What causes high blood pressure and high cholesterol

We all know that February is heart month where we bring awareness to cardiovascular diseases. Some may think high blood pressure is the main factor for cardiovascular disease. However, high blood pressure is just one main factor. Did you know the link between high blood pressure and high cholesterol puts you at a greater risk for heart disease?

What is the relationship between high cholesterol and high blood pressure?

High cholesterol and high blood pressure are the two main risk factors for heart disease and stroke. They are 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 (as mentioned previously).

When both high blood pressure and high cholesterol occur together, they can damage blood vessels, greatly increasing the risk for future complications. To prevent heart disease and stroke, it’s vital to get your cholesterol and blood pressure under control.

Does lowering your cholesterol lower your blood pressure?

Certain lifestyle changes that lower cholesterol can also lower your blood pressure. Such as: eating a healthy diet and exercising can help lower both cholesterol and blood pressure.

Medications that lower cholesterol do not have as much of an impact on lowering blood pressure, so people with both high blood pressure and high cholesterol typically need separate medications that target each problem separately.

Tips to managing your blood pressure

One symptom of metabolic syndrome in adults is when one or both blood pressure numbers are high. Blood pressure numbers of 120/80 mm Hg or higher are considered high blood pressure, or hypertension.

To keep your numbers down:

• Lose weight, if needed
• Limit saturated fat, salt, and cholesterol in your diet
• Get regular exercise
• Don’t smoke. Non-smokers have fewer and less severe diabetes-related complications and better control of their insulin dosing and blood sugar.
• Don’t drink too much alcohol
• Take any prescribed medications as directed.

Your blood pressure can easily be checked with at home monitoring or making an appointment with your primary caredoctor to get screened.

RELATED: Checking your blood pressure at home

What can I do to manage my cholesterol?

One thing to note is that high cholesterol can start early in life and continue throughout your lifetime. It can increase your risk of developing heart diseases over time.

Besides taking medication to help maintain normal cholesterol levels, the same lifestyle changes you make to keep your blood pressure numbers down, would be the same for lowering your cholesterol: quit smoking if you smoke, increase your physical activity, eat heart healthy foods, and lose weight if you are overweight.

How often do I need to get screened?

Managing your blood pressure and cholesterol levels is an important part of staying healthy.

Blood pressure screening. High blood pressure usually has no symptoms, so it can’t be detected without being measured. Follow these guidelines for blood pressure screening:

• 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

Cholesterol screening. High cholesterol doesn’t have any symptoms, so a blood test is the only way to know if your cholesterol levels are higher than they should be. Follow these guidelines for cholesterol screening:

• Normal-risk adults - have cholesterol checked once ever 4-6 months, starting at age 20.
• Higher-risk adults - get it checked more often if you have other risk factors such as: a family history of heart disease or high cholesterol, diabetes, older age, being overweight.

For more information on heart and vascular care, visit touro.com/heart.

High blood pressure and high cholesterol on their own are serious risk factors for heart disease and stroke. When both high blood pressure and high cholesterol occur together, they can damage blood vessels, greatly increasing the risk of future complications. To prevent heart disease and stroke, it's vital to get your cholesterol and blood pressure under control.

What Causes High Cholesterol?

Cholesterol is a fat-like substance that your body needs to create cell walls and certain hormones. Cholesterol is made by the liver and obtained in the diet through animal products, like meat, seafood, and dairy.

Cholesterol doesn't dissolve in the blood, and it has to be carried around the body in particles called lipoproteins. Low-density lipoprotein (LDL) is known commonly as "bad cholesterol," because it increases the risk of cardiovascular disease. High-density lipoprotein (HDL), on the other hand, is considered "good cholesterol" since it lowers risk.

Genetics and lifestyle factors play a role in causing high cholesterol. Several different genes are associated with this condition.

The typical American diet is high in cholesterol and saturated fat, which raises cholesterol. Not getting enough exercise and smoking can also contribute.

