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A growing number of people in the UK are suffering from both high blood pressure (hypertension) and high cholesterol (hypercholesterolemia). But what exactly makes up a diagnosis of high blood pressure, or high cholesterol?
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Generally, when someone takes your blood pressure, there will be two numbers; a high one and a low one. The high number should normally be below 140 (this is called the systolic), and the low one below 80 (this is called the diastolic). Anything above these numbers is a high blood pressure reading.
However, just because you have one measurement above these readings does not mean you have high blood pressure.
There are a lot of factors that go into a high blood pressure reading, and it is important to know what your blood pressure averages out to generally. For example, if you have an extreme fear of doctors and everything to do with them, it’s not surprising that you had high blood pressure the last time you were in their surgery!
Other things that can cause short-term rises in blood pressure are pain, infection, and recent exercise, to name just a few.
If you have recently had a high blood pressure reading, your doctor might decide to send you home with a “24-hour blood pressure monitor”. This is a blood pressure cuff that sits on your arm and takes measurements throughout the day, which your doctor can then use to see what your blood pressure is like on a normal day at home.
If you do have high blood pressure, the doctor will then talk to you about what your treatment options are.
Unless your blood pressure is very high, or you have an underlying medical condition causing a big increase in your blood pressure over a short period of time, it is unlikely that you will feel different at all.
High blood pressure is generally something that develops over time and with age. Your body gets used to the higher pressure and you just feel, well, normal.
If you have very high blood pressure (with a top number above 180 and a bottom above 120), you might develop symptoms such as headaches, back pain, problems with your vision and blood in your urine. If you develop any of these symptoms, it is important to see your doctor, or call NHS 111.
If you have a home blood pressure monitor and you get readings above those just mentioned, it is important to remember that many things can lead to a false reading. If you are feeling well, simply repeat the measurement a couple of times. Make sure you have been sitting for at least two minutes, you are as relaxed as possible, and the blood pressure cuff is at the same level as your heart.
The blood pressure cuff (the fabric bit that goes around your arm) should cover about 80% of the top part of your arm (above the elbow) from top to bottom, and the bit that inflates should circle just under half horizontally. Wrongly sized cuffs can also lead to falsely high, or low blood pressure readings.
Long term, high blood pressure increases your risk of other conditions, such as stroke and heart disease.
Always having higher blood pressure puts a strain on your blood vessels, which can cause small amounts of damage. This doesn’t create an immediate issue unless your blood pressure is very high, but over time, this small amount of damage leads to scarring and build-up of clots (atherosclerosis). This is what can cause issues with your heart, kidneys, and other organs.
Generally, doctors split high blood pressure into two categories; primary and secondary.
Primary high blood pressure is where you have high blood pressure, but no specific condition is directly causing it. This is likely to develop as you get older. It may be contributed to by certain lifestyle factors, such as eating a lot of salt, obesity, smoking, or drinking alcohol, but no single one of these things has caused you to have high blood pressure.
Secondary high blood pressure is where there is a disease causing you to have high blood pressure. Some examples of this would be kidney disease, thyroid problems, and even sleep apnoea. Treatment for this type of high blood pressure might be slightly different from people who have no underlying health condition directly causing it. Doctors may focus on treating the disease causing the problem, as opposed to just giving medications to bring the blood pressure down.
If your blood pressure isn’t too high, your doctor might suggest trying lifestyle changes to improve your blood pressure. This could mean losing weight, eating less salt, drinking less alcohol, quitting smoking, or increasing the amount of daily exercise that you take.
If these things don’t work, or if your doctor thinks that they are unlikely to work, then you might be prescribed blood pressure medications. There are various different tablets you could be prescribed, and the choice for the first choice of medication might depend on what other medical conditions you have, what medications you already take, and even what background you come from.
The important thing to remember is that just because one tablet hasn’t solved your high blood pressure, others still can be tried, or even added, to bring it down further. Once you have started to take blood pressure tablets, your doctor, or practice nurse will monitor your blood pressure on a regular basis to ensure that your blood pressure is improving. If it is not, they will then discuss increasing doses, or other options with you.
You could leave your blood pressure readings to your doctor, or you can buy a home blood pressure monitor to take it yourself at home. There are advantages to taking readings at home – you will generally be more relaxed and will be able to take it at more consistent times of the day. This should give you an overall better idea about how well your blood pressure is controlled. You can keep a blood pressure diary, which will help your doctor in future appointments guide your ongoing treatment.
A high cholesterol reading is anything above 5. You have very high cholesterol if it is above 6.5. Once you are over the age of 40, your doctor may measure your blood pressure and cholesterol every five years, to make sure you are not developing either of the conditions.
