High blood pressure puts extra strain on your heart as it works harder to pump blood out against the higher pressure and increasingly stiff, non-elastic arteries. As a result, having uncontrolled hypertension increases your risk of developing angina (heart pain) or a heart attack.
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High blood pressure increases your risk of heart attack
Researchers estimate that each rise in systolic blood pressure (the pressure in your system when your heart beats) of 10 mmHg, increases your risk of a heart attack by 20%. Similarly, your risk of a heart attack increases by 2% – 3% for each 1mm Hg increase in diastolic BP (the pressure in your system when your heart is relaxed between beats).
So, if your blood pressure is 130/80 mmHg your risk of a heart attack is 20% greater than if it was 120/80 mmHg. If your blood pressure is 140/90 mmHg then your risk is at least 60% higher than if it were 120/80 mmHg and so on.
The good news is that early diagnosis, making diet and lifestyle changes, and taking antihypertensive medication can help to control your blood pressure so these increased risks return to normal.
What is a heart attack?
Your heart beats around 70 times per minute, 100,800 times per day, 36,792,000 times per year and over 2,760 million times during an average lifespan. Because heart muscle contracts regularly, it needs a ready supply of oxygen, glucose and other nutrients. If this supply fails, due to narrowed or blocked arteries, heart muscle starts to cramp, causing a pain known as angina.
If the blood supply to your heart is compromised more severely, for example by spasm of a coronary artery, or a blood clot, then some heart muscle cells will die due to lack of oxygen, and this is what is known as a heart attack.
Heart symptoms you should never ignore
Angina typically feels like a tight pressure, heaviness or dull ache behind the breastbone which may spread through your chest, into the neck, jaw or down your left arm. These symptoms are typically brought on by exertion or strong emotions, and usually fade within a few minutes of resting.
Heart attack pain is similar to angina but lasts longer, is more intense and is usually accompanied by sweating, paleness and breathlessness. Often, a heart attack is heralded by insidious feelings of fatigue, indigestion, chest discomfort (rather than pain) and an urgent need to empty the bowels.
A heart attack can be hard to distinguish from heart pain due to angina. Both are due to a lack of oxygen and nutrients reaching heart muscle cells. Angina is usually brought on by exertion and resolves with rest. In contrast, heart attack symptoms can come on at any time, including sitting down, and persist despite resting.
Symptoms can include:
- Breaking out in a cold sweat
- Chest discomfort – pressure, fullness, squeezing (like a bear hug), aching, heartburn or indigestion, not just tight pain
- Discomfort radiating up to the neck, jaw, shoulders, back or down the arms (often the left arm)
- Shortness of breath
- Dizziness or light-headedness
- A sudden need to open the bowels
- Nausea or even vomiting
- A feeling of impending doom.
Chest pain or discomfort, or feeling like something is wrong, should always be taken seriously and medical advice sought without delay.
Silent heart attacks can also occur, without any symptoms, especially in older people.
If you think you are having a heart attack, call an ambulance immediately, without delay. They may advise you to chew an aspirin while waiting for help to arrive, as this can help to dissolve any blood clots.
Symptoms of heart attack in women
Although traditionally viewed as a male disease, heart attack kills three times more women than cancers of the breast, ovaries and cervix combined.
The female hormone, oestrogen, has beneficial effects on artery elasticity and helps to protect women before the menopause (an effect that is cancelled out if you smoke or have diabetes). After the menopause, however, the risk of heart attack increases and women tend to experience heart attack around 10 to 20 years later in life than men.
Women often don’t feel the classic heart attack symptoms of tight chest pain or discomfort, radiation of pain to the arm, or shortness of breath. This suggests that angina in women is linked more with arterial spasm rather than with narrowing and furring up of the arteries. Unfortunately, if heart pain is not ‘classical’ it may be misdiagnosed as musculoskeletal pain rather than angina. Some experts have suggested that any type of chest pain in women could be a sign of heart problems and that this possibility should always be born in mind.
Women are also more prone to a type of heart pain known as Cardiac Syndrome X in which angina-like heart pain occurs on exercise, but investigations (angiography) show that the coronary arteries are not narrowed or blocked. This syndrome is thought to be due to lack of oestrogen, which affects tiny blood vessels (capillaries) within the heart muscle itself, so they fail to dilate during exercise.
Cardiac syndrome X mainly affects post-menopausal women and, in one study of 134 people with this condition, just 27 were male and 104 were female with an average age of 53.8 years.
Assessing your risk of heart attack
One in three people will experience a heart attack which, of course, means that two out of three will not. The chance of a heart attack increases with the more risk factors you accumulate, such as:
- Family history (mum having a heart attack before age 60 or dad before age 45)
- Sedentary lifestyle
- Poorly controlled high blood pressure
- Poorly controlled diabetes
- Elevated cholesterol
- Raised triglycerides
- High stress levels
You can assess your overall risk of a heart attack HERE.
