Understanding How Blood Pressure and Cholesterol Are Linked to Heart Health

Maintaining your blood pressure and cholesterol are important keys to a healthy heart, yet many live with elevated levels. Nearly half the adults in the United States have high blood pressure, also known as hypertension, and two in five have high cholesterol, according to the Centers for Disease Control and Prevention.

“High blood pressure and high cholesterol are often silent, with many people experiencing no symptoms until there’s a serious blockage in the arteries to the heart,’’ says Dr. Samuel Kim, a preventive cardiologist specializing in lipidology at NewYork-Presbyterian/Weill Cornell Medical Center.

With heart disease as a leading cause of death in the U.S., Dr. Kim believes it’s important to take a proactive, preventive approach — and that includes understanding ways to adjust your lifestyle so that you stay in a healthy range. “Both conditions can increase the risk of heart attack and stroke,” he says. “If treated earlier, even a small change toward a healthier lifestyle can pay off in the long run.”

Health Matters spoke with Dr. Kim, who is also an assistant professor of medicine at Weill Cornell Medicine, to better understand blood pressure and cholesterol and what you can do to manage your numbers.

Why is it important to monitor blood pressure?
Dr. Kim: Think of your heart like an engine. Your vessels are the pipes, delivering blood throughout the body. Blood pressure is the force of blood pushing on the vessel walls. If there’s increased force in the piping of your system — which is what it means to have high blood pressure — it puts a strain on other parts of the body. And over time, the heart will wear out.

For most people with hypertension, the strain will cause the heart tissue to thicken and scar. This can lead to blockages inside the arteries and increased risk of developing heart failure or arrhythmias like atrial fibrillation.

Who is at risk of having high blood pressure?
According to the American Heart Association, an estimated 121.5 million adults in the United States have hypertension.

Risk factors include genetic predisposition or underlying conditions like thyroid or kidney disorders. Stress, physical activity, or a diet high in salt can play a major role. Sleep apnea is also a big factor, so early screening is encouraged.

Certain medications and supplements can also cause high blood pressure, including common ones like nasal decongestants or ibuprofen.

Additionally, as we get older, the blood vessels stiffen up and it’s natural for blood pressure to rise. The ability to regulate pressure is not as robust, so sometimes there may be swings between high and low readings.

People post-menopause can also see an increase in blood pressure, because declining estrogen results in the loss of protective mechanisms that improve blood vessels’ vascular tone.

On the other hand, individuals who exercise regularly tend to have a lower resting blood pressure. Physical activity strengthens the heart muscle, making it more efficient. Also, exercise may help secrete certain compounds like nitric oxide, which relaxes your blood vessels.

What do the numbers in a blood pressure reading mean?
There are two numbers in a reading: systolic blood pressure at the top and diastolic at the bottom.

Systolic is measured when the heart beats and blood is actively being pumped out, stretching on the blood vessels. Diastolic pressure is measured between beats when your heart is resting.

The ideal would be the top number being less than 120 and the bottom less than 80.

If the systolic is in the 130s or diastolic 80s to 90s, we often call that early-stage high blood pressure. If blood pressure is more than 140 over 90, we would consider that really high blood pressure that needs to be treated with more aggressive lifestyle intervention or dietary changes.

How do you get accurate blood pressure readings?
For home measurements:

• Try to find a time when you’re feeling most relaxed and calm.
• Put feet flat on the ground, uncrossing your legs.
• Make sure the cuff is not too tight, and don’t talk while the measurement is being done.

Blood pressure can fluctuate during the day. Your emotional state or what you last ate can influence a reading, so I tell patients to look at the average blood pressure measurement over several days, not just one snapshot in time, and keep a log to be proactive.

When is it time to call a doctor?
Contact your physician if your pressure is very low or very high — if the systolic number is dropping below 100, or if it is up in the 160 to 170 range.

Lifestyle change is the first stop in treatment: weight loss, exercise, and salt reduction. If that doesn’t work, it’s worthwhile discussing starting a medication.

What is cholesterol, and what happens when it’s high?
Cholesterol is a waxy substance essential for making hormones, vitamins, and cells in your body. It can be obtained through diet or produced by your liver.

Cholesterol isn’t bad, but in excess can put you at risk for plaque formation in your heart’s arteries or the carotid artery in your legs. It can also cause inflammation and damage to the lining of the blood vessel, increasing the risk of heart attack and stroke.

What are the types of cholesterol, and what do the numbers mean?
Low-density lipoprotein (LDL) is known as the “bad cholesterol.” That’s the leftover cholesterol after your body has processed it. These are particularly at risk of building plaque. Major offenders that influence your LDL include saturated fats like butter, processed foods, and red meat.

High-density lipoprotein (HDL) is “good cholesterol” and helps remove other forms of cholesterol from your blood. It’s probably the least understood cholesterol in its functionality and remains an area of research. We know that people who lose weight and exercise increase their HDL, but people who are alcoholic also have high HDL.

Triglycerides are the most common type of fat in the blood, and a function of your carbohydrate and sugar intake. The levels correlate with the risk of developing diabetes. Triglycerides are impacted by foods like bread, pizza, white rice, and pasta.

What causes high cholesterol?
Genetic mutations, certain medications, and diet can be causes. A fairly common genetic mutation is what is called familial hypercholesterolemia, which affects about 1 in 200 to 250 people. Knowing your family history is important to reduce risk.

With diet, it’s key to be mindful of what you’re eating day to day. For example, following a diet with a lot of red meat will increase LDL cholesterol.

How is it screened, and how is it treated?
Cholesterol is screened with a blood sample through a fasting or non-fasting lipoprotein profile. Your doctor will indicate whether you should fast beforehand.

The American Heart Association recommends that adults over age 20 or older have their cholesterol checked every four to six years as long as their risk remains low.

More than any medication, I emphasize small dietary changes early on, such as replacing a high-carb or high-sugar item with a vegetable snack or drinking water instead of soda. The goal is to sustain healthy numbers over decades of time.

If patients need more aggressive treatment, there are therapeutics such as injectable medications and other oral pills. Statins, or medications that work in the liver, are generally taken once a day and lower LDL.

What’s the connection between high blood pressure and high cholesterol? Hypertension and high cholesterol are serious, independent risk factors, but they share a common pathway of increasing damage to your heart.

They highlight that it’s not just one risk factor that needs to be considered when thinking about heart disease. Targeting all are important to maintain a healthy lifestyle and heart health.