Diet or Exercise: Which One is Better for Managing Blood Pressure?

High blood pressure (hypertension) is a health condition that puts you at a greater risk of having a heart attack or stroke, and that risk only increases with age. Changing your diet and getting regular exercise can make a big difference.

But for many people, it can be daunting to find a starting point for your health journey. Do you cut all salt out of your diet immediately, start going for long runs in the morning, or do you have to do both? The good news is: you don’t have to overhaul your whole diet or run a marathon to keep your blood pressure healthy. 

Diet is usually the best place to begin because most patients who have high blood pressure also have overweight or obesity, NYU Langone cardiologist Sean Heffron, MD, told Verywell. Exercise is easier once you lose a bit of weight, he said, and dieting tends to be more effective for weight loss. 

Other factors that affect your risk of high blood pressure include age and genetics, so lifestyle changes won’t always cut it; some people need medication to manage hypertension. But for most, gradually reducing sodium intake is the right place to start.

While physical activity is also an important piece of a healthy lifestyle, preventive cardiologist Marc Katz, MD, told Verywell that “you can never out-lift a bad diet.” In other words, no amount of exercise can undo the damage caused by everyday eating choices.

Salt Is Everywhere!

Reducing the amount of sodium in your diet can help lower your blood pressure, but that’s no easy feat, Katz said. According to the American Heart Association (AHA), much of the food you eat contains “too much sodium,” and that’s before you reach for the salt shaker. 

More than 70% of the sodium consumed in the standard American diet comes from packaged, prepared, and restaurant foods, according to the AHA. In many cases, salt is added for flavoring or preserving foods with a longer shelf life.

But in the human body, added salt leads to excess fluid retention. Katz explained that when you have more salt, your body holds more fluid to maintain equilibrium. More fluid means more pressure in the bloodstream, thus increasing your blood pressure.

With this balance in mind, one of the best things you can do to lower your blood pressure is to decrease your salt intake. Cutting back on salt in the long term may also reduce your risk of hypertension-related illness.

A recent study published in the Journal of the American College of Cardiology found that people who don’t shake extra salt in their foods tend to have a significantly lower risk of heart disease-related events.

Try the DASH Diet—But Not a Mad Dash

The DASH diet was created with blood pressure in mind. The plan’s name stands for Dietary Approaches to Stop Hypertension, and it’s been highly recommended by cardiologists since the 1990s.

People who follow a DASH diet have seen significant decreases in blood pressure, independent of other factors like exercise. The diet’s main cornerstone is reducing salt intake and limiting red meat and sugary snacks.

The standard DASH diet limits sodium to 2,300 milligrams or about a teaspoon of table salt daily. A more stringent goal is less than 1,500 milligrams per day, which would help lower blood pressure even further and faster.

Meeting the targets for sodium can be the most challenging aspect of the DASH diet, Katz said. “You don’t have to be perfect every day, but you should try to strive to continue to enhance your diet and make healthier eating choices,” he said.

A typical serving guide for the DASH diet, based on a 2,000-calorie-a-day diet, may look like this:

• Grains: 6–8 servings per day
• Vegetables: 4–5 servings per day
• Fruits: 4–5 servings per day 
• Lean meats, poultry, or fish: 6 or fewer servings per day
• Low-fat dairy products: 2–3 servings per day
• Nuts, seeds, and pulses: 4–5 servings per week
• Sweets: 5 or fewer servings per week

Multiple studies have found that people with hypertension who meet DASH targets experience reductions in systolic blood pressure (the top number of a blood pressure reading) by as many as 11 points, and people with borderline high blood pressure who followed the diet also achieved a decrease in blood pressure (albeit a smaller one).

Overall, this way of eating emphasizes a balance of nutrient-dense food, including fresh produce, whole grains, nuts, seeds, legumes, moderate amounts of lean protein, and low-fat dairy. Think Mediterranean diet, but hold the salt.

Staying Active Is Important Too

Prioritizing a healthy diet doesn’t mean exercising should go by the wayside, Katz said. Pairing the DASH diet with some amount of exercise works better than either strategy in isolation, and people who live an active lifestyle and get sick tend to have better outcomes than those who are not physically active.

“You don’t need to go out and run a marathon by any means, but any amount of exercise that’s getting your heart rate up can certainly put you in better shape,” Katz said.

Getting your heart pumping with regular exercise makes it stronger over time, and a stronger heart can pump blood with less effort, lowering blood pressure. Exercise can also indirectly impact blood pressure by helping you maintain a healthy body weight, which is a risk factor for high blood pressure, Heffron said.

Healthcare providers recommend at least 150 minutes of moderate aerobic exercise—or 75 minutes of vigorous aerobic exercise—weekly, often alongside light resistance training to strengthen your muscles. A combination of light-to-moderate aerobic activities and muscle strengthening tends to have the best outcome for blood pressure management, according to a 2022 study.

Walking is an excellent form of aerobic exercise, but Hefrron said many of his patients live sedentary and car-centric lifestyles. If you can walk outside or on a treadmill at three miles per hour, that’s moderate exercise; he said, for city dwellers, that’s a pretty average pace.

Aerobic exercise can include anything that increases your heart and breathing rates, including:

• Walking
• Bicycling
• Climbing stairs
• Dancing
• Jogging
• Swimming
• Active sports, such as basketball or tennis
• Gardening, including mowing the lawn and raking leaves

Although regular exercise lowers blood pressure in the long term by dilating the arteries, it can spike your blood pressure during your workout. Heffron and Katz recommend checking with a healthcare prover before starting a new exercise or diet routine.