Treatment might be started before waiting for home BP readings if you are found to have very high BP, called severe hypertension if your systolic BP is 180 mmHg or high or your diastolic is 110 mmHg or higher. If you are not already on medication, you will be started then and followed up within a few days until an acceptable level is reached. Doctors are cautious to bring this down too quickly, so you will be closely monitored.
If you do not have severe hypertension, but your readings are high enough to need treatment then your doctor will advise you on lifestyle changes that will help reduce your BP as well as starting daily tablet medication to bring the level down.
If you are overweight, have a poor diet, or are over 40 years old and have never had the test, it is recommended to check your cholesterol levels. If anyone in your family has suffered from high cholesterol or heart problems it is also recommended to get testing.
The doctor will likely take your cholesterol blood test alongside a few other routine blood tests too. Your doctor may take your blood pressure, calculate your BMI score and take into account your demographics, this will allow them to calculate your risk of developing cardiovascular disease in the next 10 years (Qrisk score).
Your doctor will use a QRisk score to calculate your risk of developing heart disease in the next 10 years. If your cholesterol level is raised, your Qrisk is above 10% or you are not improving your levels with lifestyle changes alone, then your doctor may recommend a cholesterol-lowering medication.
Statins are common medications that work by reducing the amount of cholesterol in your body. These medications are often well tolerated but in some, they can cause muscular aches and pains and affect your liver. Your doctor will guide you on how to start this medication appropriately.
Other medicines that can lower cholesterol include bile acid sequestrants, fibrates and ezetimibe – which can be used in combination with a statin, or on its own. Bempedoic acid can be used in people who don't respond to other cholesterol-lowering medication and is also available in combination with ezetimibe. A new treatment called inclisiran turns off the gene PCSK9 and increases the liver's ability to remove harmful cholesterol from the blood. However, this is only recommended if you have had a heart attack, stroke or other cardiovascular event and your LDL cholesterol remains high (above 2.6 mmol/L) on maximum treatment with other lipid-lowering therapies, including statins (or you can't take other treatments).
There are usually 4 different measures for the cholesterol level. Total cholesterol is the overall amount of cholesterol in your blood. This should be 5 or below. HDL (good cholesterol) - this reduces your risk of a heart attack or stroke. This should be 1 or above. LDL (bad cholesterol) - this increases your risk of heart problems or stroke and should be 3 or below. Triglycerides are similar to bad cholesterol and should be 2.3 or below.
Optimising your cholesterol blood results reduces your risk of developing heart attacks or stroke.
If your cholesterol level is raised, the first and most important step is to address your diet. It is important to reduce the amount of microwaveable, junk, processed, and takeaway foods that you consume. It is important to increase your good fats and nutrient-dense healthy foods; for example nuts and seeds, fruit and vegetables and oily fish like mackerel. It is advised to switch your dietary intake of pasta, rice and bread to wholemeal varieties.
It is also advised to exercise regularly by taking 150 minutes of moderate exercise or 75 minutes of intense activity a week and to stop smoking and drink less than 14 units of alcohol a week to reduce your risk of suffering from the disease.
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