High blood pressure triggers more heart attacks and strokes in the United States than any other cause; it kills more people worldwide than smoking, diabetes or obesity. Yet simple lifestyle changes often lower blood pressure significantly. When they don’t, drugs usually can.

Get screened

Your heart is a powerful muscle that pumps blood through your arteries. To withstand that pressure, healthy arteries should be flexible. Anything that makes them less supple — advancing age, a genetic predisposition, certain medications and risk factors such as inactivity, obesity and smoking, for example — can make blood pressure rise.

It’s important to detect high blood pressure early, before too much damage is done. That’s why you should have it checked at least once every two years, and more often if you’re 50 or older or have other risk factors.

To improve the accuracy of a blood pressure measurement:

- Don’t smoke, exercise or consume anything caffeinated for at least half an hour before your appointment.

- Use the bathroom first: A full bladder can affect the reading.

- Sit with your feet flat on the floor for five minutes before the reading. Rest your arm on a table so it’s at heart level.

- Remain quiet during the test.

Make lifestyle changes

Even if you don’t have high blood pressure, it’s important to take steps to keep it under control since it tends to get higher with age. For people with high blood pressure, those measures can sometimes reduce or even eliminate the need for drugs. For example, research has found that the DASH (Dietary Approaches to Stop Hypertension) diet can be as effective as medication for some people with mild hypertension. This relatively low-sodium diet is packed with fruit, vegetables and low-fat dairy products. The potassium in those foods and possibly the calcium appear to help control blood pressure.

People who slash their sodium intake further — to around 1,500 milligrams daily, less than half the typical amount consumed by U.S. adults — often see an even more significant drop in pressure. For people with normal blood pressure and no risk factors, a more modest goal of 2,400 milligrams, achievable by adopting the DASH diet alone, might help ward off the upward creep of blood pressure that tends to occur with age. Other steps include losing excess weight, exercising regularly and drinking moderately, if at all.

Get the right drugs

If healthy lifestyle changes alone don’t adequately lower your blood pressure, or if your levels are very high, you should consider medication. The first choice for many people is usually a diuretic, particularly thiazide diuretics. They’re effective, safe and available as low-cost generics.

Still, many doctors routinely prescribe other drugs, including newer and much more expensive ones. That can make sense for people with health problems that can be worsened by diuretics, such as gout or kidney disease. For example, beta blockers can make sense for people who have had a heart attack, and ACE inhibitors often work for those with diabetes. Additional drugs are sometimes necessary if a diuretic alone doesn’t adequately lower blood pressure. But if you’re otherwise healthy and your doctor recommends a drug other than a diuretic, ask why.

Don’t rely on supplements

While a diet rich in potassium and possibly calcium can help control blood pressure, it’s unclear if supplements have the same effect. And some recent research suggests that too much calcium from supplements might increase the risk of heart disease and other health problems.

As for potassium, the form in supplements (and salt substitutes) might not have the same effect as the potassium found in foods. And too much of it, even from food, can cause problems for people with heart failure or kidney disease and for those who take certain blood pressure drugs, including ACE inhibitors, angiotensin II receptor blockers (ARBs) and potassium-sparing diuretics such as spironolactone (Aldactone and its generic cousins). So talk with a doctor before increasing your intake.

Some dietary supplements — including fish oil and cod-liver oil, co-enzyme Q-10, garlic, wheat bran and pycnogenol (an abstract of pine bark) — might lower blood pressure a bit, according to the nonprofit Natural Medicines Comprehensive Database. Still, the evidence for each is meager and all can cause side effects, especially if taken with blood pressure drugs.

If you’re considering them, first talk with your doctor. If you decide to take one, choose a supplement labeled “USP Verified,” which means it meets purity and potency standards set by the U.S. Pharmacopeia, a standard-setting authority.

Copyright 2011. Consumers Union of United States Inc.