Surprising Causes of High Blood Pressure You Shouldn’t Ignore
When most people think about high blood pressure, they picture the usual suspects—too much salt, lack of exercise, maybe a family history. But what if I told you there are some surprising causes of high blood pressure you shouldn’t ignore? As an internal medicine physician who’s been managing hypertension for over a decade, I’ve seen patients shocked (and sometimes relieved) to learn that it’s not always about bad habits or genetics. Some sneaky culprits can spike your numbers without you even realizing it. Let’s break them down in everyday language—no jargon, just real talk.
1. Over-the-Counter Medications: A Hidden Risk
Here’s one I see way too often—patients using common OTC meds without realizing they could be pushing their blood pressure up. Decongestants like pseudoephedrine? Yep, that nasal spray or cold pill you grabbed from the pharmacy shelf might be messing with your BP. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen, are another group I talk about often in clinic.
- Decongestants narrow blood vessels to reduce swelling, but that also raises blood pressure.
- NSAIDs can cause fluid retention and affect kidney function, both of which contribute to hypertension.
I had a patient in her late 40s with stubborn high blood pressure despite being on two medications. Turned out she was taking ibuprofen almost daily for joint pain. Once we switched her to a safer alternative, her BP finally budged. Always check with your doctor before taking these long-term, especially if you’re already on meds for hypertension.
2. Lack of Sleep and Sleep Apnea
You’d be surprised how often I connect poor sleep to blood pressure spikes. It’s not just about feeling tired—chronic sleep deprivation messes with the systems that regulate blood pressure. And if you’re snoring loudly or waking up gasping, sleep apnea might be the culprit.
- Sleep apnea causes intermittent drops in oxygen, which can trigger a stress response that raises BP.
- Chronic insomnia activates your sympathetic nervous system (that fight-or-flight mode), keeping your pressure high around the clock.
Honestly, I’ve had several patients who got their blood pressure under control just by using a CPAP machine. One guy in particular—mid-50s, overweight, on three medications—finally saw a drop after a sleep study confirmed moderate obstructive sleep apnea. Treating that made all the difference.
3. Unmanaged Stress (Even the “Good” Kind)
This one’s personal. I’ve seen stress elevate blood pressure in patients across every age group. And it’s not always the dramatic, obvious stress. Sometimes it’s subtle—overwork, parenting, even planning a wedding (yes, I’ve seen “happy stress” raise BP, too). The body doesn’t distinguish between types of stress—it just responds.
Chronic stress leads to long-term activation of the adrenal glands, pumping out cortisol and adrenaline. Those hormones cause your heart to beat faster and your vessels to tighten up. Boom—your blood pressure goes up, often without warning.
- Tip from clinic: I often recommend patients try short daily mindfulness sessions. Even five minutes of deep breathing can help reset your nervous system.
- Journaling, walking outside, or even laughing (seriously!) helps bring those numbers down.
One of my patients—a teacher in her 30s—had textbook readings at home, but sky-high numbers in clinic. Turned out her morning routine was a chaotic rush. A few small lifestyle tweaks and some early-morning self-care brought her readings back into normal range. Stress isn’t always obvious, but it’s a powerful trigger we can’t overlook.
4. Hormonal Changes You Might Not Expect
This is an area where patients often feel totally blindsided. Hormonal shifts—especially during menopause or due to thyroid dysfunction—can absolutely wreak havoc on blood pressure. I’ve seen postmenopausal women develop hypertension practically overnight, and younger adults with undiagnosed thyroid issues whose BP refused to behave until the root cause was treated.
- Thyroid disorders—both hypo- and hyperthyroidism—can affect vascular resistance and heart rate.
- Menopause brings declining estrogen, which affects artery flexibility and sodium sensitivity.
If you’ve been struggling to get your blood pressure under control despite doing “everything right,” checking hormone levels might be your next best step. Trust me, it’s worth it. I’ve had several cases where treating a subtle thyroid imbalance led to dramatic improvements in BP control.
