Leena Watts
High blood pressure and high cholesterol are two of the major risk factors for heart disease and stroke. When they occur together, they can damage blood vessels, greatly increasing the risk of future complications. To prevent this, it is vital to get your cholesterol and blood pressure under control. While medication can help, lifestyle changes are also important. This includes quitting smoking, increasing physical activity, eating heart-healthy foods, and losing weight if you are overweight. A diet rich in fruits, vegetables, whole grains, nuts, and plant proteins can help lower cholesterol and keep blood pressure in check.
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What You'll Learn
- Lifestyle changes: quit smoking, exercise more, eat healthily, lose weight
- Medication: separate medications for high blood pressure and high cholesterol
- Polypill: a single pill with a combination of medications to treat high blood pressure and high cholesterol
- Bariatric surgery: a procedure that improves cardiometabolic health, including blood pressure and cholesterol
- Screening: get your blood pressure and cholesterol checked regularly
Lifestyle changes: quit smoking, exercise more, eat healthily, lose weight
Making healthy lifestyle changes is key to lowering your blood pressure and cholesterol levels. Here are some strategies to help you quit smoking, exercise more, eat healthily, and lose weight:
Quit Smoking
Quitting smoking is one of the best decisions you can make for your health. It can be challenging, but the benefits are significant. To quit smoking successfully:
- Consider using nicotine replacement therapy (NRT) products, such as nasal sprays, gums, or patches. These provide nicotine to satisfy your cravings without the harmful chemicals in tobacco smoke.
- Try e-cigarettes (vapes), which deliver nicotine in a vapour without the tobacco. While not completely risk-free, they are far less harmful than smoking.
- Utilize support services, such as the NHS Quit Smoking app, online communities, or local support groups. These can provide valuable advice and increase your chances of success.
- Be prepared for withdrawal symptoms, such as depressed mood, anxiety, irritability, and cravings. These symptoms typically peak in the first few days and then gradually improve over 2–4 weeks.
Exercise More
Increasing your physical activity is essential for improving your overall health and reducing blood pressure and cholesterol. Aim to incorporate a variety of exercises into your weekly routine, such as aerobic exercises, strength training, and flexibility workouts. Walking, jogging, swimming, and cycling are excellent aerobic exercises to get you started.
Eat Healthily
Adopting a heart-healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet, can effectively lower blood pressure and cholesterol. The DASH diet includes:
- Plenty of fruits and vegetables: Aim for 4–5 servings of vegetables and enjoy fruits as a dessert.
- Whole grains: Opt for whole wheat bread, brown rice, whole grain cereals, oatmeal, and whole wheat pasta.
- Low-fat dairy products: Include these in your diet while reducing overall fat intake.
- Limited sweets and fatty foods: Cut back on added sugars and limit fats and oils to 2–3 servings per day.
- Reducing sodium intake: Choose low-sodium foods and condiments, and limit processed foods.
Lose Weight
Losing weight, if you are overweight, can positively impact your blood pressure and cholesterol levels. The DASH diet mentioned above can help with weight loss while improving your overall health. Additionally, regular exercise plays a crucial role in weight loss and maintaining a healthy weight.
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Medication: separate medications for high blood pressure and high cholesterol
While medication can help manage high blood pressure and high cholesterol, it's important to note that most people will need to take more than one type of medicine to control their blood pressure. It is crucial not to stop taking your medication or alter the dosage without consulting your doctor first. They can advise on the best course of treatment and prescribe the appropriate medications.
High Blood Pressure Medications
For high blood pressure, your doctor may prescribe medications such as:
- Diuretics: These drugs, often called water pills, help the body get rid of excess water and salt through urination, reducing blood volume and, consequently, blood pressure.
- Beta-blockers: By blocking the effects of the hormone epinephrine, or adrenaline, these drugs slow down the heart rate and reduce the force of heart contractions, leading to lower blood pressure.
- ACE inhibitors: Angiotensin-converting enzyme (ACE) inhibitors prevent the formation of a natural chemical in the body that narrows blood vessels. This helps relax the vessels, improving blood flow and reducing blood pressure.
- Angiotensin II receptor blockers (ARBs): These drugs relax and widen blood vessels by blocking the effects of angiotensin II, a natural chemical that narrows blood vessels.
- Calcium channel blockers: These medications prevent calcium from entering the muscle cells of the heart and blood vessels, leading to a relaxation of blood vessels and improved blood flow.
High Cholesterol Medications
For high cholesterol, your doctor may recommend:
- Statins: These drugs block a substance your liver needs to make cholesterol, thus reducing the amount of cholesterol in your blood. They are often the first choice for lowering LDL cholesterol.
- Bile-acid-binding resins: Also known as sequestrants, these medications work by binding to bile acids in the intestine, preventing them from being reabsorbed and used to make cholesterol.
- PCSK9 inhibitors: These drugs block a protein called PCSK9, which normally helps to regulate LDL cholesterol levels. By inhibiting this protein, PCSK9 inhibitors increase the liver's ability to remove LDL cholesterol from the bloodstream.
- Niacin: This B vitamin, when prescribed in higher doses, can lower LDL cholesterol and increase HDL cholesterol.
- Fibrates: These medications reduce the amount of LDL cholesterol and triglycerides in the blood while increasing HDL cholesterol levels.