Certain diseases and medications can also cause high cholesterol, including:

• Having low levels of thyroid hormone can lead to elevated LDL levels.
• A type of kidney disease called nephrotic syndrome increases LDL levels.
• Some medications, including steroids, protease inhibitors, and certain birth control pills, can increase cholesterol.
  

The Relationship Between High Cholesterol and High Blood Pressure

High blood pressure and high cholesterol both damage the inner lining of blood vessels, known as the endothelium.

Over time, endothelial damage contributes to the buildup of cholesterol plaques and inflammatory cells in the blood vessels throughout the body, known as atherosclerosis.

Endothelial damage also results in improper regulation of blood vessel dilation. The result is stiffened, narrowed arteries that do not respond the way they should.

Prevalence of High Blood Pressure and High Cholesterol

According to the Centers for Disease Control and Prevention (CDC), nearly one-half of adults in the United States have high blood pressure, but only half of these people have their blood pressure treated appropriately.

Two-thirds of U.S. adults have high cholesterol, and of these only one-third have it appropriately treated.

It is well-known that both high blood pressure and high cholesterol on their own contribute to atherosclerosis and increase the risk of cardiovascular events like heart disease and stroke. But there appears to be a more complicated interplay between high cholesterol and high blood pressure.

For one, when the risk factors for high blood pressure and high cholesterol occur together, they further increase the risk of cardiovascular events. And treating high cholesterol in a patient already treated for high blood pressure further reduces their risk of cardiovascular events. This demonstrates that it's even more important to treat high blood pressure and high cholesterol when they occur together.

Furthermore, high cholesterol and high blood pressure frequently do occur together, and studies have shown that high cholesterol is associated with and may contribute to high blood pressure later in life. It's important to look for and treat other risk factors when either one is present.

Potential Health Risks

Both high cholesterol and high blood pressure are well-known risk factors for stroke and heart attacks because they contribute to atherosclerosis.

Atherosclerosis is the buildup of plaque in blood vessels. Depending on the blood vessels affected, this condition can lead to health problems. Finding atherosclerosis in one artery means you are likely to have blockages in other arteries in the body.

Complications of atherosclerosis include:

• Coronary atherosclerosis: This is a buildup of plaque in the arteries that feed the heart. This can lead to heart attacks, heart failure, and death.
• Peripheral arterial disease: This is a buildup of plaque in the leg arteries that can cause claudication, or pain in the legs with walking that is relieved by rest. These blockages can lead to limb ischemia, in which there is not enough blood flow to the lower legs and feet, resulting in nonhealing wounds that may eventually require amputation.
• Carotid atherosclerosis: This is plaque in the carotid arteries in the neck that can block blood flow, break off, and travel to the brain, leading to stroke.
• Mesenteric ischemia: This plaque in the blood vessels that supply the gut can lead to poor blood flow or "gut ischemia," which causes pain after eating a meal and weight loss.

Signs of Heart Attack or Stroke

If you experience any sudden change in vision, weakness or loss of sensation on one side of the body, facial drooping, or chest pain, seek medical attention immediately by calling 911. These can be signs of a stroke or a heart attack.

Managing Blood Pressure and Cholesterol Levels

Certain lifestyle changes can have a big impact on lowering both blood pressure and cholesterol. In many cases, however, lifestyle changes are not enough to bring numbers down, and medications are needed.

Living an active lifestyle can help keep blood pressure and cholesterol numbers in control. The American Heart Association (AHA) recommends getting at least 150 minutes of aerobic exercise, like walking, biking, or swimming, on a weekly basis.

A Healthy Diet

Equally important to getting exercise is eating a heart-healthy diet. To help decrease risk of cardiovascular disease, the AHA recommends a diet low in saturated and trans fats, low in sugary and processed foods, and high in the following:

• Fruits
• Vegetables
• Beans
• Nuts
• Whole grains

Healthy weight loss can lower both blood pressure and cholesterol.

When lifestyle changes aren't enough to bring cholesterol and blood pressure levels down, a healthcare provider can prescribe medication to target each condition.

