High Blood Pressure
Usually no symptoms, but it quietly raises the risk of stroke, heart attack, kidney disease and dementia. High means 140/90 in clinic or a home average of 135/85. Lowering it helps at any age.
Measuring at home. Use a validated upper-arm monitor. For 7 days, sit quietly for 5 minutes with your back supported, feet flat and arm at heart level, then take 2 readings a minute apart, morning and evening, before food, medicines or caffeine. Write them down for your GP.
The blood pressure ladder
Lifestyle steps stack: do several and the points add up. Many people still need tablets, and that’s not failure.
- Step 1 · Self-careLess salt, more plantsUnder 5 g of salt a day (about a teaspoon), plus “DASH”-style eating: vegetables, fruit, wholegrains, legumes, nuts, low-fat dairy.
- Works
- Less salt: about 5 points lower. DASH eating: up to about 10 points, as much as one tablet
- Cost
- Free, or cheaper than takeaway
- How long
- 2–4 weeks to show
- Watch for
- Hidden salt in bread, sauces, stock, takeaway and processed meats
The salt shaker isn’t the main culprit. The sauce bottle and the deli are.
- Step 2 · Self-careMove more, lose a little, drink less150 minutes of activity a week plus some strength work; weight loss if needed; no more than 10 standard drinks a week.
- Works
- Exercise: about 4–8 points. About 1 point per kilo lost. Heavy drinkers halving alcohol: about 5 points
- Cost
- Free to cheap
- How long
- Weeks to months
- Watch for
- Energy drinks, decongestants and anti-inflammatories can push it up
Walking counts. You need shoes, not a gym membership.
- Step 3 · PharmacyHome blood pressure monitorA validated upper-arm cuff, so you and your GP see your real numbers.
- Works
- On its own, only about 1–2 points lower; up to about 6 with GP or pharmacist follow-up. Catches “white coat” readings
- Cost
- About $60–150
- How long
- 7 days of readings to diagnose, then now and then
- Watch for
- Wrist and finger monitors are unreliable
Measured straight after a coffee, an argument and the stairs? Doesn’t count.
- Step 4 · PrescriptionOne tablet: ACE inhibitor or ARB, calcium channel blocker, or thiazide-type diureticThe usual starting medicines. Taken once a day.
- Works
- Each lowers it by roughly 8–10 points. Every 10 points lower cuts stroke risk by about a quarter
- Cost
- Under the $25 PBS co-payment, about $10–25 a script; many come as 2-month supplies
- How long
- 2–4 weeks for full effect; usually long term
- Watch for
- ACE inhibitors: dry cough. Calcium channel blockers: ankle swelling, flushing. Diuretics: more weeing. Dizziness on standing. ACE inhibitors and ARBs: not in pregnancy
Normal readings on tablets mean they’re working, not that you’re cured.
- Step 5 · PrescriptionTwo medicines, often in one tabletLow doses of two medicines instead of a high dose of one.
- Works
- Adding a second medicine lowers it about 5 times more than doubling one dose, with fewer side effects
- Cost
- Under the $25 PBS co-payment, usually about $15–25 a script
- How long
- Long term
- Watch for
- Same as the individual medicines. Blood tests for kidneys and potassium
Two small doses beat one big one. Teamwork.
- Step 6 · SpecialistSpecialist review for resistant blood pressureStill high on three medicines? Time to look for hidden causes such as excess aldosterone, sleep apnoea or kidney disease.
- Works
- Spironolactone lowers it about 9 more points than a dummy treatment. Finds a fixable cause in some people
- Cost
- About $200–400 for a first visit, partly rebated by Medicare with a GP referral
- How long
- Several visits and tests
- Watch for
- Missed doses. Honest pill-taking saves a lot of tests
Before blaming your glands, check the pill box.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Cuffless smartwatches and phone appsNot accurate enough to diagnose or manage blood pressure. Use a validated upper-arm cuff.
- Sea salt and pink saltSame sodium as table salt, just prettier crystals and a bigger bill.
- Garlic, coenzyme Q10 and “natural” BP blendsSome trials show small drops, but results are inconsistent and products vary. Not a substitute for proven treatment.
- Celery juice and apple cider vinegarNo good trials. Wellness influencers aren’t a blood pressure guideline.
What you can do
- Take tablets every day, even when you feel fine. High blood pressure doesn’t announce itself.
- Check labels on pharmacy medicines: anti-inflammatories and decongestants can raise blood pressure.
- Don’t smoke, and go easy on energy drinks.
- Have a Heart Health Check with your GP from age 45 (30 for Aboriginal and Torres Strait Islander people).
See your GP if
- Your home average is 135/85 or more
- You feel dizzy or faint on standing while on blood pressure tablets
- You snore loudly and are tired during the day (sleep apnoea can raise blood pressure)
- You’re pregnant or planning to be and your blood pressure is raised, or you take blood pressure tablets
Call 000 for chest pain, sudden weakness, numbness or trouble speaking, or a sudden severe headache. See a doctor the same day for a reading of 180/110 or higher, or if you’re pregnant with a raised reading, headache, vision changes or sudden swelling.
Common questions
What blood pressure is too high?
In Australia, high blood pressure means a clinic reading of 140/90 or more, or a home average of 135/85 or more. See a doctor the same day for a reading of 180/110 or higher.
How do I check my blood pressure at home?
Use a validated upper-arm monitor. For 7 days, sit quietly for 5 minutes, then take 2 readings a minute apart, morning and evening, and write them down for your GP.
Can I lower blood pressure without tablets?
Often by a useful amount. Less salt, healthy eating, regular exercise, weight loss and less alcohol each lower it, and the effects add up. Many people still need tablets as well.
Can I stop my tablets once my readings are normal?
Normal readings usually mean the tablets are working. Talk to your GP before stopping.
What are the symptoms of high blood pressure?
Usually none, which is why it’s called a silent condition. Most people feel completely well, so the only way to know is to have it measured. Very high readings with headache, chest pain, confusion or vision changes need urgent care.
Does salt raise blood pressure?
Yes. Cutting salt by about a teaspoon a day (around 4 to 5 g) lowers the top number by about 5 mmHg in people with high blood pressure, similar to some tablets. Most salt comes from bread, processed meats, sauces and takeaway, not the salt shaker.
Can stress cause high blood pressure?
Stress raises blood pressure for a short time. Long-term stress may add to high blood pressure through poor sleep, drinking more and less exercise. Blood pressure that’s high on repeated readings needs checking whatever the cause.
Helpful resources
- Heart Foundation: Home blood pressure guide and diaryOne-page how-to plus a 7-day diary to take to your GP. Free, printable.
- Validated blood pressure monitors (VDL)Independent list of monitors that passed accuracy testing, from the American Medical Association. Free; check before you buy.
- FoodSwitch appScan a barcode and find lower-salt swaps, from The George Institute. Free.
Evidence and more information
- Heart Foundation: What is blood pressure?
- MJA: Australian hypertension guideline (2016)
- Australian Prescriber: Home monitoring of blood pressure
- NICE: Hypertension in adults (NG136)
- Lancet: Blood pressure lowering and outcomes, meta-analysis (2016)
- Lancet: PATHWAY-2, resistant hypertension (2015)
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