High Blood Pressure and Atherosclerosis

Medically Reviewed by Brunilda Nazario, MD on October 20, 2021

How Does Atherosclerosis Relate to High Blood Pressure?

Atherosclerosis is plaque buildup in the arteries. When it happens in the arteries that supply blood to the heart, doctors call it coronary artery disease, or CAD.

High blood pressure can lead to CAD because it adds force to the artery walls. Over time, this can damage these blood vessels and lead to more plaque buildup. The narrowed artery limits or blocks the flow of blood to the heart muscle, which means it might not get enough oxygen.

In time, this may cause chest pain (angina). Plaque can  also break off or damage a blood vessel, possibly leading to a heart attack or stroke.

High blood pressure alone raises the risk of atherosclerosis, but it's especially dangerous if you smoke or you have diabetes or unhealthy cholesterol levels

What Are the Symptoms of Atherosclerosis?

In the early stages, you typically don’t have symptoms. Once coronary arteries start to seriously restrict blood flow to the heart, you may feel chest pain (angina) because not enough blood is reaching your heart, especially when you exert yourself or you feel angry or stressed.

What Are the Complications of Atherosclerosis?

  • Heart attack
  • Stroke
  • Peripheral arterial disease
  • Erectile dysfunction
  • Kidney disease
  • Chest pain (angina)
  • Pain in the legs (claudication)

What Is a Heart Attack?

A heart attack is a sudden loss of blood flow to the heart muscle. It usually happens when plaque deposits from atherosclerosis break open and cause a blood clot that clogs an already narrowed coronary artery and so limits or blocks blood flow.

Without enough oxygen, part of the heart muscle is injured and sometimes permanently damaged.

How Is Atherosclerosis Diagnosed?

Doctors often don’t diagnose atherosclerosis until a person complains of chest pain. At this point, the doctor may conduct tests to evaluate your risk for heart disease. These tests include:

  • Electrocardiogram (ECG): Sometimes called an EKG, it uses painless electrodes on your arms, legs, and chest to measure your heart’s rate, rhythm, and electrical activity. It may show if you've had a heart attack in the past or are having one now. It can also show any strain or thickening of the heart muscle. 
  • Exercise stress test: During this test, a medical team takes ECG and blood pressure readings as you exercise on a stationary bicycle or treadmill. The test has limitations because only serious narrowing of arteries typically shows up as abnormal on the test. So though the test is useful and means you likely don’t yet have serious atherosclerosis, you could still have growing plaque buildup in your arteries.
  • Cardiac catheterization: Here, your doctor inserts a small flexible tube (catheter) into an artery, typically in the groin, arm, or neck and guides it through to the heart. They then inject dye in order to watch which way it flows. This helps your medical team find and measure any blockages in your heart. Sometimes they can even open up any blockages by expanding a small balloon to push plaque against the artery wall (angioplasty) or placing a tiny metal tube, or “stent,” to keep the blood vessel open.
  • Echocardiogram: This test uses ultrasound waves to provide pictures of the heart's valves and chambers. It tells your doctor about chamber size, heart wall thickness, blood flow, and more. Because it’s so easy and noninvasive, the echocardiogram is often used as the first test after ECG to look for heart problems. It does have some limitations however. For example, it can’t directly detect blockages or plaque buildup in the coronary arteries. 
  • Carotid ultrasound: This test uses ultrasound waves to provide pictures of blood flow in the arteries of the neck. Because atherosclerosis affects arteries in general, detecting blockages in the neck arteries suggests that it is highly likely that blockages are present in other parts of the circulatory system (including the coronary arteries).
  • Computed tomography (CT) scan: Here, a computer uses X-rays to make a cross-wise image of the heart. This can tell doctors the likely amount of calcium in coronary arteries, which is an indication of underlying atherosclerosis. Some more advanced CT scanners give more detailed pictures of coronary arteries.
  • Magnetic resonance arteriography (MRA): This test uses a magnetic field and pulses of radio waves to create images of blood vessels and show where they may be blocked. 

What Is the Treatment for Atherosclerosis?

Treating high blood pressure can offer dramatic protection against atherosclerosis. Much of the decline in the death rate from heart attacks and strokes is due to improved treatment of high blood pressure over the past 50 years.

For example, in middle-aged and older adults with high blood pressure, lowering systolic blood pressure (the top number) by 10 points leads to:

  • 50% to 60% lower risk of dying from stroke
  • 40% to 50% lower risk of death from a heart attack

Exercise and a low-salt diet that is high in fruits, vegetables, and whole grains will reduce blood pressure by a moderate amount. Keeping a healthy weight can also help. (Ask your doctor about the right weight for you).

In many cases, your doctor will suggest medication to help control your high blood pressure.  In fact, your doctor may prescribe drugs to reduce both your high blood pressure and the risk of atherosclerosis.

High blood pressure drugs include diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, and alpha-blockers.

Treatment for atherosclerosis typically starts with changes to diet and exercise habits, along with other possible lifestyle changes like quitting smoking. Your doctor might also prescribe medications, like statins, to help reduce blood cholesterol levels.

Other treatments may include angioplasty and stenting for severe blockages.

In some cases, your doctor may suggest open heart (bypass) surgery.

Show Sources


American Heart Association. 

Rosendorf, C. Circulation, 2007; vol 115: pp 2761-2788.

Wilson, P. American Journal of Hypertension, 1994. vol 7: pp 7S-12S.

American Heart Association: "High Blood Pressure Statistics."

Jackson, R. Lancet, 2005; vol 365: pp 434-441.

Mark Silverman, MD, emeritus professor of medicine, Emory University School of Medicine, chief of cardiology, Piedmont Hospital, Atlanta.

American Medical Association.

Cleveland Clinic: “Heart Attack (Myocardial Infarction).”

Johns Hopkins Medicine: “Cardiac Catheterization.”

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