High blood pressure is extremely common. Nearly one half of adults in this country have hypertension, and unfortunately, only about one in four of them have it properly controlled. Most rely on prescription medicines to lower their blood pressure; is medication necessary? Controlling blood pressure with a healthy lifestyle may prevent, delay or reduce the need for medication.

Our arteries distribute blood throughout the body from the heart, and blood pressure is the pressure of the blood as it pushes against those artery walls. Blood pressure fluctuates significantly during the day, but if it remains high for a long time it can damage the heart, blood vessels, eyes, kidneys, and more.

In 2017, the American College of Cardiology and the American Heart Association published new guidelines for the management of hypertension, and defined hypertension as blood pressure at or above 130/80 millimeters of mercury (mmHg). If it is at or above 140/90, it is considered stage 2 hypertension.

Blood pressure medication is extremely effective, but obstacles exist. These include access to health care, a lack of desire on the part of both the patient and the doctor to push doses high enough, poor compliance in taking the medication, and cost.

Another obstacle to getting blood pressure under control can be the patient’s lack of knowledge or desire to alter their lifestyle. Here are some fairly straightforward changes that could significantly lower blood pressure:

• Lose that extra weight. Blood pressure typically follows weight, both up and down. Being overweight also disrupts breathing, which affects sleep and further raises blood pressure. Weight loss is incredibly effective. Studies have shown reductions in blood pressure of about 1 mmHg for each kilogram (2.3 pounds) of weight loss.

• Get regular exercise. This can lower blood pressure by about 5 to 8 mmHg. Aim for at least 30 minutes of moderate physical activity, four to five days per week. Regular exercise can keep elevated blood pressure from becoming lasting hypertension.

• Eat a healthy diet. A diet rich in fruits, vegetables, whole grains, and low-fat dairy products, and low in saturated fats, can lower blood pressure by up to 11 mmHg. The Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean diet are excellent for lowering blood pressure.

• Reduce salt. Even small reductions have a positive effect, improve heart health, and can reduce blood pressure by 5 to 6 mmHg. In general, don’t exceed 1,500 to 2,000 mg of sodium per day. I urge you to read food labels, reduce consumption of processed foods, don’t add salt to prepared foods and keep it minimal when cooking…and stay away from fast food.

• Limit alcohol to less than one drink a day for women and two drinks a day for men. This can lower blood pressure by 4 mmHg. Too much alcohol raises the blood pressure and reduces the effectiveness of blood pressure medicine.

• Quit smoking cigarettes. It’s very straightforward: Cigarettes increase blood pressure, and quitting does the reverse. Quitting also reduces the risk of heart disease and significantly improves general health.

• Get a good night’s sleep. Poor sleep (fewer than six hours every night) can contribute to hypertension. It is important to identify any particular cause for sleeplessness, to stick to a schedule, to create a restful space, and to not go to bed thirsty or hungry. Avoid large meals, and limit alcohol, nicotine, and caffeine close to bedtime. Avoid naps, as they limit nighttime sleep.

• Finally, work on stress. Long-term emotional stress can certainly contribute to high blood pressure. Identify the main source of your stress. Avoid taking on too much, focus on the issues you can control and make plans to resolve them, avoid stress triggers, make time to relax, and practice gratitude. You may be helped by exercise, meditation, yoga, massage, baths, hobbies and vacations.

If you’ve been told that you have high blood pressure, I suggest that you monitor it yourself – it’s easy to do, and digital home monitors sell for under $30. Share the results with your doctor, so that you can work together to combine proper medication with lifestyle changes.