Heart disease and high blood pressure

High blood pressure puts an extra strain on your blood vessels and your heart, which can lead to heart failure and heart attacks.

Heart disease is common in the UK, but by living a healthy lifestyle and keeping your blood pressure under control you can look after your heart.

If you think you or someone you’re with may be having a heart attack, call 999 straight away.

How can high blood pressure affect your blood vessels and heart?

High blood pressure can affect your arteries and your heart in a number of ways which are all interlinked. 

It can damage your blood vessels, reducing the blood flow around your body and back to your heart. Your heart then has to work harder to pump blood and can become enlarged or weak and can’t work as well as it should.

• Damage to your blood vessels. High blood pressure can lead to your arteries becoming clogged up and narrow, reducing the blood flow around your body and back to your heart. 
• Coronary artery disease (or coronary heart disease). This is where the arteries leading to the heart become too narrow, reducing the blood supply to the heart or becoming completely blocked by a blood clot, causing chest pain and heart attacks. 
• Heart attacks. A heart attack happens when the blood supply to part of the heart is cut off because an artery is blocked by a blood clot. That part of the heart muscle then quickly dies and is replaced with scar tissue, but it is possible to remove the blockage if treated quickly. 
• Enlarged heart (left ventricular hypertrophy or LVH). If your blood pressure is very high, the left side of your heart has to work harder to pump blood around your body. The muscles become larger to cope with this extra effort. This protects the heart to start with, but in the long run makes it less able to do its job, leading to heart failure. 
• Heart failure (left ventricular heart failure). Heart failure is when the left side of the heart has become so enlarged and stiff it can no longer pump blood around your body as well as it should. It doesn’t mean that your heart is about to stop working, but it can be a serious condition. 
• Atrial fibrillation. Atrial fibrillation (AF) is a type of irregular heartbeat where the heart beats very fast or with an irregular rhythm. It often doesn’t cause obvious symptoms but can lead to blood clots and strokes. 

How do you know if your heart is healthy?

Finding out if your heart is in good health means you can start making changes or getting treatment and support if you need it. There are a number of simple checks and tests available to see how well your heart is working, and if you have signs or symptoms of heart disease.

Can you lower your risk of heart disease and heart attacks?

By making changes to look after your blood pressure, you will also be looking after your heart.

Damage to your arteries

High blood pressure can lead to your arteries becoming clogged up, reducing the blood flow around your body and back to your heart.

Your arteries are the large blood vessels that carry blood from your heart around your body, carrying oxygen and nutrients to your organs and muscles. Your arteries have a role in controlling your blood pressure, and your blood pressure can affect your arteries.

How do your arteries control your blood pressure?
Your blood vessels contain muscles to help squeeze the blood around your body. These muscles respond to hormones, the flow of blood and signals from your brain, telling them to squeeze or relax.

• When the muscles squeeze, this narrows the blood vessels and your blood pressure will be higher.
• When the muscles relax, your blood vessels widen and your blood pressure will be lower.

How can high blood pressure damage your arteries?

High blood pressure can damage your blood vessel walls. Fats in the blood can collect in these damaged areas, clogging up the arteries and leading to atherosclerosis – where the arteries become narrow and stiff, reducing the blood flow around your body.

What is atherosclerosis?
A fatty substance in the blood, called cholesterol, can build up in the parts of the blood vessels damaged by high blood pressure. This forms fatty deposits, also known as plaques, atheroma, or atheromatous plaques. They make the arteries narrower, and can become harder over time, making the arteries stiffer as well. Eventually, the arteries can become too narrow for enough blood to pass through.

The fatty, damaged areas are prone to rupture, and blood clots can form over them. Bits of the blood clot can break off, known as a thrombus, and can become lodged in a blood vessel, completely cutting off the blood supply to part of the body, including the heart, brain or legs.

The narrowing and blocking of the arteries can cause a number of diseases known together as cardiovascular disease (CVD). ‘Cardio’ means heart, and ‘vascular’ refers to the blood vessels.

Cardiovascular diseases include:

• coronary artery disease – where the arteries leading to the heart are narrowed or blocked, causing chest pain or heart attacks
• peripheral artery disease (PAD) – where too little blood reaches the legs and feet, making it painful to walk
• a stroke or TIA  (mini stroke) – if an artery to the brain is blocked or bursts.

What causes atherosclerosis?
As well as high blood pressure, having too much cholesterol in your blood can lead to atherosclerosis. The type of cholesterol which is laid down is called LDL cholesterol, or ‘bad cholesterol’. It can be raised by an unhealthy diet high in saturated fats.

