerecke M et al., reduction in alcohol and blood pressure, Lancet Public Health, 2017pubmed.ncbi.nlm.nih.gov
- Peppard PE et al., sleep-disordered breathing and hypertension, New England Journal of Medicine, 2000pubmed.ncbi.nlm.nih.gov
- McEvoy JW et al., isolated diastolic hypertension, JAMA, 2020pubmed.ncbi.nlm.nih.gov
- Franklin SS et al., blood pressure and coronary risk with aging, Circulation, 2001pubmed.ncbi.nlm.nih.gov
- McEvoy JW et al., 2024 ESC Guidelines for the management of elevated blood pressure and hypertension, European Heart Journal, 2024academic.oup.com
