There is almost always more than one number to consider when assessing the health of any mammal – human being or animal. For humans and cardiovascular disease, the link and numbers between high blood pressure and high cholesterol put 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 (hypertension) 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, heart disease, and stroke. When high blood pressure and high cholesterol occur together, they can damage blood vessels, significantly increasing the risk for future complications. To prevent heart disease and stroke, getting your cholesterol and blood pressure checked and under control is vital.

What is cholesterol?

The body does not need cholesterol from food and can naturally manufacture it. The liver naturally produces cholesterol, a fatty substance that helps the body make hormones and digest fatty foods.  However, there is also cholesterol in animal-based foods, such as eggs and meat, which we consume and may impact our cholesterol numbers.

Cholesterol tests measure two types of cholesterol:

• Low-density lipoprotein (LDL): This type of cholesterol is what many people consider the “bad” kind. High levels of LDL can increase the risk of cardiovascular disease, clogged arteries, and other heart health issues.

• High-density lipoprotein (HDL): This “good” cholesterol can help remove and carry it back to the liver. Higher levels of HDL may lower a person’s risk of cardiovascular disease. 

Total cholesterol is a measure of HDL plus LDL and also triglycerides.  Triglycerides are a type of fat or lipid most influenced by what we eat and are closely related to cholesterol.  Triglyceride levels change throughout the day and can also be a risk factor for heart attack and stroke.

What is a normal cholesterol level? 

For most people, John Hopkins recommends these healthy cholesterol levels. However, the numbers are general guidelines because actual target goals may depend on the number of risk factors you have for heart disease.

• Total cholesterol: less than 200 milligrams per deciliter

• LDL “bad” cholesterol: Optimal is less than 100 mg/dL

• HDL “good” cholesterol: higher than 40 mg/dL

• Triglycerides: less than 150 mg/dL

As part of your annual preventative visit with your doctor, blood work is typically run to test a few different forms of lipids or cholesterol, which may include triglyceride levels.  Both you and your physician should review these numbers to assess potential health risks and whether lifestyle changes or medications may be needed to manage the levels. 

If a person has low HDL and high LDL cholesterol, their risk of heart disease is higher.  High cholesterol is a common health condition in the United States. According to the Centers for Disease Control and Prevention, nearly 94 million adults over the age of 20 have what could be considered borderline high cholesterol. Yet because this condition often presents without symptoms, many are unaware they have high cholesterol until they visit their doctor. 

However, as mentioned previously, your body naturally makes cholesterol, and while what you eat matters, it has less impact on cholesterol level than people might think.  One of the most significant factors determining your cholesterol levels is your genes. While the science behind this is pretty complicated, it’s safe to say that high cholesterol tends to run in families. And because genes are something we can’t change, medications are essential for treating high cholesterol. 

Other variables affecting cholesterol

While certain foods can contribute to higher cholesterol, a number of studies have found that the cholesterol a person gets from food does not substantially increase blood cholesterol. However, any change to healthier eating benefits overall heart and body health.  Additionally, we all know by now that exercise is always a component of good heart and body health and can contribute to potentially reducing cholesterol.   However, it may be less known that alcohol consumption can affect your cholesterol levels, raising both your triglyceride and cholesterol levels in your blood.    This is because the body breaks alcohol down into triglycerides, and if triglyceride levels become too high, that can increase LDL or bad cholesterol levels. 

Other variables which may play a part in high cholesterol may include other health conditions like type 2 diabetes, Rheumatoid arthritis, Lupus, Psoriasis, Inflammatory bowel disease (IBD), and even gum disease. 

Even medications, like birth control pills, retinoids, corticosteroids, antivirals, and anticonvulsants, can negatively impact your cholesterol levels. 

Cholesterol and high blood pressure run together

Unfortunately, high cholesterol and high blood pressure tend to run together. One doesn’t necessarily cause the other, but seeing both in an individual is very common. And indeed, both of them contribute to raising the risk of heart attack and stroke. 

Almost half of all adults have high blood pressure. But the tricky part is that many people don’t know they have this condition. This is because when a person’s blood pressure is high, they might not feel symptoms like cholesterol. That’s why it is important to understand your numbers and what category you fall into.

Your blood pressure is recorded as two numbers

When taking your blood pressure, keep in mind blood pressure has two numbers: systolic and diastolic. The systolic is the top number, the pressure on your arteries when the heart beats.  The diastolic is the bottom number, and it’s the pressure in between beats.  Both numbers get taken into consideration by your doctor to figure out what category you may fall into. 

Blood pressure categories

The five blood pressure (BP) ranges as recognized by the American Heart Association are:

Normal

Blood pressure numbers under 120/80 mm Hg are considered within the normal range. If your results fall into this category, stick with heart-healthy habits like following a balanced diet and getting regular exercise.

Elevated

Elevated blood pressure is when readings consistently range from 120-129 systolic and less than 80 mm Hg diastolic. People with elevated blood pressure will likely develop high blood pressure unless steps are taken to control the condition.

Hypertension Stage 1

Hypertension Stage 1 is when blood pressure consistently ranges from 130-139 systolic or 80-89 mm Hg diastolic. At this stage of high blood pressure, doctors are likely to prescribe lifestyle changes. They may consider adding blood pressure medication based on your risk of atherosclerotic cardiovascular diseases (ASCVD), such as heart attack or stroke.

Hypertension Stage 2

Hypertension Stage 2 is when blood pressure consistently ranges at 140/90 mm Hg or higher. At this stage of high blood pressure, doctors are likely to prescribe a combination of blood pressure medications and lifestyle changes.

Hypertensive crisis

This stage of high blood pressure requires medical attention. If your blood pressure readings suddenly exceed 180/120 mm Hg, wait five minutes and then test your blood pressure again. If your readings are still unusually high, contact your doctor immediately. You could be experiencing a hypertensive crisis.

If your blood pressure is higher than 180/120 mm Hg and you are experiencing signs of possible organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision, or difficulty speaking, do not wait to see if your pressure comes down on its own. Call 911.

Options to address high blood pressure

The same lifestyle changes you make to adjust your cholesterol can also lower your blood pressure numbers: quit smoking, increase your physical activity, eat heart-healthy foods, and lose weight if you are overweight.  Reducing your sodium intake to less than 1,500 milligrams a day is optimal, but any reduction may be beneficial.   Blood pressure-lowering medications are also an option to be discussed between you and your doctor after considering attempts at lifestyle changes and any other medical conditions and medications you may be taking. 

It is important to clarify medications that lower cholesterol does not have as much impact on lowering blood pressure. Hence, people with high blood pressure and cholesterol typically need different medications that target each problem separately.

Knowing your cholesterol and blood pressure numbers is essential while managing your blood pressure; cholesterol levels are important to staying healthy.