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Polypill: a single pill with a combination of medications to treat high blood pressure and high cholesterol
High blood pressure and high cholesterol are two of the major risk factors for heart disease. When both occur together, they can damage blood vessels and greatly increase the risk of future complications. Typically, separate medications are required to target each problem. However, a recent study has shown that a polypill can effectively treat both issues.
Polypill: A Single Pill with a Combination of Medications
The polypill is a single pill containing a combination of medications to treat high blood pressure and high cholesterol. The pill contains low doses of three medications that treat high blood pressure and one that lowers cholesterol. The cholesterol-lowering component of the polypill is designed to reduce LDL, the harmful cholesterol-carrying particle that contributes to artery-clogging atherosclerosis.
A randomised, controlled trial of adults without cardiovascular disease found that those who took the polypill daily for 12 months had decreased blood pressure and reduced LDL cholesterol levels compared to those who continued their usual routine medical care. The study showed an average reduction of 7 mm Hg in blood pressure and an estimated 25% reduction in the risk of experiencing cardiovascular disease.
The polypill offers a convenient and effective way to manage high blood pressure and high cholesterol, reducing the risk of associated complications such as heart disease and stroke. However, it is important to note that lifestyle changes, including a healthy diet, increased physical activity, and quitting smoking, are also crucial in managing these conditions and maintaining overall health.
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Bariatric surgery: a procedure that improves cardiometabolic health, including blood pressure and cholesterol
Bariatric surgery is a procedure that has been shown to improve cardiometabolic health, including blood pressure and cholesterol. This is especially beneficial for people with severe obesity, defined as those with a BMI of 40 or higher, or a BMI of 35 or higher along with an obesity-related health condition such as hypertension.
Bariatric surgery has been found to be the most effective treatment for severe obesity, with benefits extending beyond weight loss. The surgery has been shown to positively impact blood pressure and cholesterol levels, reducing the long-term negative impact of high blood pressure on organ damage. This is supported by various studies, including the GATEWAY randomised trial, which observed that gastric bypass surgery resulted in lowered blood pressure and increased diuresis in the long term.
There are different types of bariatric surgery procedures, which can be broadly categorised into restrictive, malabsorptive, and mixed procedures. Restrictive procedures include adjustable gastric banding (AGB), vertical-banded gastroplasty, and sleeve gastrectomy. These work by reducing the size of the stomach, thus limiting food intake. Malabsorptive procedures, such as biliopancreatic diversion (BPD) and biliointestinal bypass (BIBP), alter the digestive process, leading to reduced absorption of nutrients and calories. Mixed procedures, such as gastric bypass and Roux-en-Y gastric bypass (RYGB), combine elements of both restrictive and malabsorptive techniques.
Malabsorptive procedures are particularly effective in lowering cholesterol levels, even more so than restrictive procedures. This is due to decreased sterol absorption, which leads to decreased cholesterol and LDL cholesterol levels, along with enhanced cholesterol synthesis and catabolism. The greater weight loss associated with malabsorptive procedures also contributes to the more significant cholesterol reduction.
In addition to bariatric surgery, lifestyle modifications, including increasing physical activity, improving cardiovascular fitness, and reducing sedentary time, are crucial for lowering blood pressure and cholesterol. A healthy diet, quitting smoking, and weight loss can also positively impact both these factors. For some individuals, prescription medications or a combination of medications and surgery may be recommended to manage blood pressure and cholesterol effectively.
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Screening: get your blood pressure and cholesterol checked regularly
High blood pressure and high cholesterol are two of the major risk factors for heart disease. When both occur together, they can damage blood vessels, increasing the risk of future complications. Therefore, it is important to get your cholesterol and blood pressure under control and maintain them at healthy levels.
High blood pressure usually has no symptoms, so it cannot be detected without being measured. If you are an adult, you should get your blood pressure checked at least once a year. If your blood pressure is below 120/80 mmHg, get it checked at least once every two years, starting at age 20. If your blood pressure is higher than 120/80 mmHg, get it checked more often. If you have high blood pressure, your doctor will suggest lifestyle changes and may prescribe medications to help lower your blood pressure.
High cholesterol also does not have any symptoms, so a blood test is the only way to know if your cholesterol levels are higher than they should be. Talk to your doctor about how often you need to get your cholesterol tested and what your cholesterol numbers mean for you. If you have unhealthy cholesterol levels, your doctor may suggest lifestyle changes and, if those alone are not enough, may prescribe medications to help manage your cholesterol.
You can check your blood pressure with at-home monitoring or by making an appointment with your doctor for a screening.
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Frequently asked questions
A diet rich in fruits, vegetables, beans, nuts, whole grains, and plant proteins can help lower cholesterol. Oats, barley, psyllium, okra, eggplant, and soy are also cholesterol-lowering foods.
Quitting smoking, increasing physical activity, eating heart-healthy foods, and maintaining a healthy weight are some lifestyle changes that can help lower blood pressure.
Yes, medications like statins can help manage cholesterol levels. A "polypill" containing low doses of three medications to treat high blood pressure and one to lower cholesterol is also available and has been found effective.
Adults should get their blood pressure checked at least once a year. If you have high blood pressure, you may need to get it checked more frequently, as advised by your healthcare provider. A blood test can determine your cholesterol levels, and it is recommended to discuss the frequency of testing with your healthcare provider.
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