When healthcare professionals talk about why a person might develop high blood pressure, they usually avoid speaking in terms of direct “causes” and instead refer to “risk factors.” That’s because blood pressure has many potential drivers, some of them subtle, and it’s impossible to point to one factor as “the cause” of a person’s hypertension. Two seemingly identical people who share many of the same risk factors could end up with different blood pressure results.

Risk Factors Are Modifiable or Non-Modifiable

Some potential drivers of high blood pressure are outside of an individual’s control. These are called non-modifiable risk factors. For example, older age, African-American race, female gender and having parents or close relatives with hypertension all increase your risk for developing high blood pressure, but there’s nothing you can do to change them. However, having any or all of these non-modifiable risk factors does NOT make high blood pressure inevitable and certainly doesn’t mean that there is nothing you can do if you do develop hypertension. That’s because altering your modifiable risk factors—the potential drivers over which you do have control—is so effective in countering the non-modifiable factors.

Modifiable Risk Factor: Diet

In any discussion of modifiable risk factors for high blood pressure, what you eat and drink must take a front seat. That’s because salt (sodium) intake plays such a clear role in blood pressure, and because a healthy diet is crucial for staving off many of the conditions that either make high blood pressure more likely or become more dangerous when combined with hypertension. When you eat salt, its sodium content causes your body to retain fluid, which increases the volume of blood in your blood vessels. If you imagine an artery as a garden hose, it’s easy to see how a greater volume of liquid (in this case, blood) will cause more pressure while less blood volume is conducive to achieving normal blood pressure.

Modifiable Risk Factor: Physical Activity

An active lifestyle is one of the best ways to lower blood pressure naturally, lowering your risk for obesity, diabetes, heart attack and stroke. Try to get 2.5 hours per week of moderate physical activity. You don’t even need to go to the gym to do it, unless that’s what you enjoy. You can get the type of exercise you need by walking, working outdoors, taking stairs or cleaning your house. The important thing is not to fall into sedentary patterns. Besides movement-based exercises that increase your heart rate (aerobic exercise), add in at least two sessions per week that focus on strength or resistance training.

Modifiable Risk Factor: Alcohol

Multiple studies have shown that heavy drinking is associated with drastically higher odds of developing hypertension, especially high diastolic blood pressure. That’s particularly true for people with type 2 diabetes. If you’re a heavy drinker—especially one who already has hypertension—you should talk to your doctor about safely tapering off and ultimately quitting alcohol altogether. Experts now suggest that everyone limit their drinking to one drink per day. When it comes to blood pressure, there is no form of alcohol that’s safer than others—wine, beer and spirits all carry the same increased risk.

Modifiable Risk Factor: Sleep

In our society, sleep quality and quantity don’t get the attention they deserve as a health topic. In fact, you’ll often hear people boast about how little sleep they get. But regular, high-quality, appropriate sleep is crucial to good health and is linked to good blood pressure control. You should be getting at least seven hours of sleep each night. Work on going to bed and getting up at the same time, even on weekends. If you have obstructive sleep apnea, or think you might have it, talk to a doctor. Sleep-disordered breathing has been linked to a 54% higher risk of hypertension. Correcting sleep apnea could prove key to controlling your blood pressure.

Modifiable Risk Factor: Medications

Sometimes, people feel like they’re doing everything right to control their blood pressure—they make lifestyle changes, they get on an antihypertensive drug—and yet their blood pressure just won’t come down. In many cases, they discover that another drug they’re taking for a different condition has an unfortunate side effect in that it raises blood pressure. Increased blood pressure is a surprisingly common side effect of medications, and too often, in prescribing such medications, doctors fail to account for the fact that the patient is struggling to control their blood pressure. Fortunately, for many drugs that increase blood pressure, there are alternatives without that side effect. Whenever you’re prescribed a medication, ask if it’s likely to increase your blood pressure. And if your blood pressure seems to be stuck despite “doing all the right things,” ask your doctor to review all your medications to see if one or more might be holding you back.

Be on the lookout for these over-the-counter drugs, which may contain high amounts of sodium or are otherwise known to increase blood pressure:

  • Sodium bicarbonates
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Pseudoephedrine (in cold medicines)
  • Licorice root
  • Ephedra
  • Guarana

Semi-Modifiable Risk Factor: Air Pollution

High levels of ozone and nitrogen dioxide in the air you breathe can cause sudden high blood pressure, especially in people who already have hypertension. Unfortunately, most people who live in areas of high pollution can’t just pull up stakes and move. But you can protect your blood pressure by trying to avoid occupational exposure to polluted air, as well as staying indoors on air-quality alert days when possible.

Semi-Modifiable Risk Factor: Stress

“That makes my blood boil.” When you’re overwhelmed by emotion, you can almost feel your blood pressure climbing. But the effect of stress on blood pressure doesn’t just happen in those moments of high emotion. Living in a constant state of low-level stress—because of financial problems, relationship issues, family responsibilities, job pressures and so on—keeps your body in fight-or-flight mode, which releases the stress hormone cortisol, known to increase blood pressure. Plus, being constantly stressed out makes it harder to do all the other things that help us control our blood pressure, like eating right, exercising and sleeping properly. It’s not easy to simply remove stress from your life, but it helps to at least be mindful of your mental state and then do what you can to bust that stress. That can take the form of deciding to cut certain stressors out of your life, as well as engaging in exercise, music, meditation, breathing exercises, worship, or just talking it out with a friend or therapist.

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