Can you prevent high blood pressure in your 40s and 50s? Are there non-medicated ways to lower it?

You don’t really think much about your blood pressure, except when Anger takes control, like in the animated movie Inside Out. Or the more sobering scenario when you receive the results of your recent health examination. It is enough to make you give up wagyu beef, even if momentarily.
But why is high blood pressure or hypertension such worrying news? Blood pressure is the force your blood exerts on the inner walls of your arteries and other blood vessels as it gets circulated throughout the body. It is not a good sign if this force is consistently too high and your heart has to work overtime to pump the blood. Untreated, hypertension increases the risk of heart attack, heart failure, stroke, kidney failure and can basically unalive you.
What is more concerning is that you may not be aware you have hypertension. In most cases, people “incidentally discover they have high blood pressure during asymptomatic screening at health carnivals, pre-employment checks, or before planned surgery”, said Adjunct Associate Professor Low Ting Ting, a senior consultant with Department of Cardiology, National University Heart Centre, Singapore.
“Hypertension most often presents without symptoms until serious complications such as stroke, heart attack or kidney disease have occurred,” said Dr Hong Rilong, an associate consultant with National Heart Centre Singapore’s Department of Cardiology.
WHAT IS CONSIDERED HYPERTENSION?
“Although the optimal blood pressure is below 120/80mmHg, hypertension is only formally diagnosed, according to local clinical practice guidelines, as an in-office blood pressure of above 140/90mmHg,” said Dr Hong.
However, doctors are moving away from “one-size fits-all recommendations” for blood pressure goals, said Dr Hong. “The optimal blood pressure targets vary according to the risk profile of the patient. For example, patients with chronic kidney disease or increased cardiovascular risk may require a lower blood pressure target.”
You’ll notice that your blood pressure reading consists of two numbers, which indicate the following, said Adj Assoc Prof Low.
But what if one of the blood pressures is normal but the other puts you in Stage 2 hypertension, for example, 160/80mmHg? Your blood vessels and organs will still experience “abnormal stress levels, which have been demonstrated to increase cardiovascular risk”, said Dr Hong. “As long as one component is elevated, it is considered hypertension.”
Here’s a look at what your blood pressure readings mean, according to Healthhub: 
WHY IS MY BLOOD PRESSURE READING INCONSISTENT?
Anyone who has been monitoring their blood pressure would know that the measurements can fluctuate over the course of the day. In fact, US researchers have found that the time of day and even the time of year can influence blood pressure readings by as much as 40 per cent.
“Blood pressure has a 24-hour circadian pattern,” explained Dr Low Lip Ping, chairman emeritus of Singapore Heart Foundation. “In the morning, blood pressure is slightly higher than in the evening. When you sleep, blood pressure drops by 10 per cent to 15 per cent. It rises again in one to two hours before you wake up.”
The best time to accurately take your blood pressure, according to Dr Low, is in the morning. Do it before breakfast and more than 10 to 15 minutes after waking up, he said. It is also a good idea to pass urine first as a full bladder can increase blood pressure.
IS HYPERTENSION INEVITABLE WITH AGE?
The chances of developing hypertension does increase with age, said Adj Assoc Prof Low, more commonly after age 50. “Currently, about one in three Singaporean adults suffers from hypertension.”
The numbers seem to back that up. For instance, about 8 per cent of Singaporeans between 18 and 29 years old have hypertension, according to the 2022 National Population Health Survey. This number rises significantly to almost 77 per cent among those above 70 years old. 
The reason for the higher prevalence as you get older is that your “arteries stiffen due to the reduction in elasticity of the artery wall over the years”, said Dr Low. This “increases the resistance to the pumping of the heart, causing the heart to beat harder and the blood pressure to increase”, he said.
There’s also a genetic connection. “Having one or two family members with high blood pressure makes it twice as likely for you to develop hypertension due to genetic factors,” added Dr Low.
And we haven’t factored in other things that come along in life such as stress, high-sodium diet (more than the limit of one teaspoon a day), sedentary lifestyle, weight gain, smoking, excessive alcohol consumption and the use of some medications such as birth control pills and certain weight-loss aids.
CAN YOUNGER PEOPLE ALSO GET HYPERTENSION?
“Although older people are more at risk of hypertension (aka primary hypertension), young adults from 18 to 40 years of age, and in fact, children, too, can be diagnosed with high blood pressure (aka secondary hypertension),” said Adj Assoc Prof Low.
“Primary hypertension is the more common form, also known as essential hypertension, which describes hypertension with no obvious cause,” she said. “Secondary hypertension is less common, usually affecting young adults or even children, and describes high blood pressure with an underlying identifiable cause.”
Examples of such medical causes can include sleep apnoea, hormonal disorders, thyroid disorders or the narrowing of the arteries or aorta, said Adj Assoc Prof Low. 
In older adults, diabetes, in particular, often go hand in hand with hypertension, said Dr Low. “Elevated blood sugar levels damage the artery walls, causing them to develop and accumulate plaque,” he said. “Subsequently, the blood vessel wall stiffens, leading to increased blood pressure.”
