How to Lower Your Systolic Blood Pressure

If you or someone you know has high blood pressure (hypertension), you may want learn more about how to lower systolic blood pressure.

If the top number of your blood pressure reading is 130 or higher, you have high systolic blood pressure. This can be due to lifestyle choices like smoking, age, genes, and medical conditions like thyroid disease. Consistently high systolic pressure is enough to diagnose you with high blood pressure—even if the bottom number, your diastolic pressure, is normal.1

While finding out you have high systolic blood pressure can be a cause for concern, it’s also a chance to take action and lower your risk of serious events like heart attack, stroke, and even death.

This article discusses what high systolic blood pressure is, how you can lower it, and how to prevent complications with lifestyle changes and medication.

How to Read Your Blood Pressure

Blood pressure readings have two numbers: a systolic pressure and a diastolic pressure, given in units of milligrams of mercury (mm Hg).

The higher number is the systolic blood pressure, which is the pressure generated by the heart pumping blood through the arteries. The lower number is the diastolic blood pressure, which is the pressure in the arteries while the heart is relaxing.

A normal blood pressure is less than 120 systolic over less than 80 diastolic.2 A systolic blood pressure in the 120s is considered elevated, even with a normal diastolic reading.

Hypertension is diagnosed with a systolic reading of 130 or higher, or a diastolic reading of 80 or higher.

Blood Pressure Categories
	Systolic (mm Hg)	Diastolic (mm Hg)
Normal Blood Pressure	<120	<80
Elevated Blood Pressure	120s	<80
Hypertension	≥130	≥90

Both systolic and diastolic measurements are important when considering your heart’s health. A high systolic reading is the most common form of high blood pressure, especially in older people, due to arteries stiffening over time.

Isolated Systolic Hypertension

Isolated systolic hypertension is any blood pressure in which the systolic blood pressure is elevated while diastolic pressure is normal. Generally, when healthcare providers use this term, they are referring to situations in which systolic pressure is significantly higher than normal.

This situation is much more common in older people due to the stiffening of arteries that comes with age. However, isolated systolic hypertension can occur in younger adults, and when it does, it is associated with an increased risk of heart disease later in life.3

Studies have shown that treating high systolic blood pressure levels consistently decreases the risk of complications, regardless of how high the diastolic reading is.2 However, this can be a particularly challenging situation in older adults who have more side effects from blood pressure medications.

In addition, diastolic pressure is important because the coronary arteries fill during diastole, and a diastolic blood pressure less than 60 mm Hg increases the risk of cardiac events.4 So those with isolated systolic hypertension whose diastolic pressure is normal may run into trouble if blood pressure medications lower the diastolic pressure too much.

People with high systolic pressure can benefit from lowering blood pressure, including lifestyle changes and medications.

Causes

High systolic blood pressure can have many causes. As we age, our arteries stiffen, and over time this contributes to high blood pressure. The genes we inherit can also play a role. Certain underlying conditions like thyroid disease, cortisol excess, and obesity can also cause high blood pressure.

How to Lower Systolic Blood Pressure

There are many steps you can take to help lower your blood pressure, including lifestyle changes and medications.

Medications can lower systolic blood pressure in a matter of hours to days. Lifestyle changes, like exercising and eating a healthy diet, might take several weeks to make a difference.

Eat a Diet for Lowering Blood Pressure

The most powerful lifestyle change to lower blood pressure is implementing a healthy diet. Making changes to your diet can lower your systolic blood pressure by up to 11 points.2

The American Heart Association (AHA) recommends the DASH diet (Dietary Approaches to Stop Hypertension) to help lower blood pressure. The DASH diet is low in salt, added sugars, and red and processed meats.5

Some additional diet guidance and foods that can help lower blood pressure include:

• Focus on eating colorful fruits and vegetables, since their high potassium content can help lower blood pressure.
• Choose whole grains whenever possible, and limit white flours such as those found in white bread and pasta.
• Avoid drinking sweetened drinks like juice and soda, and watch for salt in processed foods and canned items.
• Limit intake of saturated fat by choosing lean meats like skinless chicken and turkey.
• Choose low-fat or nonfat dairy items.

Exercise

Exercising can help lower systolic blood pressure by 5–8 points.2

The AHA recommends all adults get at least 150 minutes of moderate aerobic exercise per week.7 Aerobic exercise is exercise that raises your heart rate, like walking, biking, dancing, and water aerobics.

Limit Alcohol

Drinking alcohol in excess can contribute to high systolic blood pressure. Limiting alcohol intake can lower systolic blood pressure by up to 4 points.2

Alcohol should be limited to no more than two standard drinks per day for men, and no more than one per day for women. A standard drink is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of liquor.8

Stop Smoking

While it’s not as clear that quitting smoking will directly lower your systolic blood pressure, it will definitely reduce your risk of some of complications of high blood pressure.

The nicotine in cigarettes causes arteries to constrict, resulting in a temporary increase in blood pressure. Smoking also causes fatty plaque to build up in the arteries, which can lead to stroke and heart attacks.