5. Hidden Sodium in “Healthy” Foods
Now, this one gets people every time. You’re eating a salad, drinking a veggie smoothie, maybe even avoiding the salt shaker—and yet, your blood pressure is still high. I can’t count how many times I’ve had to break it to patients that their “healthy” meals were sneaky sodium bombs in disguise.
Foods marketed as low-fat, plant-based, or “heart smart” can still pack a punch when it comes to salt. I’ve seen folks eating canned soups, deli turkey, and even certain protein bars thinking they were making great choices. And hey, kudos for the effort—but those milligrams add up fast.
- Breads and wraps – You wouldn’t guess it, but some whole grain wraps can have over 400mg of sodium… per serving.
- Plant-based meat substitutes – They’re better for cholesterol, maybe—but many are loaded with sodium for flavor.
- “Low-calorie” frozen meals – Great for portion control, awful for blood pressure in many cases.
One of my patients, a marathon runner in her 60s, came in confused about her blood pressure creeping up. After digging into her food journal, we found the culprit: a daily veggie burger and canned lentil soup habit. We swapped in homemade options with low-sodium broth, and voilà—her numbers came right back down.
6. Loneliness and Social Isolation
This might sound a little “soft” compared to the other causes, but trust me—it’s legit. There’s growing research (and I’ve seen it firsthand) showing that chronic loneliness can raise blood pressure, especially in older adults. It’s not just about mental health—it actually causes physiological changes.
When people feel isolated, it tends to activate the body’s stress pathways. Cortisol rises, inflammation increases, and sleep patterns suffer. Over time, that mix creates the perfect storm for elevated blood pressure.
- Lack of social interaction can reduce resilience to everyday stress.
- Emotional stress from isolation increases sympathetic nervous activity—just like anxiety or trauma.
I remember a sweet gentleman in his 70s who came in every few months. His numbers were always borderline high, despite great compliance with meds and diet. After a few longer chats, he shared that he’d been feeling lonely since his wife passed. I connected him with a local support group and he started volunteering. Next few visits? His blood pressure improved, and so did his energy. Human connection is powerful medicine.
7. Too Much Licorice (Yes, Really)
This one still surprises folks—and honestly, I love telling the story because it’s so unexpected. Licorice root (especially the real stuff, not just the candy flavoring) can cause significant increases in blood pressure.
The compound responsible is glycyrrhizin, which can cause your body to retain sodium and lose potassium. That imbalance can lead to hypertension—and even low potassium complications like muscle weakness or irregular heart rhythms. I had a patient who was drinking herbal tea with licorice root for digestion. Her BP readings had been creeping up for months. Once she cut it out, things went back to normal within two weeks.
- Check labels on herbal teas, supplements, and traditional remedies.
- If you enjoy black licorice, go easy—especially if you’re on blood pressure meds.
It’s not something I see every day, but it’s a great example of how even natural or “healthy” things can backfire in unexpected ways. Always bring your supplements or herbal routines up with your doctor—we’re not judging, we just want to help you stay safe.
8. Inconsistent Medication Timing
Let me end this section with a super practical tip that makes a huge difference. Taking your medications at different times every day—or skipping doses here and there—can really mess with your blood pressure control. You’d be amazed how many patients struggle with this without even realizing it.
I once had a patient whose BP would spike randomly during the week. We ruled out every possible cause until we figured out the pattern: on weekends, she slept in and took her meds two or three hours late. That small timing shift made a big difference, especially since she was on a short-acting ACE inhibitor. Once we switched to an extended-release version and set up a consistent routine, her numbers smoothed out beautifully.
- Use a pill organizer or reminder app—whatever works best for your lifestyle.
- If your schedule changes frequently, talk to your doc about long-acting options or flexible regimens.
Consistency is key. Hypertension meds aren’t like pain relievers—you don’t take them “as needed.” It’s about keeping steady levels in your bloodstream to support your cardiovascular system all day, every day.
