Mainstream doctors rarely run into a high number that they don’t want to treat with drugs. High blood pressure, or hypertension, is a perfect example. If your systolic blood pressure (that’s the higher number; diastolic is the lower) comes in over 130 or 135, and almost certainly over 140, out come the prescription pads for drugs which, particularly at higher doses, can make you feel tired or cause you to pee more frequently or interfere with your sex life. That’s a lot of medicated people, given that one in three in Americans have high blood pressure, over the age of sixty, more than one in two.

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Here’s the thing. For very high blood pressure, let’s say 150 or over, the trade-off is usually worth it. Hypertension is a major driver of both stroke and heart attack. But for common cases of borderline high blood pressure, the best medicine is upgrading the way you live: your diet and your exercise habits and the way you deal with stress.

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The good news? Not only will your blood pressure number go down, but every system in your body will raise its game and you’ll feel just plain better. And even if you do have the kind of hypertension that should be treated medically, making these changes should allow you to reduce the drug dosage and reduce, or possibly eliminate, the nasty side effects.

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Sound like a plan? Here are the specifics:

Greens to the rescue.

How you fuel yourself plays a big role in how efficiently your heart pumps blood throughout your body. (That systolic blood pressure number is a measure of the force with which the blood presses against those vessel walls.) A mineral that is crucial for healthy blood pressure – it helps regulate the amount of fluid that’s circulating in the system – is potassium. And leafy green veggies like spinach and broccoli have plenty of it. They also have the added benefit of being low in calories, a good thing since being overweight is a risk factor for high blood pressure. Potassium does its job in balance with another mineral, sodium, or in plain language, salt, technically sodium chloride. Too little potassium, too much sodium in the diet can be a problem. It’s a tricky subject – for too long, dietary salt was vilified as the universal high-blood pressure bogeyman. The truth is, plenty of people aren’t salt-sensitive but if you avoid processed food – the major source of salt in the American diet – you’ll be better off whether you are or aren’t.

Nitrites – the relaxation enhancer in your diet.

Beyond leaning into veggies in general, you can maximize you’re the health of your circulation by loading up on vegetables that are high in one specific class of compounds – nitrates. Inside your body, the nitrates convert to nitrites (not to be confused with the nitrites that are added as a preservative to processed foods) which then converts to nitric oxide. Nitric oxide is a gas that relaxes the vessels allowing them to deliver blood under less pressure, exactly what we want.

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Arugula, the peppery-tasting salad green (sometimes known as rocket or roquette) is the nitrites mother lode – a 4 oz. serving comes in at 500 mgs. But celery, butter leaf lettuce, and beets are also winners, with roughly a third to a half that amount per serving.

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If you don’t always have the time or space on your plate for a full-on salad, a handy work-around is to get your beets in juice form. The catch is, that a relatively small 4-oz. serving of beetroot juice (and try make it organic) packs 11 grams of sugar – and that’s too much if, like a lot of people with high blood pressure, your blood sugar levels are above normal. One solution is beetroot powder, also available in pill form, which delivers the goods with much less sugar.

Enjoy the upsides of magnesium.

It’s hard to imagine a cheaper, safer, non-pharma therapy for high blood pressure than a magnesium supplement. The mineral itself regulates metabolism in a myriad of ways but it has a generally relaxing effect on the system, including the blood vessels. We take in this essential mineral in the food we eat – think veggies, legumes and nuts -- but if your blood pressure is running high, odds are good, you’ll benefit from a supplemental dose in addition to eating well. At the health food store, it comes in different forms: magnesium glycinate which is well tolerated, can double as a mild sleep aid and magnesium chelate, is also helpful in other ways as well, offering a mild laxative effect.

Low carb for what ails you.

High blood pressure is often a sign that your entire metabolism – not just your cardiovascular system – is functioning at a sub-par level. That’s why we have the diagnosis of “metabolic syndrome” which captures a number of these problems that tend to crop up together: high blood pressure, high blood sugar, a big waist, low HDL (or good) cholesterol, etc. While doctors are often happy to play “whack-a-mole,” treating each different problem with a different pill, when you lose weight, you see improvements across the board. And a low-carb approach has been shown to deliver the most metabolic bang for the buck. Which only stands to reason. Less carbs means your body needs to produce less insulin, with the net result that we burn food as energy more efficiently, with fewer calories sent into fat storage.

Move it and lose it!

We evolved to be a species that moves. When we don’t push back against the modern sedentary lifestyle and sit in front of our computers all day, we pay a health cost -- and that includes high blood pressure. But when we exercise, or really, engage in any kind of regular, physical activity, we are literally moving towards health, and helping to manage our weight. Aerobic or cardio exercise has been the best studied. Keeping our heart rate up for a sustained amount of time burns up the excess blood sugar that gums up the works and strengthens the heart muscle so it can pump blood with less strain. When we’re brisk walking or jogging or cycling or swimming or doing whatever we do, we push up our blood pressure to supply the muscles’ increased demand for blood. Then when we’re done, the parasympathetic nervous system takes over and we enter a state of deep relaxation, a blood pressure yin/yang that is a tonic for the heart. Strength work, or resistance exercise, can also play role. But if your blood pressure hasn’t yet been brought under control, discuss a strength program with your doctor first (and don’t hold your breath when you’re pushing against resistance), and work with a trainer who is well-versed in working with those withnblood pressure issues. If you’re more of a DIY type, with the doc’s OK, doing body-weight exercises or resistance bands or light hand/ankle weights should fine for most people. Just start slow and build up your strength over time.

Meditate, now!

Bottom line: We should all meditate. And if you have high blood pressure, you need to! Blood pressure is intimately tied to the way we respond to stress. If every instance of irritation or anxiety during the course of the day supercharges our “fight or flight” hormones, we’ve got a problem, one that is going to be reflected in lousy blood pressure numbers.

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If you don’t already have a practice, start small. Take 10 or 15 minutes in the morning or at lunchtime, find a quiet spot, and clear your mind while taking slow, steady breaths. There is no one right way to meditate, but I, and a lot of my patients, practice a “mindfulness” style, eyes closed, paying attention to the in and out of each breath. If you need an assist getting into a meditative state try an app like Calm, or one of the thousands of others on-line.

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But what about the rest of the day, when you’re not in that calm, clear state? If you stick with a practice, and especially if you can meditate more frequently or for a longer period of time, you will slowly begin to rewire your body’s response to stress. Sure, you’ll still get anxious or irritated but, most of the time, it won’t send your blood pressure soaring. Better yet, you’ll be starting from a lower point on the stress-o-meter – which is something we all should shoot for!