Generally, people with high cholesterol won’t have any symptoms at all. Sometimes, you might get white rings around the coloured part of your eye (called arcus senilis), or small yellow changes in the skin around your eyes (xanthelasma.) People with high cholesterol levels however, are more likely to have no symptoms at all, than either of these things.
Unfortunately, high cholesterol goes hand-in-hand with high blood pressure. It is another symptom that puts you at a higher risk of heart disease and stroke.
It is most likely if you are suffering from high cholesterol that it is due to lifestyle factors such as diet and weight. Rarely, it can be caused by specific genetic conditions. If you are diagnosed as having very high cholesterol levels at a young age, and members of your family also suffer from it, then your doctor might decide to test you for something called “familial hypercholesterolaemia”. This is a condition where members in your family genetically have higher cholesterol levels. The good news is that this condition is rare in the UK, and it is more likely that high cholesterol levels are due to general aging and lifestyle factors.
You may have heard people talking about “good cholesterol” and “bad cholesterol”. This refers to the different types of cholesterol in your blood.
Broadly there are three main types:
HDL, or high-density lipoproteins. These are the ones sometimes referred to as “good cholesterol”. They help by moving the “bad cholesterol” to the liver, where it can be broken down.
LDL, or low-density lipoproteins. These are known as “bad cholesterol”. High levels of this type of cholesterol in the blood are associated with a build-up of fat in the arteries. This is what puts you at an increased risk of heart attack, or stroke.
Triglycerides. Again, high levels of these can cause fat to line the walls of your arteries and increase your risk of stroke and heart attack.
As with high blood pressure, when you are diagnosed, your doctor might talk to you about some healthy lifestyle changes that you can make to decrease your cholesterol without tablets. Some of these include cutting out certain types of fats from your diet, increasing the amount of fruit and vegetables that you eat, and exercising more often.
If this does not work, your doctor might start you on medication to reduce your cholesterol. The drug most commonly prescribed is called a “statin”.
Statins are drugs that lower the amount of cholesterol in your blood. Not only do they decrease the amount of cholesterol, but they also reduce your risk of stroke and heart disease. In fact, if you had a heart attack and didn’t have high cholesterol, your cardiologist would likely start you on a statin anyway, as it has positive effects on the heart. Research shows that out of every fifty patients taking a statin, one person will be saved from having a serious condition like a heart attack, or stroke.
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A lot of people in the UK could benefit from living a healthier lifestyle, but it’s difficult to know where to start. There are many different reliable sources of information out there to help you, but the NHS recommends a combination of healthy diet and exercise.
This includes:
It is recommended that we do at least two and a half hours of exercise a week, and of course, stop smoking and drinking less alcohol, with at least some alcohol free days a week.
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The British Heart Foundation has a call-line which you can ring for support and advice about any heart condition, including high blood pressure. They will be able to discuss your situation and point you to further help, if needed. You can also chat with them live, online on their website, or email them.
The NHS website also has a lot of information on high blood pressure, and its treatments.
Heart UK is a specific cholesterol charity. They have plenty of online resources that you can use to understand the condition and its treatments better. They also run a helpline Monday to Friday from 10am to 3pm for people who just prefer to talk to someone.
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Medical terms are often baffling and difficult to fully understand. To help, we have listed some frequently used terms below.
Arcus Senilis – a white ring you might develop around the iris (coloured part of your eye) when you have high cholesterol
Atherosclerosis – the build-up of clots in the walls of your arteries. It is a direct risk for heart attack and stroke
Blood pressure cuff – the fabric part of a blood pressure monitor that goes around your arm and inflates to take the blood pressure readings
Blood pressure monitor – a machine that takes measurements of your blood pressure
Cardiologist – a doctor who specializes in medicine to do with the heart
Cholesterol – a kind of fat which is vital for several things in the body, including making up cells. It can be found in the blood, and higher levels are associated with a heart attack and stroke
Diastolic – the lower number of a blood pressure reading. This number comes from the pressure inside your blood vessels when your heart is not actively pumping and relaxed
Familial hypercholesterolaemia – a genetic condition that runs in families and causes high levels of cholesterol in the blood at younger ages than you would typically expect. It is associated with high rates of heart attack and stroke, but is rare in the UK
Hypercholesterolaemia – a condition where there are high levels of cholesterol in the blood
Hypertension – a condition where your blood pressure is high
Primary hypertension – a condition where your blood pressure is high, but there is no disease directly causing this
Secondary hypertension – a condition where your blood pressure is high, but this is caused by a specific condition, like kidney disease
Statins – drugs that are commonly used to lower cholesterol levels in the blood and decrease the risk of heart attack and stroke
Systolic – the higher number in a blood pressure reading. This is the pressure in your blood vessels when your heart is actively squeezing to pump blood through your arteries
Xanthelasma – fatty skin deposits around the eyes, generally related to high cholesterol levels