How do you know if you have atherosclerosis?
Atherosclerosis doesn’t usually have any symptoms to start with so you won’t know if you have it. But there are some simple tests and checks you can have to get a good idea of the health of your heart and blood vessels.

How is atherosclerosis treated?
The treatments for atherosclerosis aim to stop it from getting worse and causing serious problems. They include:

• making healthy changes to your lifestyle
• medications to lower your blood pressure
• medications called statins – to lower blood cholesterol
• medicines to reduce your risk of blood clots, such as aspirin
• medication for diabetes – as diabetes can damage the blood vessel
• an angioplasty – where a wire mesh tube is inserted into an artery to hold it open, allowing blood to pass through
• surgery to bypass a blocked artery – so that the blood can still flow to the part of the body the artery leads to.

Coronary artery disease (or coronary heart disease)

This is where the arteries leading to the heart become too narrow, reducing the blood supply to the heart or becoming completely blocked by a blood clot, causing chest pain and heart attacks. It’s also known as ischaemic heart disease.

The coronary arteries supply blood to the heart. When they become narrowed by about 70% due to atherosclerosis, the heart muscle doesn’t receive enough blood. It causes chest pain when you’re active or exercising, known as angina or angina pectoris, although it sometimes doesn’t have any symptoms.

As well as being painful, the lack of blood flow to the heart means the heart muscle can’t work properly, leading to problems such as atrial fibrillation.

If a blood clot forms in the narrowed area, the artery can become completely blocked. This is called a coronary thrombosis and it leads to a heart attack.

How is coronary heart disease treated? 
By making healthy changes to your lifestyle you can improve the health of your heart. There are treatments to manage chest pain and lower the risk of heart attacks. The treatments are the same as for atherosclerosis, as well as medicines called beta blockers to prevent angina and lower blood pressure, and nitrates to widen your arteries. In severe cases a heart transplant may be needed.

Heart attacks

A heart attack happens when the blood supply to part of the heart is cut off because an artery is blocked by a blood clot. That part of the heart muscle then quickly dies and is replaced with scar tissue, but it is possible to remove the blockage if treated quickly. 

A heart attack is a medical emergency. If you think you or someone you’re with may be having a heart attack, call 999 straight away. If you can reach an aspirin easily, chew a tablet until the ambulance arrives but don’t get up to look for one as it puts extra strain on your heart.

What does a heart attack feel like?
The symptoms of a heart attack include:

• a crushing chest pain which can travel up into your jaw and into your back and arms. The pain is similar to angina but more severe and lasts longer, usually more than 15 minutes, and sometimes several hours
• sweating
• shortness of breath
• feeling sick or vomiting
• feeling weak or faint.

Sometimes the pain will be a mild discomfort rather than a severe pain, similar to heartburn or indigestion. It’s the combination of symptoms that is important rather than how bad the pain is.

Occasionally there won’t be any pain at all, and the heart attack might be diagnosed at a later stage. 

How are heart attacks treated?
The treatments for heart attack vary depending on what’s best for each person.

• aspirin to thin the blood – if you haven’t had one already
• pain relief
• medicines to break up blood clots and prevent others from forming
• suction to remove blood clots
• an angioplasty – where a wire mesh tube called a stent is placed inside the blocked artery to keep it open and restore blood flow to the heart
• medicines called beta blockers – which stop the hormone adrenaline from making the heart work too hard
• insulin to control your blood sugar levels
• oxygen to protect your heart muscle from further damage.

Complications of a heart attack
If a large amount of heart muscle is damaged it’s more likely be fatal or to cause complications such as heart failure, an irregular heartbeat, angina or another heart attack. A heart attack can also cause cardiac arrest, where the heart stops beating and needs to be restarted straight away with a defibrillator. 

Recovering from a heart attack 
If a small amount of tissue is damaged, it will often heal with a small patch of scar tissue and your heart will keep working normally. Many people recover well and some can return to work after two weeks, while others take several months to recover.

You should be invited to join a cardiac rehabilitation programme a few weeks after leaving hospital to help you get back on your feet. By following a healthy lifestyle and by taking your medications, you can dramatically lower your risk of having another heart attack.

Enlarged heart (left ventricular hypertrophy or LVH)

If your blood pressure is very high, the left side of your heart has to work harder to pump blood around your body. The muscles become larger to cope with this extra effort. This protects the heart to start with, but in the long run makes it less able to do its job, leading to heart failure.

When the muscle is enlarged, the chambers of the heart can’t hold as much blood, putting pressure on other parts of the heart. The muscles become stiffer and the rhythm of the heart is disturbed.

