How to lower your blood pressure
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Eating the DASH way, cutting sodium, regular exercise, losing excess weight and drinking less each lower systolic pressure (the top number) by a few points. Measure your pressure at home for a week before and after, and you’ll see what worked for you. Never change a prescribed medication on your own, and if a clinician who knows your history tells you something different, go with their advice.
If you have chest pain, shortness of breath, back pain, weakness, numbness, vision change or trouble speaking, call emergency services, no matter what your numbers are. If your systolic is 180 or higher, or your diastolic (the bottom number) is 120 or higher, and you have none of these, rest five minutes and measure again. If it stays that high, call your doctor the same day.
What lowers it, ranked by size
Most of these sizes come from the non-drug table in the 2017 US guideline, which gives one number for people with hypertension and one for people without. The rest come from trials.
| Change | Typical systolic change | Time until it shows | Confidence | Who it does not apply to |
|---|---|---|---|---|
| DASH eating pattern | About 11 mmHg with hypertension, 3 without (2017 table). 11.4 in the 1997 trial’s hypertension group (Appel) | Within 2 weeks (NHLBI) | High, from controlled feeding trials | Anyone with advanced kidney disease, without their care team, because of the potassium |
| Isometric holds, such as wall sits or hand grips | About 5 with hypertension, 4 without (2017 table). 8.2 pooled across trials (Edwards 2023) | 8 to 10 weeks at the guideline dose | Moderate. Trials are small | Heart failure, unstable heart disease, a recent cardiac event or stroke, or chest pain on exertion, until a doctor clears it |
| Aerobic exercise, 1.5 to 2.5 hours a week | About 5 to 8 with hypertension, 2 to 4 without (2017 table). 4.5 pooled (Edwards 2023) | Weeks. Pooled trials ran at least 2 weeks | High | A recent cardiac event needs clearance |
| Less sodium | About 5 to 6 with hypertension, 2 to 3 without (2017 table). 8 between a very low and a high sodium week (Gupta 2023) | 1 week (Gupta 2023) | High | If you have heart failure or take a water pill, agree on it with your care team first |
| Weight loss, if you carry excess weight | About 1 mmHg per kg (Neter 2003). 4.4 for about 5 kg | As the weight comes off. ENCORE measured it at 4 months | High | People who are not overweight, and anyone pregnant |
| Dynamic resistance training | About 4 with hypertension, 2 without (2017 table) | Weeks. Pooled trials ran at least 2 weeks | High | Same as aerobic exercise. Breathe through every lift |
| More potassium from food | About 4 to 5 with hypertension, 2 without (2017 table). 3.5 pooled, with the effect in people with hypertension (Aburto 2013) | By 8 weeks in DASH’s fruit and vegetable arm (2.8 mmHg) | High for food | Kidney disease or drugs that raise potassium, without a doctor. Don’t start supplements on your own |
| Less alcohol | 5.5 from 6 or more drinks a day, 3 from 4 to 5, 1.2 from 3, and no clear change at 2 or fewer, cutting by about half (Roerecke 2017) | Median trial lasted 4 weeks | High above 2 drinks a day | People at 2 drinks a day or fewer see little change. Heavy daily drinkers should talk to a doctor before stopping suddenly |
| Potassium salt substitute | 3.3 in about 21,000 older or post-stroke adults in rural China (Neal 2021) | Measured over about 4.7 years | High in that group | Trial excluded kidney disease, potassium-sparing drugs and potassium supplements. Ask a doctor first if any of those is you |
| Treating sleep apnea with CPAP | About 2.5 in the office (Pengo group 2024) | Not fixed. More hours of use go with a larger effect | Moderate | Only people with diagnosed sleep apnea |
| Slow-breathing devices | No clear effect in blinded comparisons (Landman 2014) | No result to wait for | Low | It’s fine for relaxing, but don’t count on it to change your average |
You can’t just add the sizes together when you combine changes. In the DASH-Sodium trial, DASH plus low sodium lowered systolic pressure by 11.5 mmHg in people with hypertension, and 7.1 without. In ENCORE, the drop in clinic pressure was 11.2/7.5 mmHg with DASH alone, and 16.1/9.9 mmHg when people added exercise and weight management. But that was a supervised program with weekly sessions, so you’d probably see less doing it on your own.
The plan
We put these steps in this order so the quickest and biggest changes come first. Test one change at a time when you can, so you know which one moved your average.
- Measure a home week. Take two measurements morning and evening for seven days, using the seven-day home week. Without a starting average you can’t tell whether anything worked.
- Bring drinking down to two a day or fewer if you drink more. The 2025 US guideline says ideally none, and at most two a day for men and one for women.
