High blood pressure and atherosclerosis

Lesley Dobson / 29 March 2017

What is atherosclerosis and how is it connected to high blood pressure?



Atherosclerosis is a condition that happens when fatty substances carried in your blood build up in patches on the inner lining of your arteries. This fatty material is known as atheroma or plaques.

Cardiovascular disease glossary: heart jargon explained

When does atherosclerosis begin?

Atherosclerosis can begin during childhood, and can carry on into older age, making our arteries progressively narrower and stiffer.

Atherosclerosis can be referred to as hardening of the arteries, so don’t be surprised if your doctor uses this phrase.

Read our guide to cardiovascular disease

How does atherosclerosis affect health?

This narrowing of the artery makes it more difficult for our oxygen-carrying blood to pass through, and reach our heart and brain. Eventually the space in your artery can become so narrow – or even blocked - that it allows little or no blood to pass through.

Sometimes an area of atheroma cracks on the inner side. In some cases this can means that a blood clot forms over the affected atheroma. This can cause serious problems, as it may block the blood flow through that part of the artery.

Who gets atherosclerosis?

Some people are more likely to develop atherosclerosis because of existing health conditions. High blood pressure is one of the conditions that can increase your risk of developing atherosclerosis.

This is because high blood pressure means that your blood travels around your blood vessels with greater force than it does when under normal or low blood pressure. This extra force can, eventually, cause damage to the inner walls of the arteries.

After years of being subject to this extra force, your artery walls can become more damaged, and this can make them more prone to atherosclerosis, and the problems that can come with it.

Read our guide to blood pressure

Other factors that can increase your risk of developing atherosclerosis include having a diet that’s high in fat, smoking, drinking too much alcohol, being overweight and being of African, African-Caribbean or south Asian descent.

There are other risk factors that you can’t control. Men are more likely to develop atherosclerosis at a younger age than women. However, as women age their risk of developing this condition becomes about the same as for men. Overall, growing older increases your chances of developing atherosclerosis.

Subtle signs of women's heart disease

Family history can also increase your risk. If you have a father or brother who developed a heart or circulatory condition before the age of 55, or your mother or sister developed either of these health problems before 65, this increases your risk.

What are the symptoms of atherosclerosis?

In much the same way as high blood pressure is a silent condition, atherosclerosis doesn’t cause any signs and symptoms at first.

You only experience symptoms when it has reached the stage where it seriously affecting the flow of blood through your arteries. And, even then, you may not realise that you have a health problem. Unless you have had this condition diagnosed by a doctor or nurse, you are very unlikely to know that you have it.

If you are concerned about your blood pressure – especially if you have a history of high blood pressure in your family – it’s worth asking your GP if you can have a health check.

This would give the health team at your GP’s surgery an idea of your overall health. If they are concerned about your blood pressure they may suggest medication to reduce your blood pressure, and advice on diet and exercise to help keep your weight under control.

Lifestyle changes to lower your blood pressure

What is a heart attack?

A heart attack is the result of the blood flow to part of your heart suddenly stopping. This usually happens when your heart has been affected by coronary heart disease (CHD). When you have this condition, some of the fatty material known as atheroma, that has slowly been building up in your coronary arteries, can break off. This can cause a blood clot that may cause a blockage in your coronary artery. If this happens, it can block the passage of the blood supply to your heart muscle, and prevent your heart from receiving the vital blood and oxygen it needs. When this happens, you have a heart attack. A heart attack is also known as a myocardial infarction.

Another term that you may hear is cardiac arrest. The British Heart Foundation states that this when your heart isn’t able to pump blood around your body. This can cause a heart attack, but there are different terms for different situations.

Read our guide to coronary heart disease

How is atherosclerosis diagnosed?

Diagnosis of atherosclerosis involves taking into account a number of possible factors. People aged from 40 to 74 should have an NHS Health Check every five years.

This health check takes a number of different elements into account. These include your age, sex, weight and height, your ethnic group, and whether anyone in your family has had cardiovascular disease (CVD).

Tests include checking your blood pressure and cholesterol levels – both are particularly important in terms of your risk of having atherosclerosis. They will also need to know whether you have ever smoked in the past, and are smoking now, and whether you have any long-term conditions, such as high blood pressure and diabetes.

As well as checking your blood pressure, your GP may order the following tests if they think that you may have atherosclerosis:

  • An electrocardiogram (ECG) checks your heart’s electrical activity, to see how well your heart is working. ECGs can show whether you have heart disease.
  • An ultrasound test uses a scanner to pass sound waves through your body. This can produce blood pressure measurements throughout your body. Changes in blood pressure may indicate places where your arteries have become blocked.
  • An angiogram, also known as a coronary angiogram involves having a special dye passed through a catheter (a thin tube) that has been fed through your blood vessels until it reaches your heart. A dye is fed through the catheter, and this highlights any sections of blood vessels that have narrowed, as well as any blocked areas. 

These tests are important because they allow your medical team to see whether you have narrowed or blocked coronary arteries, and if you have, what treatment you need.

What is the treatment for atherosclerosis?

There isn’t, at the moment, any treatment that can reverse the effects atherosclerosis has on our arteries. That doesn’t mean that we just have to wait and hope for the best. There is medication that we can take that can slow down the rate at which atherosclerosis builds up plaque in our arteries.

The arteries most affected by this condition include the following:

  • coronary arteries, the pipelines that take blood to our hearts
  • carotid arteries that take blood to our brains
  • peripheral arteries that supply blood to our legs

The treatment your doctor prescribes for you will depend on what’s causing your atherosclerosis, and the health problems this condition is creating.

You may be prescribed statins if you have high levels of low-density lipoprotein (LDL) cholesterol. This type of cholesterol is often described as the ‘bad cholesterol’, because it affects our arteries, making them stiffer and narrower. Statins help by reducing the amount of LDL that your liver produces.

Learn more about cholesterol

The medication your doctor prescribes for high blood pressure will depend on your particular circumstances. The options available are ACE inhibitors that work by helping your blood vessels to relax. You may be given angiotensin-2 receptor blockers – commonly known as ARBs – if the side effects of ACE inhibitors make you feel unwell.

Other medications used to help lower blood pressure include calcium channel blockers, diuretics and beta blockers. Your doctor will prescribe those that they think are best suited to you.

You may also be prescribed aspirin, or a drug called clopidogrel, to lower your risk of blood clots forming.  

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