Keeping smart about your heart

Keeping smart about your heart
We can do a lot to maintain a healthy heart writes Chai Brady


Many people are not seeing their family doctor as regularly as normal due to Covid-19. Most general practitioners are offering consultation via telephone or over the internet and people who are on regular medication are continuing to prescribe this. There have been some reports of people experiencing chest pains possibly related to heart issues not attending hospital emergency departments due to fears about coronavirus. The advice from the experts is clear: if one is experiencing symptoms then the hospital is the place to be.

What can be frightening for people is that heart problems often creep up on patients and there are often no symptoms. High blood pressure – or hypertension – is often called the “silent killer”. Most of the time, it has no obvious symptoms to indicate that something is wrong. Many people with high blood pressure don’t even know they have it. Often the signs and symptoms are misunderstood. High blood pressure develops slowly over time and can be related to many causes. High blood pressure cannot be cured. But it can be managed effectively through lifestyle changes and, when needed, medication. By increasing exercise and making simple changes one can substantially reduce the risk of heart attacks and strokes.

Dr Kevin McCarroll, a consultant geritrician at St James’ Hospital in Dublin warns that a key starting point is knowing what exactly one’s blood pressure is. “Measurement of blood pressure, as we all know, is a fundamental part of the routine clinical examination – and for good reason.

“This is because high blood pressure or hypertension is for the most part a silent condition which, over time, may have far-reaching health consequences,” according to Dr McCarroll.

He says that “to some extent, an elevated blood pressure may be considered a normal part of ageing.

“While below 40, hypertension is uncommon, by middle age prevalence increases to up to 50% and further rises to approximately 75% in those over 65.

“The importance of getting your blood pressure checked is emphasised by the fact that in up to half of cases hypertension is undiagnosed. The reasons underlying hypertension are complex and not fully understood but involve changes in resistance to blood flow in our arteries,” he says.

Dr McCarroll says that the effects of high blood pressure are manifold. “It significantly accelerates atherosclerosis or hardening of the arteries, a process whereby they become internally coated with plaque and narrowed.

“This can cause damage to the arteries anywhere in the body including in the heart, kidneys, eyes, legs and brain, and can lead to coronary artery disease, kidney impairment, visual problems and poor circulation,” he says.

Hypertension is also a major risk factor for stroke and puts strain on the heart which can lead to impaired heart muscle function and heart failure.

In the past, high blood pressure was often not diagnosed until later in life, by which time it may have caused organ damage, or was only picked up incidentally. According to Dr McCarroll, “diagnosis and treatment of hypertension even later in life will substantially reduce the risk of cardiovascular disease and events”.

A doctor or nurse will be able to check if one has high blood pressure and it is recommended that this is checked each time one visits the GP, or at least once every six months.

Blood pressure is measured by a standard test, which is painless and only takes a few minutes. The doctor or nurse will put a cuff around the arm above the elbow; air is pumped into the cuff and the measurement is read as the air is let out. Two numbers measure the level of blood pressure.

The higher (systolic) number represents the pressure when the heart is beating. The lower (diastolic) number represents the pressure when the heart is resting between beats.

Blood pressure varies due to age, emotion and activity and one raised reading does not mean one has high blood pressure.


There are a number of factors that usually combine to cause the condition, including:

– Smoking;

– Not eating enough fresh fruit and vegetables;

– Drinking too much alcohol;

– Taking too much salt in the diet;

– Being overweight;

– Family history of the condition;

– Ageing;

– Stress’

If high blood pressure is diagnosed, a doctor may first recommend some lifestyle changes, which may be enough to treat it, such as:

– Stopping smoking;

– Losing weight – and keeping the weight off;

– Drinking less alcohol;

– Cutting down on salt;

– Eating more fruit and vegetables;

– Reducing fat in your diet;

Doctors say that it is important to exercise regularly and recommend a brisk walk for at least 30 minutes most days of the week.

Sometimes medication, usually taken long-term, is prescribed to treat the condition. This helps to prevent the risk of heart attack or stroke and it is important to take this medication once prescribed. Cholesterol

Another issue that affects heart health is high levels of cholesterol. Cholesterol is a fatty substance which is essential for a healthy nervous system, good digestion and the production of hormones. The body produces cholesterol and we also get it from our diet, but too much cholesterol in your blood can be dangerous as it builds up on the walls of the blood vessels and leads to narrowing or hardening of the arteries.

There are two main forms of cholesterol:

– LDL cholesterol (low density lipoprotein) – known as ‘bad’ cholesterol. This attaches to the wall of the arteries and causes narrowing, which may contribute to angina, heart attack or stroke;

– HDL cholesterol (high density lipoproteins) – known as ‘good’ cholesterol. This cholesterol collects extra, unwanted cholesterol and carries it to the liver where it can be broken down;

As with hypertension, there are no symptoms to indicate if one has high cholesterol, but a simple blood test at your doctor’s surgery will show your overall level of cholesterol.

Depending on the results of this test, the doctor may arrange for a further test that will breakdown the HDL (good) cholesterol from the LDL (bad) and it may be necessary to fast before this test. Patients should check with their doctor. One raised reading does not mean you have high cholesterol, as levels may vary from day to day.

Many factors contribute to high cholesterol. These include:

– Not taking enough regular exercise;

– Too much fat in the diet;

– Being overweight;

– Family history of the condition;

A doctor may also prescribe drug treatment to reduce high cholesterol. Dr McCarroll warns that when it comes to blood pressure “if other risk factors including high cholesterol, diabetes or smoking are present, there is a ‘snowball effect’ whereby the risk increases exponentially.

“This is why a diagnosis of hypertension should always prompt a complete assessment for other vascular risk factors,” he says

He insists that “while there are no natural cut-offs for blood pressure, there are well defined treatment targets and even a small drop in blood pressure can significantly reduce the risk of stroke and heart disease. If you have diabetes, heart disease or end organ damage then a tighter control of your blood pressure will be recommended”.

Dr McCarroll says that if cases of mild hypertension, paying attention to the above factors may remove the need to go on anti-hypertensive medication. “However, in practice at some stage during the course of your hypertension you are likely to require medical treatment,” he says.

Several medications are available to choose from and which one is used will depend on how high the blood pressure is, the presence of other conditions like diabetes or kidney/heart disease and the potential for side effects. Treatments are very effective and usually well tolerated.

“High blood pressure is common and rarely gives rise to any symptoms. However, it is a ‘silent killer’ and needs to be checked and monitored closely,” he says.