The Relationship Between High Cholesterol and High Blood Pressure

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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.

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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, being overweight, 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

In people who are overweight, with a body mass index (BMI) greater than 25, 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. Your 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 your 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, eating a heart-healthy diet, and maintaining a healthy weight 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 your 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.

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9 Sources
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.
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