Lifestyle changes can be as effective as medication.

Taking medication to lower high blood pressure is a proven way to reduce your risk for heart disease. But adopting lifestyle changes may let you maintain healthy readings and perhaps even avoid drug therapy. "Unless a person's blood pressure is very high, medication most often does not start immediately," says Dr. Howard LeWine, editor in chief of Harvard Men's Health Watch. "For people with elevated blood pressure or stage 1 hypertension, the first order of business is to get serious about modifying their lifestyle."

By the numbers

Normal blood pressure is defined as a reading of less than 120/80 millimeters of mercury (mm Hg). Elevated pressure means systolic blood pressure (the first number in a reading) is 120 to 129 mm Hg with a diastolic pressure (the second number) of less than 80 mm Hg. People who have consistent readings of 130 to 139 for systolic pressure or 80 to 89 for diastolic pressure are said to have high blood pressure (stage 1 hypertension).

"But your target numbers may differ based on your health and individual goals, as determined in consultation with your doctor," says Dr. LeWine.

Healthy lifestyle habits are the cornerstone of managing blood pressure, whether or not you require medication. A lifestyle approach to management also helps people feel more in control of their health.

"Understandable, sometimes people are reluctant to start a drug because they don't want to be dependent on medication," says Dr. LeWine. "And this resistance can provide extra motivation for making the necessary changes." Still, don't be discouraged if your doctor wants you to begin taking a low dose of medication. Once you reach your blood pressure goals, maintaining a healthy lifestyle may mean you can take a drug holiday (with your doctor's approval). "And even if you still need medication, your healthy lifestyle changes can help prevent dose increases or additional blood pressure drugs," says Dr. LeWine.

The big six

Six lifestyle changes have the most significant influence on blood pressure, according to Dr. LeWine. They include the foundation for healthy living — diet, exercise, and weight control — as well as limiting sodium and alcohol and managing stress.

"While all of these are important, don't try to change them all at once," says Dr. LeWine. "In consultation with your doctor, you first want to concentrate on the one or two most important modifications, based on what's likely to have the greatest impact."

Diet. While most experts advocate plant-based diets to help lower blood pressure numbers, a recent study found that the Dietary Approaches to Stop Hypertension (DASH) diet may have the most significant impact. The researchers found that adopting the DASH diet could prevent an estimated 15,000 annual heart attacks and strokes among men with high blood pressure. DASH emphasizes fruits, vegetables, lean proteins, nuts, seeds, and grains and limits consumption of red meat, sodium, and sugar-sweetened foods and drinks.

Exercise. Guidelines call for a minimum of 150 minutes of moderate-intensity exercise per week. A reasonable starting goal is 20 to 30 minutes every other day. Any kind of exercise is always better than nothing. But if you need motivation, join a walking club or sports league (like golf, bowling, basketball, or pickleball), hire a personal trainer, or sign up for fitness classes at a gym or community center. You can also increase your daily movements, like walking for five minutes every hour, doing two sets of five to 10 push-ups on the floor or against the kitchen counter, or 20 minutes of yoga or stretching.

Weight. While it's natural for men's weight to increase somewhat with age, even five to 10 pounds over their ideal number can raise blood pressure. "In fact, for overweight men, every pound lost could lower systolic blood pressure by up to 1 mm Hg," says Dr. LeWine. Your doctor can determine your target weight for your age and body type. Investing in a healthy diet and increasing exercise can help reduce weight.

Sodium. "People with high blood pressure sometimes have a significant improvement by avoiding sodium," says Dr. LeWine. Processed foods account for much of the sodium that people consume. These include foods like canned vegetables and soups, frozen dinners, lunch meats, instant and ready-to-eat cereals, salty chips, and other packaged snacks. Cut back on these items, or select low-sodium options.

Alcohol. Drinking more than moderate amounts of alcohol can raise blood pressure. Guidelines says men should consume no more than two standard drinks per day, with a single drink defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of distilled spirits. However, cutting back on alcohol as much as possible is ideal.

Stress. Reducing stress is also a priority. Stress can lead to chronic inflammation that damages artery walls, making them less elastic. In addition, ongoing stress can trigger the adrenal glands to release hormones that raise blood pressure. "Uncontrolled stress often manifests as poor sleep, overeating, and physical inactivity," says Dr. LeWine. To manage stress, practice relaxation breathing and meditation, or perhaps just set aside time every day to do whatever you wish, even if it's nothing at all.