What causes high blood pressure? Hypertension (as high blood pressure is also known) is a complex condition driven by multiple possible factors including genetics, smoking, obesity, aging, salt intake, alcohol consumption, and a sedentary lifestyle. Some of those factors, such as genetics and aging, are beyond an individual’s control, while others, like alcohol consumption and a lack of exercise, are what we call “modifiable risk factors,” since we do have the power to change them. Anxiety, also known as emotional stress, is a hypertension risk factor that falls into a gray area. We have a certain amount of control over the stress in our lives, and we have some control over how we deal with stress, but no one’s life is stress-free, nor do we usually get to choose what to be stressed about.

The Stress/Blood Pressure Connection

When we feel stressed-out or anxious, our autonomic nervous systems flood our bloodstreams with chemicals such as adrenaline and cortisol that once helped our ancient ancestors get out of dangerous situations by prompting a sudden increase in blood pressure and heart rate. This physiological reaction is known as the “fight or flight” response. When our distant forbears were being chased by a predator, for example, fight-or-flight gave them the burst of wild energy they needed to get to safety. Afterward, the heart rate slowed and the blood pressure returned to normal.

Unfortunately, today many of us live with constant stress that’s not as exciting as being chased by a predator but that can still trigger the fight-or-flight response. Enduring a constant gnawing anxiety about money, dreading the outbursts of an unreasonable boss, worrying that you’ll forget something important during your hectic day…any of these things can keep you in a state of heightened anxiety that raises your blood pressure and keeps it there day in and day out. The long-term toll on your cardiovascular system can be devastating. Fight-or-flight is adaptive and healthy in brief emergencies, but we weren’t made to live with it “turned on” all the time.

Stress Can Be Subtle

We’re so good at suppressing our anxious feelings that many of us are walking around with chronic anxiety without even realizing it. An example of just how subtle anxiety can be is the phenomenon known as white coat hypertension, in which a patient’s blood pressure reads normal when taken at home but is elevated when read in a healthcare setting. Many people with white coat hypertension would tell you that they’re not anxious about being in the doctor’s office, yet stress is the most likely explanation for the phenomenon. And even if you don’t feel nervous around doctors, you may have had a stressful time getting to your appointment, you might be worried about the other errands you have to run today, and so on. These small worries can manifest in an elevated blood pressure reading.

Make Some Tough Decisions

Battling stress and lowering blood pressure should begin with a careful examination of your life. Are there things you can do to remove unnecessary stressors? Is it possible to switch jobs? To cut back on a volunteer activity or church commitment? To exit a toxic relationship? To say no to requests from your children’s school? Only you can decide what to leave in and what to leave out, but making even one or two such changes can help you recover a lost feeling of empowerment and make your other stressors easier to bear.

Get Moving

One of the most effective ways of releasing stress while managing your blood pressure is exercise. Aerobic exercise (the kind that gets your heart beating faster) has been shown to be as effective as some blood pressure medications. And as a stress relief, exercise of any kind can make an enormous difference in how you feel. The trick is to find something you enjoy doing so that you’ll seek it out consistently. It doesn’t have to be an impressive, highly physical activity. Gardening, after-dinner walks, bike rides, dancing…anything that gets you moving will burn both calories and stress, which is doubly good for your blood pressure and heart health.

Good Sleep

How much and how well you sleep is closely tied to your blood pressure, to your feelings of anxiety and to your ability to manage stress. Adults should get at least seven hours of sleep per night and should keep the same waking and rising times throughout the week. If you suspect you have a sleeping disorder such as obstructive sleep apnea, talk to your doctor about getting help. And if your anxiety is causing insomnia or disrupted sleep, consider seeing a sleep specialist and perhaps a psychotherapist.

Eat Well

The foods we eat are not immediately related to stress. In other words, there are no “stress-busting” nutrients. But we do know that what we eat affects the way we feel. When we’re putting nutritious foods into our bodies, we feel less anxious, partly because we know we’re not compounding our stress by making ourselves feel out of control and guilty about our health. Eating a Mediterranean or DASH diet is therefore a good tool for stress management.

Anxiety’s Revolving Door

One of the troubling aspects of stress as a driver of hypertension is that when we’re anxious, we’re less inclined to engage in the kinds of behaviors that are good for our blood pressure. Stressed-out people tend to binge-eat the worst foods, they smoke, they drink, they sleep poorly and they usually don’t feel like exercising. Yet those are the very things that you must try to do to keep stress at bay and limit its impact on your blood pressure. Even doing a little bit helps. Try switching one negative behavior for one positive behavior at a time. Let the momentum and good feeling you get from small changes propel you toward larger ones.

Enlist Help

It’s very difficult to reduce the negative effects of stress all by yourself. Seek out someone to help you in your journey, as a sounding board or advisor. A friend, a family member or professional counselor could help you see things from a different perspective and lift the emotional load that’s taking its toll on your blood pressure. Therapists can share with you breathing exercises and other techniques to help manage stress and lower blood pressure when you’re feeling overwhelmed. If you show symptoms of high anxiety, a therapist might also prescribe anti-anxiety medications.

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