How to avoid a heart attack
Stop Smoking Smokers are five times more likely to have a heart attack in their 30s and 40s than non-smokers – and three times more likely to have one over all. Stopping smoking can reduce your risk of a heart attack by as much as 50% – 70% within 5 years
Lose some excess weight Those who are obese are one and a half times more likely to have a heart attack than someone who maintains a healthy weight – especially if you store excess fat around your middle (apple-shaped). Getting down to a healthier weight can reduce your risk of a heart attack by 35% – 55%. You don’t have to lose all your excess weight, however. Data from 97 studies, following more than 2.88 million individuals world-wide, for up to 40 years, found that those who were classed as overweight (BMI of 25– <30) were 6% less likely to die, from any medical cause, during the follow-up period of X years, than those of normal weight (BMI of 18.5– <25). As expected, obesity was associated with a higher risk of death. While controversial, this suggests that a few extra pounds are not as dangerous as previously thought.
Take regular exercise People who exercise for 30 to 60 minutes, at least five times per week, are half as likely to have a heart attack as those who are physically inactive. Activities such as DIY, gardening and dancing are just as effective as swimming or cycling for heart health.
Keep alcohol intake within safe limits A moderate alcohol intake – especially red wine – can reduce your risk of heart disease by 25% – 45%. If you regularly drink more than one or two units of alcohol in one session however, your risk of a heart attack increases.
Cut back on salt It’s estimated that if everyone reduced the amount of salt in their diet, at least one in seven heart attacks would be prevented. Avoid obviously salty foods (crisps; bacon; pickled fish/meats; products tinned in brine) and stop adding salt during cooking or at the table. Obtain flavour from herbs, spices and black pepper instead.
Follow a Mediterranean-style DASH Diet One in three heart attacks are due to an unhealthy diet with too much processed foods, excess carbohydrates (especially sugar and white flour), and not enough vegetables and low-glycaemic fruits. Concentrate on obtaining whole foods providing beneficial fats such as olive, rapeseed, walnut and fish oils, and cut back on processed, high-glycaemic foods such as donuts, cakes, biscuits.
Eat more fish Fish oil can thin the blood, lower blood pressure and – if you suffer from heart disease – can reduce your risk of a fatal heart attack by a third. Aim for two portions of fish per week, of which one should be oily (eg salmon, tuna, herrings, sardines, mackerel). If you don’t like fish, consider taking an omega-3 fish oil supplement instead.
Avoid excess stress When you are under excess stress, your blood pressure goes up by an amount equivalent to carrying an extra 40 lbs in weight, or an additional 20 years in age. Together with spasm of coronary arteries, this can trigger a heart attack. Take time out to relax whenever you feel tense.
Isoflavones may protect older women Isoflavones are weak plant hormones that interact with oestrogen receptors within the circulation to mimic some of the beneficial effects of oestrogen, helping to dilate coronary arteries, increase heart function, reduce blood levels of harmful LDL-cholesterol and reduce blood stickiness to prevent unwanted clotting. Plant oestrogens are found in soy products, lentils, flaxseed, yellow-green vegetables and cruciferous plants – these include exotic members of the cabbage and turnip families (eg kohl rabi; Chinese leaves), chickpeas and sweet potatoes. Soy isoflavone supplements are also available.
Check your blood pressure regularly Even if your blood pressure is dangerously high, you may feel relatively well. A home blood pressure monitor is key.
Have a regular diabetes screen A woman is 3 to 7 times more likely to have a heart attack if her blood sugar level is raised or poorly controlled (for a man, the risk is 2-3 times greater). Have your urine screened regularly for glucose – at least once a year. If you have diabetes, you can reduce your risk of a heart attack by keeping your blood sugar level within tight limits – ask your doctor for further advice.
Have your blood fat levels checked Some types of fat in the circulation (eg HDL-cholesterol) help to protect against a heart attack, while others (eg triglycerides, LDL-cholesterol) are linked with an increased risk of heart disease. Reducing abnormally raised blood cholesterol levels by just 10% could prevent one in four heart attacks occurring.
Should you take aspirin? Aspirin is so powerful at preventing blood clots that only a small dose (75mg to 150mg) is needed per day to reduce your risk of a heart attack by a third. Your doctor may suggest you take a mini aspirin if you have:
- already had a heart attack
- had heart surgery
- poor circulation in the limbs
- an increased risk of heart disease from any cause.
However, aspirin can increase the risk of bleeding so don’t take mini aspirin except under medical advice.
An alternative option is a tomato jelly extract known as Fruitflow.
Drink more tea Research suggests that drinking four cups of tea per day may halve your risk of a heart attack. Tea is a rich source of flavonoid antioxidants with protective effects on artery walls.
Supplements to consider
Omega-3 fish oils – to improve overall heart health
Garlic tablets – to improve arterial elasticity and blood flow
Folic acid – to lower levels of homocysteine, an amino acid that can hasten narrowing of the arteries
Plant sterols – to lower cholesterol
Isoflavones – to boost oestrogen levels in post-menopausal women
Coenzyme Q10 – to improve energy production in heart muscle cells
Have you experienced a heart attack? What were your symptoms like? Please share your experience via the comments below.