If your blood pressure is high, the good news is that there are ways to lower it. That’s important since high blood pressure is one of the main risk factors for stroke and often has no warning signs. Here are five steps a vascular neurologist, or stroke doctor, recommends to help manage your blood pressure.
1. Know what is considered “high” blood pressure
High blood pressure is also called hypertension. The American Heart Association stroke prevention guidelines recommend a consistent reading below 130/80. The top number, known as systolic blood pressure, is the pressure when your heart beats. It should be 130 or lower. The bottom number, known as diastolic pressure, is the pressure when your heart rests. It should be 80 or lower.
Some people may have higher blood pressure readings at the doctor’s office. This is known as “white coat hypertension.” Anxiety during the visit, along with activities like walking into the clinic or climbing stairs, can raise blood pressure above what it usually is during daily living. I strongly advocate that patients get a blood pressure cuff and check readings a couple of times a day at home during routine life for more accurate numbers.
2. Make basic diet changes
I recommend following a Mediterranean diet. Remember, too much salt in food increases heart disease risk over time. For patients with high stroke risk, the recommendation is no more than 1 teaspoon of salt per day. But salt is found nearly everywhere—fast foods, processed foods, canned foods, and restaurant meals—which makes it difficult to avoid. I get it; I like chips and snacks, too. However, limiting the amount of high-salt foods we eat is important for maintaining good blood pressure numbers. Talk to a nutritionist about salt substitutes like lemon juice or infused olive oils so your food still tastes great without the sodium.
3. Don’t be afraid of medication
You may be unsure if you want to start taking medicine, but if your numbers are consistently elevated, it is a good idea to take blood pressure-lowering medication. In many adults, more than one medication may be needed to keep the levels under control. If the medication is making you feel bad or you’re having side effects, let your doctor know, even between appointments. Call, send messages through the patient portal, have a telehealth visit, or link cardio and heart data to the office from a smart device or wearable. If cost is a concern, ask about more affordable generic medications.
4. Learn risk factors for heart disease and stroke
Elevated blood pressure is perhaps the top risk factor for stroke. But just as important is how long it has been high. Over time, high blood pressure can damage your heart, blood vessels, and other organs. It can also lead to long-term memory problems and cognitive decline. Controlling other vascular risk factors will help regulate your blood pressure. Avoid smoking, maintain a healthy weight, and stay active. If you are obese, your heart has to work harder than it should. Obstructive sleep apnea stresses your heart and body, causing oxygen loss and higher stroke risk. Consider getting a sleep screening if you don't feel rested when you wake up in the morning, if you snore, and especially if you stop breathing in your sleep. If you have or are diagnosed with obstructive sleep apnea, wear a CPAP mask overnight to help regulate breathing.
5. Consider how better vascular health will improve your life later on
Blood pressure is not just two numbers the medical assistant notes on your chart. The risk of having a stroke is real at any age. Managing your blood pressure and other stroke risk factors can help protect the activities, relationships, and independence that are important to you. Whether it's spending time with loved ones, enjoying hobbies, or staying active in your community, keeping your blood pressure in a healthy range can help you continue doing the things you value most and maintain your independence.
Overall, keep in mind that with the right lifestyle changes and preventive measures, you can lower your blood pressure and reduce your risk of stroke.
Dr. Southerland is a vascular neurologist and professor of neurology and public health sciences at the University of Virginia and UVA Health.
-As told to Alice Garbarini Hurley