WHY IS HYPERTENSION MORE COMMON IN MEN THAN WOMEN?
Hypertension is indeed more common in men than women before age 50, according to Dr Ian Phoon, a senior consultant with SingHealth Polyclinics​, on HealthXchange. “Some studies demonstrated that women tend to have higher heart pump output and lower blood vessel resistance, thereby minimising blood vessel injury,” he said.
However, after the age of 55, the trend is reversed and more women are diagnosed with hypertension instead. “W​omen’s blood pressure can escalate when oestrogen levels fall after menopause, around the age of 50,” said Dr Phoon. “By 70 years old, about 80 to 90 per cent of women are likely to have developed high blood pressure.”
“Oestrogen has a beneficial effect on blood pressure,” explained Adj Assoc Prof Low. “This hormone effectively relaxes artery walls and prevents atherosclerosis (the build-up of fatty plaques) in the blood vessels. The protective effect of higher oestrogen levels is lost with menopause and the arteries become stiffer with age.”
Let’s not forget about the middle-age spread either. This is the period when the metabolism rate slows down, “leading to a higher tendency for weight gain and build-up of body fat, that can also contribute to a tendency for developing high blood pressure”, said Adj Assoc Prof Low.
DOES HAVING HYPERTENSION MEAN HAVING TO TAKE MEDICINE FOR LIFE?
If you are already on hypertension medication, chances are, you’ll have to keep at it for a long time. “In general, about 60 per cent to 80 per cent of patients would require medications apart from lifestyle modification to manage their blood pressure,” said Dr Hong.
It is important to stay on course because when hypertension is left uncontrolled, organ damage “may occur over many years to decades but once set in, is not usually reversible”, said Dr Sun Jingfeng, a family physician from SingHealth Polyclinics, on HealthXchange. “Thus, prevention is better than cure.”
However, Dr Sun said it is not necessarily to be on medication for life. “The need to continue hypertension medications may vary for different individuals and their health conditions,” she said.
HOW DO I BRING DOWN MY BLOOD PRESSURE LEVELS WITHOUT MEDICINE?
You shouldn’t skip the medicine if you’ve been prescribed. You can try, along with the meds, to bring down your blood pressure numbers by getting more exercise, losing weight and managing stress. Quitting smoking, and cutting down on alcohol and salt would also help.
What about foods and supplements? “It is important to note that they are intended to complement or augment existing treatments for hypertension,” said Ng Jing Wen, a dietitian with 365 Cancer Prevention Society. “They should not be viewed as replacements for medication.” And check with your doctor first before tweaking your diet or splurging on supplements.
If you want to try eating healthier for your blood pressure, fish oil and probiotics may be worth a shot. In studies, omega-3 fatty acids in fish oil have shown a potential to mitigate elevated blood pressure by reducing oxidative stress as well as cholesterol levels, said Ng. “Omega-3 fatty acid supplementation within the range of 2g to 3g a day could be considered as an adjunctive therapy for hypertension.”
You might also want to check with your doctor about probiotics if you’re hypertensive and diabetic as well. Citing studies, Ng said that probiotics’ “blood pressure-lowering effect may be particularly significant in hypertensive patients with Type 2 diabetes”.
“Probiotics are more effective when consumed in the long term (eight weeks or more) and at higher doses (exceeding 5 billion colony forming units or CFU per day),” said Ng. “Lactobacillus plantarum has been associated with a significant decrease in blood pressure compared to other groups, although consuming multiple species may potentially yield greater benefits.”
As for foods – such as beetroot juice, garlic, ginger and green tea – which are often touted on social media as hypertension-lowering, Ng isn’t so sure as there is mixed evidence or limited research.
Another popular supplement that is often associated with blood pressure reduction is the antioxidant CoQ10. According to Mary-ann Chiam, the senior principal dietitian with Allium Healthcare, this is especially so for people on statin therapy as statins can deplete CoQ10 levels, she said.
However, when it comes to blood pressure management, CoQ10’s efficacy is still debated, with some studies showing benefits while others do not, said Chiam. Furthermore, this antioxidant has anticoagulant effects, so those with bleeding disorders or are on anticoagulant medications should take heed.
Potassium and magnesium are other nutrients that have caught many people’s eyes. Potassium does help to get rid of excess sodium, which is known to cause water retention and increase blood pressure, said Chiam, adding that it can also relax the blood vessel walls to reduce blood pressure.
But be careful if you have kidney problems because an excessive potassium intake can affect your heart health, she said. “Potassium supplements can also interact adversely with ACE inhibitors and potassium-sparing diuretics.”
Magnesium seems like a do-gooder that aids vascular relaxation, regulates muscular contraction and increases the effectiveness of all antihypertensive drug classes. “A magnesium intake of 500mg to 1,000mg a day may reduce blood pressure by as much as 5.6/2.8mmHg,” said Chiam. However, there are also studies that show no change at all, she said.
The caveat: Magnesium may interact with antibiotics and osteoporosis medicines. Another minus is, it can accumulate and exacerbate pre-existing kidney issues. “Elevated magnesium levels can potentially impact cardiac function in susceptible individuals,” said Chiam.