The changes in the heart’s function can be detected with an electrocardiogram or ECG.

What are the symptoms of an enlarged heart?
The changes in the heart can cause a number of symptoms, including:

• dizziness
• chest pain
• shortness of breath
• temporary loss of consciousness.

How is an enlarged heart treated?
An enlarged heart can be controlled and can even be reversed if blood pressure is brought under control.

The treatments include:       

• medicines used to treat high blood pressure – in particular, ACE inhibitors and angiotensin receptor blockers
• medicines to correct changes in your heart rhythm and to help the heart muscle to contract – such as beta blockers
• diuretics to remove excess fluid from your body.

Heart failure (left ventricular failure or LVF)

Heart failure is when the left side of heart has become so enlarged and stiff it is no longer able to pump blood around your body as well as it should. It doesn’t mean that your heart is about to stop working, but it can be a serious condition.

Heart failure can also be caused by a heart attack or other heart problems. It can be made worse if you have coronary artery disease as well, where the blood supply to the heart is reduced due to clogged up arteries. The blood collects in the left atrium, the upper chamber of the heart which receives blood coming from the lungs, which expands to hold the blood. The blood then collects in the veins and the lungs become congested, causing breathlessness and exhaustion.

What are the signs and symptoms of heart failure?

The signs and symptoms are caused by poor blood circulation, bringing blood back from the lungs and around your body, so a lack of oxygen and energy can be carried to where it’s needed. Symptoms include:

• shortness of breath while lying flat
• episodes of breathlessness in the night
• feeling tired or exhausted most of the time, especially when exercising
• dizziness, fainting and feeling weak or confused
• an irregular heartbeat (palpitations) or a fast heart rate
• weight gain and swelling in the legs or ankles, due to a build-up of fluid
• coughing, due to poor circulation in the lungs
• needing to wee at night
• nausea (feeling sick).

Symptoms can develop slowly over weeks or months, or they can develop quickly. Visit your GP if you have symptoms of heart failure. Call 999 if they develop very quickly as you may need urgent treatment.

How is heart failure treated?
Treatment for heart failure aims to slow down its progression and control its symptoms. Your doctor will try to find out what’s causing your heart failure so they can treat the cause, which can sometimes cure it. Treatments include:

• blood pressure medicines – such as diuretics to reduce fluid build-up, and ACE inhibitors and angiotensin receptor blockers to open up your blood vessels
• medicines called beta-blockers – to slow down your heart and protect it from hormones such as adrenaline which make it work harder, these are different to the type of beta-blockers that are used to treat high blood pressure
• a device which can be implanted in your chest to control your heart rhythm, such as a pacemaker
• changes to your lifestyle – such as eating less salt to lower your blood pressure, stopping smoking and being active
• surgery, including a bypass or a heart transplant.

Living with heart failure
Heart failure is quite unpredictable in how it will develop. It’s a long-term condition that tends to slowly get worse over time and impacts on what you’re able to do. It can also impact on your mood, leading to depression.

Some people will stay stable for a long time while others get worse quickly, and it can be fatal, but medications and changes to your lifestyle can make a big difference.

Atrial fibrillation

Atrial fibrillation (AF) is a type of irregular heartbeat where the heart beats very fast or with an irregular rhythm. It often doesn’t cause obvious symptoms but can lead to blood clots and strokes.

The heart has a natural pace maker which sends out electrical signals so that the heart beats in a regular rhythm. In AF, electrical signals fire at random and often very fast, overriding the natural pacemaker. The chambers of the heart don’t have a chance to fill up with blood in between beats and the heart doesn’t push blood around the body with enough force.

The causes aren’t properly understood, but coronary artery disease can reduce the blood supply to both the heart muscles and the pacemaker so they don’t work as well as they should. And heart failure or an enlarged heart can stop the left side of the heart from contracting properly. 

With an enlarged heart and heart failure, blood clots can form in the enlarged left atrium. The blood clot can sometimes break off and be transported around the body in the blood stream, often into the brain, causing a stroke or mini stroke.

What are the signs and symptoms of AF?
With AF your pulse may be very fast, well over the usual 60-100 beats per minutes, and may be irregular.

AF can cause a number of symptoms:

• heart palpitations – where you’re aware of your heart beat and it feels like it’s pounding, fluttering or beating irregularly.
• feeling light-headed, dizzy or faint
• feeling tired or lethargic
• feeling out of breath
• chest pain.

AF can be short term, with episodes lasting two days or a week, or it can be long term, lasting a year or longer.

