If your blood pressure reading is high, your next step depends on how high it is and whether you have symptoms. A reading above 180/120 with chest pain, blurred vision, or shortness of breath is a medical emergency requiring a 911 call. A reading that’s elevated but below that threshold gives you time to bring it down through specific, proven changes.
Before doing anything else, make sure your reading is accurate. Then figure out which category you fall into and take the right steps from there.
Make Sure Your Reading Is Accurate
A single high reading doesn’t necessarily mean you have high blood pressure. Stress, caffeine, a full bladder, or even sitting the wrong way can inflate your numbers by 10 points or more. The CDC recommends sitting in a comfortable chair with your back supported for at least five minutes before taking a reading. Rest your arm with the cuff on a table at chest height. Don’t talk during the measurement.
If the number comes back high, wait five minutes and take it again. If both readings are elevated, that’s meaningful. Write down the numbers and the time so you can share them with your doctor or track them over the coming days.
Know Your Numbers
The 2025 guidelines from the American Heart Association and American College of Cardiology break blood pressure into four categories:
- Normal: below 120/80
- Elevated: 120 to 129 systolic (top number) with the bottom number still under 80
- Stage 1 hypertension: 130 to 139 systolic, or 80 to 89 diastolic
- Stage 2 hypertension: 140 or higher systolic, or 90 or higher diastolic
If your systolic and diastolic numbers fall into different categories, the higher category is the one that applies. So a reading of 135/72 counts as Stage 1, even though the bottom number looks fine.
When to Call 911
A reading of 180/120 or higher is considered a hypertensive crisis. If that number comes with any of the following symptoms, call 911 immediately:
- Chest pain
- Shortness of breath
- Severe headache
- Blurred vision or other vision changes
- Confusion or trouble speaking
- Numbness or tingling in the face, arm, or leg (especially on one side)
- Trouble walking
- Seizures or unresponsiveness
These symptoms can signal a stroke, heart attack, or organ damage in progress. If your reading is above 180/120 but you feel fine, wait five minutes and recheck. If it’s still that high, contact your doctor or an urgent care line for guidance, even without symptoms.
Dietary Changes That Lower Blood Pressure
The most well-studied dietary approach is the DASH eating plan, developed by the National Heart, Lung, and Blood Institute. It emphasizes fruits, vegetables, whole grains, and low-fat dairy while limiting saturated fat and added sugars. The standard plan caps sodium at 2,300 mg per day, roughly one teaspoon of table salt. Dropping to 1,500 mg per day lowers blood pressure even further.
One underappreciated part of the DASH plan is its potassium content, about 4,700 mg per day. Potassium helps your body flush out excess sodium through the kidneys, and it also relaxes blood vessel walls directly. In studies, people consuming 90 to 120 millimoles of potassium daily (roughly that 4,700 mg target) saw systolic blood pressure drop by about 7 points. Good sources include bananas, potatoes, beans, spinach, and yogurt.
Reducing sodium matters, but increasing potassium may matter just as much. Both work together: potassium essentially flips a switch in the kidneys that stops them from reabsorbing sodium, which helps your body release extra fluid and brings pressure down.
Exercise That Makes a Real Difference
Regular aerobic activity, things like brisk walking, cycling, or swimming, can reduce blood pressure by 5 to 8 points diastolic and 4 to 10 points systolic. The target is 150 minutes per week of moderate activity, or 75 minutes of vigorous activity. That’s about 30 minutes on most days.
You don’t need to do it all at once. Three 10-minute walks throughout the day count. The key is consistency. Blood pressure tends to improve within a few weeks of starting regular exercise, but it will climb back up if you stop.
Isometric exercises, where you squeeze or hold a position without moving, also show promise. In one study, people who did handgrip squeezing exercises three times a week for 12 weeks lowered their systolic pressure by 7 points and diastolic by 5 points. These exercises are simple to do at home with an inexpensive hand gripper.
How Long Lifestyle Changes Take to Work
Most people see measurable improvement within a few weeks of making consistent dietary and exercise changes, but the AHA uses six months as its benchmark. If your blood pressure hasn’t come down to below 130/80 after six months of sustained lifestyle changes, medication is generally the next step. That doesn’t mean lifestyle changes failed. They still reduce your cardiovascular risk and may mean you need a lower dose of medication than you would otherwise.
Common Substances That Raise Blood Pressure
Some things you may already be taking can push blood pressure higher without you realizing it. Over-the-counter pain relievers like ibuprofen (Advil) and naproxen (Aleve) cause your body to retain water, which raises pressure. If you take these regularly for joint pain or headaches, talk to your doctor about alternatives.
Decongestants found in cold and allergy medicines are another common culprit. Ingredients like pseudoephedrine and phenylephrine work by narrowing blood vessels in your nose, but they narrow blood vessels everywhere else too. If you have high blood pressure, look for “decongestant-free” versions of cold medicines.
Caffeine causes short-term spikes in people who don’t consume it regularly. If you’re not a daily coffee drinker, even one cup can temporarily raise your reading. Energy drinks, which combine caffeine with other stimulants, can be especially problematic.
Certain herbal supplements also interfere with blood pressure, including licorice root, ginseng, guarana, and ephedra. If you take any of these, mention them to your doctor. They can interact with blood pressure medications or raise pressure on their own.
What to Do Today
If your blood pressure is in the elevated or Stage 1 range, start with the basics: cut back on sodium, add more potassium-rich foods, get moving for 30 minutes most days, and limit alcohol. Check your medicine cabinet for NSAIDs and decongestants that could be working against you. Buy a home blood pressure monitor and track your numbers at the same time each day, following the proper technique of sitting quietly for five minutes with your arm at chest height.
If you’re in Stage 2 territory (140/90 or higher), do all of the above and schedule an appointment with your doctor soon. Stage 2 readings usually warrant a conversation about medication alongside lifestyle changes, especially if you have other risk factors like diabetes, kidney disease, or a family history of heart disease. Bringing a week or two of home readings to that appointment gives your doctor a much clearer picture than a single reading taken in the office.