Question & Context

Blood pressure and heart – what can I do myself?

In brief

Quite a lot. In studies, a low-salt diet rich in vegetables lowered the upper blood pressure value by up to eleven mmHg, regular training by four to eight, and those who drink a lot gain noticeably from drinking less alcohol. The first step, however, is to measure correctly, because readings in the doctor's office are often clearly higher than readings at rest. The 2024 European guideline already classifies values from 120 over 70 as elevated and recommends aiming for an upper value between 120 and 129 with treatment. Lifestyle and medication are not opposites here; they work together.

What matters first

Measure correctly

Blood pressure varies strongly with the situation. In a Japanese study, the usual office readings were on average 10.4 mmHg higher systolic than the values measured at rest and unobserved according to a strict study protocol. The cuff matters too: in people with a very muscular or large upper arm, a standard cuff that was too small showed on average 19.5 mmHg too much. So measure at home after five minutes of sitting quietly, with a suitable upper-arm cuff, several times, and write down the values. The guideline explicitly recommends measurements outside the doctor's office.

Salt down, vegetables up

The DASH diet, with plenty of vegetables, fruit, legumes and low-fat dairy products, together with little salt lowered the upper value in a study with 412 participants by 11.5 mmHg in people with high blood pressure and by 7.1 mmHg in people without. Both components worked on their own and most strongly together.

Swap the salt

In a large trial in 600 Chinese villages with 20,995 older or at-risk people, a salt made of 75 percent sodium chloride and 25 percent potassium chloride replaced normal salt. Strokes were 14 percent less frequent, deaths 12 percent. If you have kidney disease or take medication that raises potassium levels, you should discuss potassium salt with a doctor first.

Move, including static exercise

A meta-analysis of 270 randomized trials with 15,827 people shows that every form of training lowers blood pressure: endurance training by around 4.5 mmHg, strength training similarly, the combination by 6 mmHg. Isometric exercises such as wall sits or handgrip exercises worked most strongly, at around 8 mmHg. The best is whatever you keep up regularly.

When you should have this checked by a doctor

High blood pressure usually does not hurt, which is why regular measuring is so important. Get medical advice if your home readings are repeatedly elevated, and have your blood lipids, blood sugar and kidney values checked at the same time. Snoring with pauses in breathing and severe daytime tiredness can point to sleep apnea, which puts additional strain on blood pressure. You should call the emergency number 112 immediately in case of chest pain or pressure in the chest, sudden shortness of breath, paralysis on one side, speech or vision problems, and very high readings together with such complaints. Please never stop blood pressure medication on your own, even if your values improve through lifestyle; the dose can be adjusted together with your doctor's practice.

What the numbers mean

The 2024 European cardiology guideline distinguishes three levels. An office reading below 120 over 70 is not elevated, a range of 120 to 139 or 70 to 89 is elevated, and from 140 over 90 it is called high blood pressure. For people taking blood pressure medication, the standard target is an upper value between 120 and 129, provided the treatment is well tolerated.

The background is large trials. In SPRINT, 9,361 people with increased cardiovascular risk were treated to a target value below 120 or below 140; in the stricter arm, overall mortality was 27 percent lower. Important: there, measurements followed a precise protocol, at rest, three times in a row and averaged. A single measurement in the doctor's office is therefore not directly comparable.

Alcohol, sleep and stress

With alcohol, there is a clear threshold. In a meta-analysis of 36 studies, drinking less alcohol lowered blood pressure only in people who drank more than two drinks a day. Those who cut six or more drinks a day by about half gained on average 5.5 mmHg.

Sleep and stress are the quieter factors. Untreated sleep apnea puts a strain on the heart and circulation, and treatment improves mainly tiredness and quality of life. Relaxation techniques, regular sleep times and breaks in everyday life support the big levers, but do not replace them.

What the database says

Sorted by strength of evidence. The BK-Score rates the state of knowledge, not the substance.

Blood pressure target – 120 at home is a different 120 Evidence 9/10 · Well supported, heavily overhypedWhere the target below 120 comes from, why it was determined in the SPRINT trial according to a strict measurement protocol, and what that means for your own readings.
Reducing alcohol Evidence 9/10 · Well supportedDrinking less alcohol is one of the best-supported levers of all. For blood pressure, those who benefit most are people who drink more than two drinks a day.
CPAP for sleep apnea Evidence 9/10 · Well supported, heavily overhypedThe breathing mask almost completely eliminates nighttime pauses in breathing and improves daytime tiredness and quality of life. In the largest trial, however, it did not prevent heart attacks and strokes.
Strength training 3× a week Evidence 9/10 · Well supportedStrength training lowers blood pressure about as much as endurance training and is among the best-supported measures in the database.
Zone 2 & VO2max training Evidence 7/10 · Supported, with caveatsEasy endurance training as the foundation, supplemented with hard intervals: endurance fitness is one of the strongest markers of a long life.
Magnesium Evidence 7/10 · Supported, with caveatsMagnesium is involved in hundreds of enzyme reactions and in studies is associated with slightly lower blood pressure. It is not a replacement for salt reduction and exercise.
Beetroot / nitrate Evidence 7/10 · Supported, with caveatsNitrate from beetroot is converted in the body into vasodilating nitric oxide. In a meta-analysis, the upper value fell in people with hypertension, with low certainty of evidence.
Air quality and particulate matter Evidence 6/10 · Supported, with caveatsParticulate matter is one of the big underestimated risk factors for the heart. In small studies, air filters lowered blood pressure slightly, especially with elevated baseline values; long-term data are still lacking.
Lipoprotein(a) Evidence 8/10 · Well studied – effect not confirmedA genetically determined blood lipid value that is not measured in a normal cholesterol check. The European Atherosclerosis Society recommends having it measured at least once in a lifetime.

Frequently asked questions

At what point is blood pressure too high?

According to the 2024 European guideline, an office reading of 140 over 90 or above counts as high blood pressure, and values between 120 and 139 systolic count as elevated. What matters are repeated measurements at rest, ideally also at home. Whether and how it is treated also depends on your personal cardiovascular risk.

How do I measure my blood pressure correctly at home?

Before the first measurement, sit quietly for five minutes and do not talk during the measurement, as in the protocol of the large SPRINT trial. Use an upper-arm cuff of the right size, because a cuff that is too small shows clearly too high values. Measure several times in a row and take the average; in SPRINT, it was three measurements.

How much does eating less salt help?

In the DASH trial, less salt lowered blood pressure in people with and without high blood pressure, most strongly in combination with a diet rich in vegetables. In a large trial, a salt substitute containing potassium even reduced strokes and deaths. If you have kidney disease, you should discuss potassium salt with a doctor first.

Which exercise lowers blood pressure best?

All forms of training work; in the studies, isometric exercises such as wall sits or handgrip exercises worked most strongly. Endurance and strength training lowered blood pressure to a similar extent, and the combination somewhat more. Regularity is more important than the choice.

Can I replace my blood pressure tablets with lifestyle changes?

Sometimes the dose can be reduced if weight, diet and exercise improve significantly. However, this should always be done together with your doctor's practice and never on your own. Lifestyle and medication complement each other and work best together.

Do food supplements help against high blood pressure?

For nitrate from beetroot and for magnesium there are indications of a slight reduction. However, the effects are smaller and less certain than those of salt reduction, exercise, weight loss and less alcohol. Food supplements are at most an addition.