Limit Caffeine

While chronic caffeine use has not been shown to contribute to high blood pressure, caffeine does cause a temporary increase in blood pressure. This happens because caffeine is a vasoconstrictor, causing blood vessels to narrow.

In people with high blood pressure, caffeine should be limited to no more than 300 milligrams per day.2 For reference, a 12-ounce “tall” cup of Starbucks coffee has 235 milligrams of caffeine.10

Reduce Stress

Stress is a well-known contributor to high blood pressure, and managing stress is an important part of a healthy lifestyle. Both short-term stressors, like losing a job, and chronic stressors, like relationship problems, can contribute to elevated blood pressure.

Although they haven’t yet been definitively tied to lowering blood pressure, practices like yoga, meditation, talk therapy, and breathing exercises may help combat stress that could be contributing to high blood pressure.11

Getting a good night’s sleep may also help relieve stress. Poor quality sleep or a lack of sleep altogether can increase stress hormone levels, which can raise blood pressure.12

Take Antihypertensive Medications

The lifestyle changes above can be helpful for anyone with elevated blood pressure, including those with isolated systolic blood pressure. But people with persistent high systolic blood pressure may need blood pressure-lowering medication (antihypertensive medication) to help bring their blood pressure to healthy levels.

Several different classes of medications can be prescribed by your healthcare provider to lower systolic blood pressure and decrease your risk of heart disease and stroke.

Some of the most prescribed medications that are effective at reducing blood pressure include:13

• Diuretics, such as Hygroton (chlorthalidone) and Microzide (hydrochlorothiazide)
• ACE inhibitors and angiotensin receptor blockers, such as Zestril (lisinopril) and Diovan (valsartan)
• Calcium channel blockers, such as Norvasc (amlodipine) and Adalat CC (nifedipine)
• Beta-blockers, such as Coreg (carvedilol) and Trandate (labetalol)

Blood pressure–lowering medications can pose challenges in older adults with isolated systolic hypertension because of side effects.

Orthostatic hypotension, low blood pressure upon standing, can cause dizziness and is a more common side effect in older adults treated for hypertension. It can result in increased falls and hip fractures, both of which have been found to be more common in older adults on blood pressure-lowering medications compared to those not on medications for blood pressure.14

Selection of blood pressure medication is important in older adults with systolic hypertension. However, there does not seem to be any benefit of one medication class over another when only one medication is required, with the exception of beta-blockers.2 Beta-blockers are not recommended to be used as a first-line treatment unless another compelling reason exists, like coexisting heart failure.

The combination of ACE inhibitor with a calcium channel blocker has been shown to provide better outcomes than the combination of ACE inhibitor with a diuretic. For this reason, many healthcare providers prefer to first prescribe a long-acting calcium channel blocker, such as Norvasc, in older adults with high blood pressure, and add an ACE inhibitor if needed for additional blood pressure control.15

Another important part of treating systolic hypertension in older adults is starting new medications at lower doses and increasing doses more slowly. This is because older adults have a slower metabolism and clearance of medications and, therefore, more side effects.

Avoid Certain Drugs and Supplements if You Have High Blood Pressure

It’s just as important to avoid substances that can increase your blood pressure as it is to make lifestyle changes and take blood pressure medications.

Here is a list of substances to avoid if you have high blood pressure:

• Over-the-counter “decongestant” cold medications that contain pseudoephedrine or phenylephrine, like Sudafed
• Chronic use of NSAIDs (nonsteroidal anti-inflammatory medications), like Motrin (ibuprofen), Advil (ibuprofen), and Aleve (naproxen)
• Black licorice
• Cocaine

Monitoring Blood Pressure at Home

The AHA recommends home monitoring for everyone with high blood pressure. This is to help healthcare providers determine if treatments are working.16

It’s best to use upper arm cuff devices instead of wrist devices, as they provide more reliable readings. Be sure to read the instructions carefully before using.

When measuring your blood pressure, it’s important to:17

• Sit quietly for a few minutes before taking a measurement
• Take measurements on the skin rather than over clothing
• Avoid taking measurements right after eating, smoking, or exercising
• Sit in the correct position (feet flat on the floor with your legs uncrossed)
• Remain still during the reading
• Take multiple readings and record the results
• Measure at the same time every day

When to See a Healthcare Provider

High blood pressure is a serious condition that can lead to stroke, heart attack, and even death if left untreated. While there is a lot you can do at home to help lower your systolic blood pressure, it’s important to follow all treatment recommendations from your healthcare provider.

If you experience severe headache, blurred vision, drooping on one side of the face, weakness on one side of the body, chest pain, or other concerning symptoms, seek medical attention immediately.

Summary

High systolic blood pressure is a very common condition that can increase your risk of serious health problems like stroke and heart attack. It can be stressful to find out you have high systolic blood pressure, but it is also a chance to make some healthy changes that can have a meaningful impact on your overall health.

Changes to diet, exercise, drug use, as well as starting blood pressure medication can help. Talk to your healthcare provider about starting a treatment plan.