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High Cholesterol and High Blood Pressure

Medically Reviewed by Brunilda Nazario, MD on June 07, 2021

High cholesterol and high blood pressure have a complicated relationship. About 38% of all American adults have high cholesterol, or a total cholesterol number over 200 milligrams per deciliter (mg/dL). More than 43% have high blood pressure. High blood pressure means either your top number (systolic reading) is 140 or higher, or your bottom number (diastolic reading) is 90 or higher, or both.

More than 60% of people with high blood pressure also have high cholesterol. Both also threaten heart health because they’re risk factors for cardiovascular disease. But you can get all your numbers under control with many of the same steps.

What’s the Connection?

The link between high blood pressure and high cholesterol goes in both directions. When the body can’t clear cholesterol from the bloodstream, that excess cholesterol can deposit along artery walls. When arteries become stiff and narrow from deposits, the heart has to work overtime to pump blood through them. This causes blood pressure to go up and up.

Over time, high blood pressure can damage arteries in its own way. It makes tears in artery walls where excess cholesterol can collect.

Researchers are trying to find out exactly how high blood pressure and high cholesterol interact. It could have to do with a body function called the renin-angiotensin system (RAS). This is a complex set of reactions that involve the proteins, enzymes, and hormones that regulate blood pressure. High cholesterol may keep the RAS from working the way it should.

High cholesterol and high blood pressure are also the two main risk factors for heart disease and stroke because of the damage each one does over time. When you have both, your risk is even higher.

High cholesterol and high blood pressure are also among a cluster of conditions that together are called metabolic syndrome. Metabolic syndrome raises your risk for diabetes as well as heart disease and stroke.

Managing High Cholesterol and High Blood Pressure

Lifestyle changes are often the first step to improving both conditions.

Eat a healthy diet. Choose plenty of fruits, vegetables, whole grains, poultry, fish, and other lean proteins, nuts, seeds, and vegetable oils. Good plans to follow are the DASH diet, designed to lower blood pressure, and the Mediterranean diet.

Keep saturated fat to less than 6% of your daily calories. Blood cholesterol is more a reflection of how much saturated fat you eat than the cholesterol in foods, but these diets naturally limit dietary cholesterol, too.

Key foods to avoid or at least limit are red meats, processed meats and other high-salt foods, and sugary foods and drinks. A plant-based diet often brings the best results.

Be more active. If you can get in 150 minutes of moderate-intensity cardio activity each week, you can help lower both cholesterol and high blood pressure. And that doesn't have to mean pounding it out on a treadmill. Throw a Frisbee with your kids (or dogs) in the backyard, and take brisk walks in a nearby state park.

Lose excess weight.  Obesity is linked to high blood pressure, high cholesterol, and more. It can increase LDL cholesterol (the “bad” cholesterol) and lower HDL cholesterol (the “good” cholesterol). It can also raise blood pressure. A weight loss of as little as 5% to 10% of your excess body weight can help improve cholesterol numbers and blood pressure.

Don’t smoke, and limit alcohol. Smoking and vaping lower your good cholesterol. If your LDL is already high, smoking worsens the already bad effects of high blood pressure. It also raises your risk of heart disease. Drinking too much alcohol can drive both blood pressure and another type of blood fat called triglycerides higher. High triglycerides can add to cholesterol buildup in your arteries.

Take medication if needed. When lifestyle changes aren’t enough to move your numbers, medications targeting each condition can make the difference. You’ll likely need statins for lowering cholesterol and RAS blockers to control blood pressure. Together, they help you reduce heart disease and stroke risk. Depending on your blood pressure level, it might take two types of blood pressure-lowering drugs to get the job done.

To get the most benefits from these drugs, stick with the plan your doctor prescribes. It’s estimated that only half the people on these medications actually lower their numbers, but this is mostly because they just don’t take them. Taking lots of pills can be a hurdle, so scientists are looking for a single pill that does both jobs.

The Importance of Screening

There are no early warning signs for high blood pressure or high cholesterol. They’re pretty sneaky when it comes to doing damage. The only way to find out your numbers is to get screened with a painless blood pressure measurement and a simple blood test.

Because these conditions are starting at earlier ages than in the past, the American Heart Association recommends everyone 20 years or older get screened and work with their doctor to rein in high numbers.

Need another reason? High blood pressure and cholesterol levels in young adults may increase heart disease risk later in life, even if those levels are brought under control later on.

Research shows that high LDL in early adulthood is linked with a 64% increase in heart disease risk later on, compared to a healthy LDL level. High systolic and diastolic blood pressure are linked with 37% and 21% increased risks, respectively, for heart failure.

Screening not only saves lives, but also helps you avoid the costs and emotional toll of medical care to treat advanced conditions.

WebMD Medical Reference

Sources

SOURCES:

American Heart Association: “2021 Heart Disease and Stroke Statistics Update Fact Sheet At-a-Glance,” “Health Threats from High Blood Pressure,” “How Can High Blood Pressure Cause a Heart Attack?” “Combining drugs that lower blood pressure and cholesterol could do more to prevent stroke,” “Prevention and Treatment of High Cholesterol,” “Is drinking alcohol part of a healthy lifestyle?”

Hypertension: “2020 International Society of Hypertension Global Hypertension Practice Guidelines.”

Circulation: “Blood Pressure and Cholesterol Control in Hypertensive Hypercholesterolemic Patients: NHANES 1988-2010,” “Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association.”

Journal of Clinical Medicine: “A Similar Lifetime CV Risk and a Similar Cardiometabolic Profile in the Moderate and High Cardiovascular Risk Populations: A Population-Based Study.”

Cleveland Clinic: “Cholesterol: High Cholesterol Diseases.”

Nutrition, Metabolism, and Cardiovascular Diseases: “Renin-angiotensin system at the crossroad of hypertension and hypercholesterolemia.”

Merck Manual: “Regulating Blood Pressure: The Renin-Angiotensin-Aldosterone System.”

CDC: “High Blood Pressure and Cholesterol.”

Clinical Cardiology: “A defined, plant-based diet utilized in an outpatient cardiovascular clinic effectively treats hypercholesterolemia and hypertension and reduces medications.”

Journal of Hypertension: “Obesity and cardiovascular risk: a call for action from the European Society of Hypertension Working Group of Obesity, Diabetes and the High-risk Patient and European Association for the Study of Obesity: part A: mechanisms of obesity induced hypertension, diabetes and dyslipidemia and practice guidelines for treatment.”

National Heart, Lung, and Blood Institute: “Your Guide to Lowering Blood Pressure,” “Wake-up call: High blood pressure and cholesterol in young adults associated with later heart disease.”

Journal of the American College of Cardiology: “Associations of Blood Pressure and Cholesterol Levels During Young Adulthood With Later Cardiovascular Events.”

Annals of Family Medicine: “Health Benefits and Cost-Effectiveness of Asymptomatic Screening for Hypertension and High Cholesterol and Aspirin Counseling for Primary Prevention.”

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