Statins are a commonly prescribed and extremely effective cholesterol-lowering medication that can lower LDL by more than 50%. Many effective and well-tolerated medications exist for lowering blood pressure. A healthcare provider can help decide which type of medications are appropriate for your situation.

Summary

High cholesterol on its own increases risk of heart disease and stroke, but having high blood pressure on top of high cholesterol greatly increases these risks. It's important to have your cholesterol and blood pressure checked regularly, lead a healthy lifestyle, and take medications to lower your blood pressure and cholesterol if prescribed by a healthcare provider.

A Word From Verywell

Even though they may not necessarily cause symptoms, high cholesterol and high blood pressure shouldn't be ignored, especially when they occur together. A healthy lifestyle that includes frequent exercise and eating a heart-healthy diet can have a dramatic effect on lowering your risk of future heart disease and stroke.

Many people will also need medication to get their numbers in control. Talk with a healthcare provider to understand your risk of heart disease and what actions you can take to prevent future heart attacks and stroke.

Frequently Asked Questions

• What are the signs that your blood pressure is too high?

  High blood pressure often does not cause any symptoms, which is why it's known as "the silent killer." With very high blood pressure, some people can have headaches and shortness of breath.

• What are the warning signs of high cholesterol?

  High cholesterol often does not cause symptoms for many years. However, there may be warning signs for related conditions.

  In peripheral artery disease, blood vessels in the legs are blocked by cholesterol plaque, which causes leg fatigue and weakness with exercise.

  In coronary artery disease, blood vessels feeding the heart become blocked with cholesterol, which causes angina. Angina is chest discomfort that often comes on with exercise. Fatigue and shortness of breath may also be present.

  Some people who have a genetic disease called familial hypercholesterolemia have extremely high cholesterol and can develop yellowish skin deposits of cholesterol on the back of the ankles, on the knuckles, and around the eyes.

• Does lowering your cholesterol lower your blood pressure?

  Certain lifestyle changes that lower cholesterol can also lower blood pressure. For example, eating a healthy diet and exercising can help lower both cholesterol and blood pressure.

  Medications that lower cholesterol do not have as much of an impact on lowering blood pressure, so people with both high blood pressure and high cholesterol typically need separate medications that target each problem separately.
  

• What are the signs of an unhealthy heart?

  The most common sign that cholesterol plaque could be blocking the arteries that feed your heart include chest discomfort and shortness of breath, especially with exercise. This is called angina. Signs of heart failure, or a weak heart that does not pump properly, include shortness of breath when exercising or lying flat, waking up in the night feeling short of breath, and leg swelling.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. American Heart Association. Causes of high cholesterol.

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3. Centers for Disease Control and Prevention. High blood pressure and cholesterol out of control.

4. Egan B, Li J, et al. Blood pressure and cholesterol control in hypertensive hypercholesterolemic patients. Circulation. 2013;128(1):29-41. doi:10.1161/circulationaha.112.000500

5. Halperin RO, Sesso HD, et al. Dyslipidemia and the risk of incident hypertension in men. Hypertension. 2006;47(1):45-50. doi:10.1161/01.HYP.0000196306.42418.0e

6. Johns Hopkins Medicine. Atherosclerosis.

7. American Heart Association. American Heart Association recommendations for physical activity in adults and kids.

8. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140:e596–e646. doi:10.1161/CIR.0000000000000678

9. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139:e1082–e1143. doi:10.1161/CIR.0000000000000625.

By Angela Ryan Lee, MD
Angela Ryan Lee, MD, is board-certified in cardiovascular diseases and internal medicine. She is a fellow of the American College of Cardiology and holds board certifications from the American Society of Nuclear Cardiology and the National Board of Echocardiography. She completed undergraduate studies at the University of Virginia with a B.S. in Biology, medical school at Jefferson Medical College, and internal medicine residency and cardiovascular diseases fellowship at the George Washington University Hospital. Her professional interests include preventive cardiology, medical journalism, and health policy.

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