Beyond salt: Research highlights underappreciated sources of high blood pressure

blood pressure

High blood pressure, also called hypertension, has become a public health threat—an alarming 122.4 million American adults have it, according to the American Heart Association, and only 1 in 4 have it under control.

The consequences can be serious: Hypertension has been linked to a higher risk of heart attack, stroke, and heart failure, and it contributes to nearly half a million deaths each year.

Studies have attributed much of this risk to excess sodium or salt in the diet, which is why Americans have long been urged to cut down on this widely used food additive. While salt can often be a major culprit, researchers are working hard to identify other factors that cause high blood pressure, which is a complex disease involving genetic, behavioral, and environmental influences. Studies now show that certain lesser-known culprits—including sleep apnea and decongestants—can increase blood pressure.

The good news: You can take steps to reduce their impact by increasing your awareness of them.

“It’s important for people to know their blood pressure numbers and take steps to reduce high pressure levels, including becoming aware of the many reasons those levels can rise above normal levels,” said Lawrence Fine, M.D., chief of the Clinical Applications and Prevention Branch at NHLBI. “We urgently need more effective strategies to help people get and keep their levels under control.”

Here are five things (beyond salt) that can increase your blood pressure—and what you can do. Additional details are described in an NHLBI website section entitled High Blood Pressure: Causes and Risk Factors.


Being overweight or having obesity increases your risk of developing high blood pressure, research has shown. In fact, the NHLBI’s Framingham Heart Study suggested that approximately 78% of the hypertension cases in men and 65% in women can be directly attributed to obesity. One way to lower your weight is by following the Dietary Approaches to Stop Hypertension (DASH) eating plan, which limits fats, sugars, and foods that are high in sodium while emphasizing fruits, vegetables, whole grains, low fat dairy, beans, nuts, fish, lean meats and poultry. The DASH plan, developed decades ago, is also scientifically proven to reduce blood pressure and was recently named by U.S. News & World Report as No. 1 in “Best Heart-Healthy Diets.” .

Lack of exercise

Researchers who study cardiovascular health have long known that lack of exercise is associated with higher blood pressure. But now they’re learning what specifically can help. One study showed that substituting just 30 minutes of moderate to vigorous physical activity—which can range from housework to walking or running—for sedentary behavior was associated with lower systolic and diastolic blood pressure. Systolic is the top number in a blood pressure reading, while diastolic is the bottom number. A normal blood pressure reading is less than 120/80 millimeters of mercury (mm Hg). The researchers used data from NHLBI’s Multi-ethnic Study of Atherosclerosis (MESA) study, which included an ethnically diverse group of middle-age and older U.S. adults. More recently, a study found that exercise in combination with the DASH eating plan can help lower “resistant” or uncontrolled hypertension, one of the most difficult forms of high blood pressure to treat.

Certain medicines

Nearly 1 in 5 people with hypertension may be taking medications for other conditions that can unintentionally increase their blood pressure, according to a study published in JAMA Internal Medicine. Medicines that are linked to high blood pressure include nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and aspirin, antidepressants, decongestants, and hormonal birth control pills. Check your medication labels to see if what you’re taking may put you at added risk or talk to your doctor about medicines that could affect your blood pressure.

Sleep apnea

Obstructive sleep apnea is a common disorder that occurs when your breathing stops and restarts many times while you sleep, and it can contribute to serious health problems. Studies have linked sleep apnea to high blood pressure, particularly in adults. But the risk apparently can begin in childhood. A recent study found, for example, that children with obstructive sleep apnea are nearly three times more likely to develop high blood pressure when they become teenagers than children who never experienced sleep apnea. Talk to your healthcare provider if you think you or your child might have this condition.


One study found that women who have a preterm pregnancy have a higher associated risk for developing high blood pressure later in life. It is important for women to monitor blood pressure and consult with a healthcare provider during and after pregnancy, as high blood pressure can harm a mother’s health as well as that of her unborn child. In fact, another study found that women who have high blood pressure during pregnancy, also known as preeclampsia, have a greater risk of premature death. On a more positive note: A recent study found that treating chronic hypertension in early pregnancy benefits both mother and child. The study, which involved more than 2,400 pregnant adults, found that those who received medication to lower their blood pressure below 140/90 mm Hg were less likely to have a preterm birth or experience one of several severe pregnancy complications, such as preeclampsia. Additionally, the birth weight of the infants did not appear to be affected by antihypertensive treatments.

Journal information:
JAMA Internal Medicine

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