Hypertension, or high blood pressure, usually has no symptoms. But chronic stress does show up in the body, and it could be a cue to monitor your blood pressure.

“Hypertension is mostly silent until advanced stages—you may not know your blood pressure is high unless you check it, which is why regular screening is so important,” said Piyumika de Silva, MD, a primary care physician in the Cedars-Sinai Medical Network. “But you can feel stress—and you should talk to your doctor about it, because ongoing stress can raise your blood pressure over time.”

Chronic stress and anxiety are linked to hypertension, which can cause heart attack, stroke, kidney disease and dementia. But if you address it early, you can lower your blood pressure and reduce your risk for developing debilitating conditions.

“Sometimes we have to make significant changes to our lives in order to be healthy,” said Florian Rader, MD, medical director of the Hypertension Center of Excellence in the Smidt Heart Institute at Cedars-Sinai. “It's not an easy thing to fix, but it can work both ways: Having better blood pressure is a big stress relief, and relieving stress may lower your blood pressure.”

Regardless of stress levels, all adults should be screened for high blood pressure at least once a year, at an annual preventive visit. Readings that are consistently higher than 130/80 mm Hg indicate hypertension.

De Silva recommends that patients whose blood pressure is borderline, or those who have a family history of high blood pressure, purchase an FDA-approved at-home blood pressure cuff. Ask your doctor to show you how to use it.

“In the two weeks before your annual physical, take twice daily measurements so your doctor gets a more complete picture of your health,” she said.

Researchers are still defining the connection between chronic stress and blood pressure. But we know stress heightens the sympathetic nervous system, which governs the fight or flight response and releases hormones such as cortisol, which can increase blood pressure.

Chronic stress, and stress levels in general, are difficult to define, because everyone experiences stressors and situations differently. Stress might feel like a racing heart, shortness of breath, headaches, muscle pain or gut troubles.

“Stress and stress levels are hard to quantify, and what feels normal for one person may be overwhelming for another,” de Silva said. “That’s why it’s important to talk with your doctor about what triggers your stress, how you experience it and how your body responds.”

There is no specific test for chronic stress, which is subjective from person to person—it’s difficult to measure, and some people might not even realize they’re experiencing stress.

“A busy day for one could be very fulfilling, but for another, it could be pure stress,” Rader said. “Highly functional people are often used to the stress and thrive on it. Is it healthy? Probably not, and some people might benefit from being more aware of how they feel and what stress does to their body.”

To treat mild blood pressure elevations, the first thing doctors recommend is lifestyle modification—which includes stress reduction. Blood pressure readings should be reevaluated every three to six months to see if changes are effective.

“Be the best you that you can be: Healthy sleep, good diet and exercise can have huge improvements on both stress levels and blood pressure,” Rader said.

Stress and anxiety can lead to unhealthy coping mechanisms, such as drinking, smoking or stagnation, that can also increase blood pressure further, de Silva said.

“Listen to your body when you’re stressed and seek the care you need so that you don't develop that maladaptation that can raise your blood pressure even more,” she said.

Cedars-Sinai doctors can connect patients with behavioral health support, such as cognitive behavioral therapy resources, that can help you lower both stress and blood pressure. They also suggest:

“Slow breathing has been shown to reduce stress and blood pressure,” Rader said. “Take 10 minutes out of every day to focus on breathing, and try for a rate of less than 10 breaths a minute.”

“Simply being very present in the moment is an evidence-backed way of stress management for anybody,” de Silva said. “Ask yourself: What am I feeling in this moment and why? Take time throughout your day to scan your body and listen to the cues it is giving you.”

“Lack of sleep or poor sleep has been associated with higher blood pressure, so sleep hygiene is an absolutely crucial part of the lifestyle modifications you can do to lower blood pressure,” Rader said. “Evidence shows that at least seven hours a night is important in balancing your hormone response to stress.”

“Wearable technology can give you helpful information and insights to help you monitor your stress and analyze what’s going on,” de Silva said. “These devices can also be good tools to help you get regular exercise, by tracking 10,000 steps a day, or help manage stress with guided breathing exercises. However, wearable devices are not always completely accurate, unless they are clinically validated. Also, if the information overload makes you anxious, consult a physician about how to tailor your use to make the technology productive.”

If lifestyle modifications don’t lower your blood pressure to a healthy range, medications can help. Patients with genetic or advanced forms of hypertension often need medication, even if they practice healthy lifestyles.

Doctors often opt for the blood pressure medications with the fewest side effects, since studies show that about half of patients stop using drugs if they have adverse effects, Rader said. For many patients, the best drugs are angiotensin receptor blockers and calcium channel blockers.

Patients who are taking a combination of three or more medications and still have high blood pressure greater than 140/90 might quality for a newer procedure. Renal denervation, which was approved by the FDA in 2023, is a one-time, minimally invasive procedure to lower blood pressure.

During renal denervation, a surgeon inserts an IV into an artery near the groin to apply heat to the kidney artery. This ablation disrupts the nerves in the artery, disconnecting stress signals from the brain to the kidney, which can lower blood pressure.

The procedure is as effective as medication, and may work to lower blood pressure lifelong, said Rader, who conducted clinical trials on renal denervation at Cedars-Sinai.

Stress might be caused by deeply ingrained patterns in your relationships, at work or at home—but stress management shifts can work. Start small and then consider whether you need to make more radical changes.

Most importantly, de Silva emphasizes: High blood pressure isn’t necessarily a lifelong disease. If you detect and deal with it early, you can maintain your health and reduce your risk for stroke, heart attack and other conditions.

“There’s a lot you can do to lower blood pressure in addition to medications—and even medications don’t have to be forever with good lifestyle modifications,” she said.

Does stress affect blood pressure?

Though researchers don’t understand the exact relationship, chronic stress and blood pressure are linked.

How can you tell if stress is causing hypertension?

Get screened for high blood pressure at least once a year, and talk to your doctor about your lifestyle and stress symptoms. Stress is subjective and hard to measure, but your doctor can give you guidance for recognizing and dealing with stress.

How can you lower blood pressure?

Lifestyle modifications, including stress reduction, can help lower blood pressure. Medications can also improve hypertension when lifestyle changes aren’t enough, and some people may qualify for a newly approved FDA procedure that treats hypertension.