- Cut sodium. The 2025 US guideline says to keep it under 2,300 mg a day and work toward 1,500 mg. Most people get most of their sodium from packaged and restaurant food, so compare the labels on those.
- Move toward the DASH pattern. Eat more vegetables, fruit, beans, whole grains and low-fat dairy, and less saturated and total fat. Those foods also bring your potassium up toward the 3,500 to 5,000 mg a day the guideline suggests.
- Exercise most days. Aim for 1.5 to 2.5 hours a week of aerobic exercise, and add resistance training. Add isometric holds if you’re cleared for them, and keep breathing through each hold.
- Lose weight if you’re carrying extra. The 2025 US guideline sets a goal of losing at least 5 percent of your body weight.
- Ask about sleep apnea if you snore loudly and your morning numbers stay high. A sleep study can tell you if you have it.
If you take blood pressure medication
Make these changes on top of your medication. Keep taking every dose as prescribed. Bring your home averages to your prescriber, and tell them if you get dizzy when you stand up or your numbers are far below your usual. Any change to your medication is up to your prescriber.
If you are not on medication
Under the 2025 US guideline, adults at 130 to 139 over 80 to 89 with lower risk, meaning a PREVENT 10-year score under 7.5 percent, start with lifestyle changes. If your pressure is still up after 3 to 6 months, that’s when medication comes up. You and your doctor make that decision, and the advice is different if your risk is higher or your numbers are in stage 2.
If you are pregnant
This list doesn’t apply to you. Follow your care team’s schedule and thresholds.
How you know it worked
Repeat the home week the same way, with the same cuff, the same arm and the same times. Compare the two seven-day averages with the home average tool.
- Give it time. Wait as long as the table above says each change takes. Sodium can show in a week. Weight and exercise take longer.
- Allow for noise. Researchers who looked at 163 people found a week of home measurements gave the most repeatable result of any method. But even then, the average was only within about 8 to 10 mmHg of the true figure, with 80 percent confidence (Warren 2010). A shift of a few points between two weeks may just be noise. If a drop holds across several home weeks, it’s a real change.
- Change one thing at a time when you can, and write down the date you changed it.
When a doctor is the next step
| What you see | What to do |
|---|---|
| Any number with chest pain, shortness of breath, back pain, weakness, numbness, vision change or trouble speaking | Call emergency services now |
| 180 or 120 and up, no symptoms | Rest five minutes and measure again. If it stays that high, call your doctor the same day |
| A home week averaging 130/80 or higher | Book a visit and bring the sheet. See what 130/80 means and what 140/90 means |
| Faintness, dizziness on standing or numbers far below your usual | Call your doctor |
| Pregnant, or recently gave birth, with 140/90 or higher | Call your care team today. At 160/110 or higher, or with a severe headache or vision change, get care right away |
17 sources
- Whelton et al., 2017 ACC/AHA high blood pressure guideline, nonpharmacological table, 2017, as reproduced in the HSHS clinical guideline, 2019hshs.org
- ACC, New high blood pressure guideline press release on the 2025 AHA/ACC guideline, 2025acc.org
- ACC, New in Clinical Guidance: high blood pressure, 2025acc.org
- Appel et al., DASH trial, NEJM, 1997pubmed.ncbi.nlm.nih.gov
- Sacks et al., DASH-Sodium trial, NEJM, 2001pubmed.ncbi.nlm.nih.gov
- NHLBI, Why DASH Works, 2020internet-prod.nhlbi.nih.gov
- Gupta et al., CARDIA-SSBP, JAMA, 2023pmc.ncbi.nlm.nih.gov
- Edwards et al., exercise training and resting blood pressure, British Journal of Sports Medicine, 2023bjsm.bmj.com
- Neter et al., weight reduction and blood pressure, Hypertension, 2003researchinformation.umcutrecht.nl
- Aburto et al., potassium intake, BMJ, 2013pubmed.ncbi.nlm.nih.gov
- Roerecke et al., alcohol reduction and blood pressure, Lancet Public Health, 2017pmc.ncbi.nlm.nih.gov
- Neal et al., SSaSS, NEJM, 2021, as reported by the ACCacc.org
- Pengo group, CPAP and blood pressure, European Respiratory Society Congress abstract, 2024publications.ersnet.org
- Landman et al., device-guided breathing, JAMA Internal Medicine, 2014, as summarized by 2 Minute Medicine2minutemedicine.com
- Blumenthal et al., ENCORE, Archives of Internal Medicine, 2010pmc.ncbi.nlm.nih.gov
- Warren et al., variability of office, ambulatory and self-monitored blood pressure, British Journal of General Practice, 2010pmc.ncbi.nlm.nih.gov
- American Heart Association, When to call 911 about high blood pressureheart.org