9. Chronic Pain and Inflammation
Here’s something I wish more people—and honestly, more clinicians—paid attention to. Chronic pain isn’t just a quality-of-life issue. It’s a blood pressure issue too. Whether it’s from arthritis, fibromyalgia, or even untreated migraines, ongoing pain sends stress signals throughout your body, often raising your blood pressure over time.
I had a patient with early-stage osteoarthritis. She was tough, rarely complained, and said she didn’t need pain meds. But her blood pressure told a different story—persistently high, even though she was active and eating well. We added a gentle anti-inflammatory and a physical therapy plan. Not only did her mobility improve, but her blood pressure finally responded to treatment.
- Inflammatory cytokines released during chronic pain contribute to vascular stiffness.
- Stress hormones (hello again, cortisol) stay elevated when pain is ignored.
If you’ve been silently “pushing through” pain, consider this your sign to bring it up at your next appointment. It’s not weakness—it’s part of your blood pressure story.
10. Vitamin D Deficiency
This one doesn’t get enough press, but it’s backed by solid research—and I’ve seen it play out with my own patients. Low levels of vitamin D have been linked to elevated blood pressure, possibly due to effects on renin-angiotensin system regulation and vascular function.
Living in northern climates? Working night shifts? Wearing sunscreen 24/7 (which we should, by the way)? All of these can leave you a little D-deficient. And while deficiency alone won’t cause hypertension overnight, it can quietly add to the mix.
- Have your levels checked during routine labs, especially if your BP is tough to manage.
- If you’re low, a simple supplement or increased safe sun exposure might help more than you expect.
I once saw a 34-year-old new mom with creeping blood pressure despite being healthy overall. Her labs showed borderline-low vitamin D. After 3 months of supplementation, we saw her readings drop by 10-15 points. Was that the only reason? Probably not. But it clearly played a role.
11. Overtraining or Excessive Exercise
This one tends to surprise the fitness enthusiasts I work with. Yes, too much exercise—especially without proper rest—can raise blood pressure in certain people. It’s rare, but I’ve seen it enough to know it’s not just a myth.
Your body perceives overtraining as stress. Combine that with electrolyte imbalances, dehydration, or even adrenal fatigue, and your once-healthy habit can backfire. It’s more common in competitive athletes or folks who suddenly increase intensity without adjusting nutrition and recovery.
One of my patients, a CrossFitter in his 40s, saw a sudden spike in blood pressure after doubling his training days. We scaled him back, bumped up hydration and recovery, and sure enough—his readings normalized. He still trains hard, just smarter now.
- Watch for symptoms like fatigue, irritability, and poor sleep—that’s your body’s warning system.
- Recovery days aren’t a luxury—they’re part of the prescription.
References
- Centers for Disease Control and Prevention (CDC)
- National Institutes of Health (NIH)
- American Heart Association (AHA)
- Mayo Clinic
Final Thoughts
High blood pressure isn’t always about what you eat or how often you hit the gym. It’s often about what’s happening beneath the surface—your habits, your hormones, your hidden stressors. And as a physician, I’m always reminding my patients: you don’t have to be perfect—you just need to be informed.
If something feels off or your numbers won’t budge no matter how hard you try, don’t blame yourself. Dig deeper, ask questions, and bring your full story to your provider. That’s how we uncover these surprising causes—and start seeing real progress.
Disclaimer
This article is for educational and informational purposes only and is not intended as medical advice. Always consult your physician or healthcare provider before making changes to your health regimen, including medications, supplements, or lifestyle factors related to blood pressure management.

Dr. Gwenna Aazee is a board-certified Internal Medicine Physician with a special focus on hypertension management, chronic disease prevention, and patient education. With years of experience in both clinical practice and medical writing, she’s passionate about turning evidence-based medicine into accessible, actionable advice. Through her work at Healthusias.com, Dr. Aazee empowers readers to take charge of their health with confidence and clarity. Off the clock, she enjoys deep dives into nutrition research, long walks with her rescue pup, and simplifying medical jargon one article at a time.