How to lower high blood pressure

A great deal of effort gets spent chasing a reading that was never accurate to begin with.

Blood pressure moves constantly. It rises when you talk, when you have just walked in from the car park, when your bladder is full, and reliably when a doctor is holding the cuff. A single clinic measurement is a snapshot of one unusual moment.

What your doctor can act on is a series taken properly at home:

• Sit still for five minutes first. Feet flat on the floor, back supported, arm resting at heart height. Not perched on the edge of a chair with your arm hanging.
• Do not talk during the reading. Talking alone can add several points.
• Two readings, a minute apart. Record both.
• Morning and evening, for seven days. Then discard day one and average the rest.

Day one is discarded because first-day readings run high for almost everyone. A week done properly will often look meaningfully different from the number that prompted the worry.

This is where the biggest single change sits, and a 2026 analysis has sharpened what kind of exercise to do.

Researchers pooled 105 randomised trials in people with raised or established high blood pressure. The differences between exercise types were substantial.

The practical version is unglamorous: keep the walking, and add two short sessions a week of something that loads your muscles. Bands, bodyweight, a couple of dumbbells. It is the pairing that produces the number above.

Salt is the advice everyone has heard and almost nobody has been told the important part of.

A Cochrane review pooled 185 studies comparing low sodium intake against high, and the result splits sharply depending on whether blood pressure was already raised.

So the honest answer to "should I cut salt" is: if your blood pressure is high, yes, and it is worth real effort. If your blood pressure is normal and you are doing it as insurance, the evidence for that is thin.

There is a further wrinkle worth knowing. The same review found that low sodium intake significantly raised renin, aldosterone, noradrenaline, cholesterol and triglycerides. None of that overturns the blood pressure finding in people with hypertension, and it is a reason to treat aggressive salt restriction as a targeted intervention rather than a default.

Most dietary salt is not the salt cellar. It is bread, processed meat, sauces, stock and takeaways. Cooking more at home moves the number further than removing the shaker from the table.

Weight

Losing weight lowers blood pressure reliably, and the relationship is roughly linear, so partial progress produces partial benefit. This matters because the target does not have to be a transformation. Several kilograms is a worthwhile change on its own, and the reading responds without waiting for a goal weight.

Alcohol

Regular drinking above moderate levels raises blood pressure, cutting back lowers it, and the size of the change scales with how much you were drinking. If you drink most evenings, this is frequently the change with the most available room in it.

It is also the one people most often overlook, because a couple of glasses in the evening does not feel like a cardiovascular risk factor in the way that a salt shaker does.

Sleep

Short and disrupted sleep raises blood pressure, and untreated sleep apnoea is a common and frequently missed cause of readings that will not come down whatever else is tried. If you snore loudly, stop breathing at night, or wake unrefreshed after adequate hours, that is worth investigating before anything else on this page.

If your sleep is simply poor rather than disordered, our guide to sleep sets out what the evidence supports.

The mechanism behind all of this is worth understanding, because it explains why blood pressure tends to drift upward over decades rather than arriving suddenly.

Nitric oxide is a signalling molecule produced by the endothelium, the single-cell lining of your blood vessels. Its job is to tell the smooth muscle in the vessel wall to relax. When that happens the vessel widens, and a wider vessel offers less resistance to the blood being pushed through it.

Production of nitric oxide declines with age, and declines further where the vessel lining has been under sustained strain from raised blood sugar, smoking or long-term high pressure itself. Less nitric oxide means less relaxation signal, stiffer vessels, and more work for the heart.

This is also why exercise works as well as it does. Blood moving faster across the endothelium is one of the main stimuli for nitric oxide production, which is part of the reason the exercise numbers earlier in this article are as large as they are.

The precursors

Your body makes nitric oxide from the amino acid L-arginine. It can also make it from L-citrulline, which converts to arginine in the kidneys, and which raises arginine availability more effectively than taking arginine on its own because more of it survives first-pass metabolism.

That conversion pathway is the reason both appear in supplements aimed at circulation, and the reason citrulline is usually the larger of the two doses.

Everything above works, and for a substantial number of people it is not sufficient on its own. That is not a failure of effort.

Blood pressure has a strong genetic component, it rises with age regardless of behaviour, and some people arrive at high readings while doing everything on this page correctly. Medication exists because of them.

If you are already on medication and reading this because you would like to be on less of it, the sequence matters. Make the changes, measure properly for a few weeks, take the record to your doctor, and let them decide what the numbers mean. That is the route that ends well.