Blood pressure, sugar and fats: how do they act together on the heart and vessels?

One vessel, several problems

Patients who come to an internal medicine doctor often have a list: “I have high blood pressure, my blood sugar is borderline, and they have told me my blood fats are high too”. In the mind, each is a separate file. But the vessels are one. Blood pressure, blood sugar and blood fats all press on the same place: the wall of the vessel, and then the heart, brain and kidneys, which get their blood from these same vessels. For this reason, an internal medicine doctor usually looks at them together.

What does each one do?

High blood pressure. It keeps the vessels under pressure. High blood pressure often has no symptoms, so the only way to find out is to measure. If it is not controlled, it can lead to heart attack, heart failure, stroke, kidney damage and an irregular heartbeat.

High blood sugar. High blood sugar can damage the blood vessels and the nerves that control the heart. Adults with diabetes are at about twice the risk of heart disease or stroke compared with people without diabetes, and heart disease often starts earlier in them.

High blood fats. Extra cholesterol is deposited in the walls of the vessels, narrows the vessel and reduces blood flow to the heart and brain. For adults, a total cholesterol below 200 mg/dL and an LDL below 100 mg/dL are given as the “healthy” range, but each person’s target depends on age, family history and other risk factors.

Why are they worse together?

Because these factors are often present at the same time and each makes the others worse. Obesity raises bad cholesterol and triglycerides and can lead to high blood pressure and diabetes. Inactivity raises the risk of obesity, high blood pressure, high blood fats and diabetes. Smoking damages the vessels and nicotine raises blood pressure. Salt raises blood pressure; alcohol raises blood pressure and triglycerides. So your problem is not just “one number”; it is the combination of numbers and habits that makes up the risk.

In diabetes, other factors also raise the risk: high blood pressure, unhealthy blood fats, excess weight especially around the waist, chronic kidney disease, smoking, and a family history of heart attack before the age of 50, which roughly doubles the risk.

What cannot be changed, and what can?

Age, sex and family history are not in our hands. But many of the others can be changed: blood pressure, sugar and fats can be controlled with lifestyle change and, if needed, with medicine, together with the doctor. A healthy weight, regular activity, low-salt food, stopping tobacco and cutting down on alcohol help. The details of food and activity are in the patient guide.

What is the numerical target?

On this, sources do not fully agree, which itself shows that the target must be set separately for each patient:

• For blood pressure, some guidelines put blood pressure from 130/80 and above in the high blood pressure category, and others say the diagnosis is at least 140/90 recorded on two different days. For people with diabetes, both a target of “below 140/90” for most people and “below 130/80” for some are seen.
• For diabetes, the HbA1c target for many people is below 7%, but some may have a slightly higher target.

Ask the doctor what your target is. Do not use these numbers to judge yourself.

Signs that do not wait for an appointment

If your blood pressure is above 180/120 and you also have chest pain, shortness of breath, numbness or weakness, a change in vision or trouble speaking, call 115 (Iran’s emergency number) immediately. The signs of a heart attack and stroke, including unusual signs such as sudden tiredness or new shortness of breath in women, older people and people with diabetes, are in the section “When should I call urgently?”.

What you can do this week

• Measure your blood pressure and write it down, or have it checked somewhere accessible to you.
• Find out when your last blood sugar and blood fat tests were; if you do not know or they are old, book a visit.
• Write down your questions: “Which factor matters most in my case? What is my target? How long before I should be reviewed again?”