AF sometimes doesn’t have any obvious symptoms and is found by chance while carrying out routine tests. As soon as people have treatment they realise that they feel much better and the AF had been making them feel tired but they had put the feeling down to getting older.

How are high blood pressure and AF linked?
High blood pressure does not directly cause AF, but it can speed up the processes of atherosclerosis and coronary artery disease, which can lead to AF.

AF is quite common in the UK, and it’s quite common to have high blood pressure at the same time, and both raise the risk of having stroke. Finding out if you have AF can be an important step in preventing a stroke.

You can measure your heart rate by feeling the pulse in your neck or wrist, and an electrocardiogram can be used to see if you have AF. See your doctor if your heart rate is consistently under 60 bpm, or over 100bpm, particularly if you have other symptoms. See them straight away if you have chest pain or you notice a sudden change.

How is AF treated?

There are a number of treatments which can be used for AF.

• Medicines called warfarin and direct-acting oral anticoagulants (DOACs) can be used to thin the blood to prevent blood clots and strokes. Aspirin can also be used alongside other treatments.
• Medications to control the heart rate or rhythm.
• Cardioversion – where a controlled electric shock restores the normal rhythm of the heart.
• Catheter ablation –where the part of the heart that is causing the abnormal rhythm is treated with radiofrequency energy. You may then need a pacemaker fitted to control your heart beat.

If AF causes a stroke, this needs treating straight away, and medicines to break down the clot can prevent all or some of the problems caused by a stroke.

How do you know if your heart is healthy?

You can get a good idea of the health of your heart with some simple tests and checks: 

• take the  Heart Age Test, a quick online questionnaire
• have a blood pressure check
• get an NHS Health Check  – you should have one every five years if you’re aged between 40 and 74
• visit your GP or practice nurse.

There are a number of ways your doctor can find out if you could have any of these health problems or could be developing them, including questions about your medical history, family history and your lifestyle, as well as blood tests.

How are heart diseases diagnosed?

If you have high blood pressure or any signs or symptoms of heart disease, there are a number of tests that can be used to see if any damage has been done to the heart.  

The tests include:

• blood tests – to measure cholesterol, proteins, urine and hormones, as well as other signs of disease and damage
• an echocardiogram – a type of ultrasound scan which gives a moving image of the heart. It shows the structure of the heart, including the valves, how well it’s working and signs of damage
• an ECG (electrocardiogram) – which measures electrical signals in the heart, using sensors attached to your skin, to show if the heart is working properly
• a treadmill test – where your heart is monitored with an ECG to see how it responds to the physical stress of using the treadmill
• a radionuclide scan – a type of scan that uses a radioactive chemical which collects in certain parts of the body
• a CT scan – which is similar to an X-ray but more detailed and it gives a 3D image
• an MRI scan – this gives a very detailed 3D image which is taken in a large tunnel-shaped scanner, these tend to be used in people with more complex symptoms
• a coronary angiography – a type of scan where dye is injected into your blood vessels and the dye can be picked up on the scan, showing any blockages.

Can I lower my risk of heart disease and heart attacks?

By making changes to look after your blood pressure, you will also be looking after your heart.

Healthy lifestyle
Your lifestyle plays a major role in high blood pressure, atherosclerosis and heart disease, and making healthy changes will lower your risk. Stopping smoking is particularly important, as well as cutting down on alcohol, losing weight if you need to, being active and eating a healthy diet which is low in salt and saturated fat.

Treatment for other health problems
You might be offered statins if your blood cholesterol is raised. If you have any other medical conditions that can affect the heart and blood vessels, such as diabetes, it’s important to keep these under control, which might involve medications.

What else raises the risk of heart disease

There are a number of risk factors which can mean you’re more likely to develop atherosclerosis and heart disease. These are:

• age – atherosclerosis and diseases of the heart become more common with age
• being male – heart disease is more common in men than women
• family history of cardiovascular disease – including heart attacks and stroke
• being of South Asian or African-Caribbean descent
• other health problems including diabetes and kidney disease, as these can damage the blood vessels.

While these can’t be changed, making changes to your lifestyle and getting other health problems under control will make a big difference. 

Read more  

The British Heart Foundation has information on different heart conditions, the treatments available, living with a heart condition and heart-healthy recipes. 

NHS Choices have information on heart disease, its causes and treatments, as well as a healthy lifestyle and eating well. They have created this video on how the heart works, and how atherosclerosis and diseases of the heart develop. 

An important new study has shown that DOACs are better at preventing stroke, safer, and more cost effective than Warfarin.

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