High blood pressure (HBP) — or hypertension — won’t kill you directly. But HBP can lead to potentially fatal diseases, such as heart, stroke and kidney disease, says Andrew Freeman, MD, director of clinical cardiology at National Jewish Health in Denver. About 1 in 3 U.S. adults — or 67 million people — have high blood pressure. What’s worse is that more than half of Americans don’t even know it. 

Hypertension is known as the “silent killer” because the condition is usually symptomless. HBP is diagnosed when you have repeated readings of 140 mm Hg over 90 mm Hg, or 140/90. The condition can go undiagnosed for years, only revealing itself once damage is done, says Freeman. When your arteries have to work extra hard to get the blood to where it needs to go, over time this pressure damages your arteries. When those damaged arteries can’t supply enough nutrient- and oxygen-rich blood to your organs, your organs don’t work as well. Basically, your whole body suffers, says Freeman.

That’s why it’s important to get to your doctor for yearly physical exams to make sure your blood pressure is at — and stays at — a healthy range. If you’re diagnosed with HBP, here are a few helpful facts that can help you manage and treat the condition.

Fact: Medications aren’t the only answer

Depending on how high your pressure is, and whether you have other medical conditions, your doctor may suggest you start taking antihypertensive medications right away to prevent a heart attack or stroke. The American Heart Association says that many doctors will start medications when systolic blood pressure is 140 or higher, or diastolic is 90 or higher.

But not all physicians follow this general rule. If your systolic reading is somewhat elevated (in the 150s) with no other symptoms, your doctor may let you try some lifestyle changes first, says Freeman. “If possible, I like to hold off on medications and allow my patient to try to change their blood pressure with lifestyle changes, followed by frequent follow-up visits,” he says.

If your doctor recommends meds right away, don’t worry. This doesn’t mean you’ll be on them forever. Freeman says many of his patients are able to get off of their medications soon after they incorporate lifestyle changes, including adjusting their diet, adding exercise, and reducing stress. He says he often see changes quickly, sometimes in just a week or two.

Fact: Exercise has a long-term positive effect on blood pressure

“Exercise can be just as potent as medication in lowering blood pressure,” says Freeman. Some studies find that it can lower your blood pressure by up to 10 mm Hg. The key is to get to a level where you’re short of breath for 30 minutes at least five times a week. However, since exercise in the short-term increases blood pressure, depending on the severity of your pressure your doctor may recommend an exercise stress test to make sure it’s safe for you to begin exercising.

Fact: Sodium is hiding in your favorite foods

If you haven’t already, ditch the saltshaker. There’s a whopping 2,300 milligrams of sodium in one teaspoon of salt. The recommended daily amount of sodium for anyone with high blood pressure is less than 1,500 mg.

The saltshaker isn’t your only enemy if you have HBP. People are shocked to learn that bread is the number-one source of hidden salt in the American diet, says Freeman, with one slice having up to 230 mg sodium. Here are some other foods where sodium tends to hide.

  • Pizza, up to 760 mg per slice
  • Cold cuts and cured meats; two slices of bologna, 578 mg
  • Chicken nuggets; between five and six, average 600 mg
  • Canned soups; 1 cup of canned chicken noodle soup, 940 mg
  • Salted nuts; ½ cup dry roasted pistachios or almonds, 250 mg

Always opt for low-sodium or no-sodium versions of your favorite foods, when possible.

Fact: You can eat your way to better numbers

Commit to a plant-based diet, such as the DASH (Dietary Approaches to Stop Hypertension) eating plan, which recommends four to five servings each of fruit and vegetables and two to three servings of low-fat dairy every day, along with foods rich in whole grains, fish, poultry, beans, seeds, and nuts. Research has shown that blood pressure can be lowered in as little as 14 days by eating this way.

Fact: Stress less to keep your pressure lower

When you’re in a stressful situation, your body releases powerful hormones (adrenaline and cortisol) which make your heart beat faster and your blood vessels constrict raising blood pressure. The good news is when the stress goes away, your blood pressure returns to normal. However, many people experience chronic stress on a daily bases, which keeps your blood pressure higher for longer periods of time. It’s not clear whether stress causes heart disease. But stress is definitely something you should aim to decrease in your life.

Experts say you can reduce stress by giving yourself enough time for daily tasks (such as getting the kids to school, getting to work on time); engaging in activities that are relaxing for you at least once a day (for 15 to 20 minutes); and focusing on supportive relationships with family and friends. 

Jessica DeCostole is a licensed registered dietitian and health writer living in Baltimore, MD.