About 6 million South Africans suffer from high blood pressure and out of all these people only 26% of men and 51% of women knew that they had hypertension. The number of people with high blood cholesterol levels is similar. These two key risk factors for cardiovascular disease (CVD) are often called the ‘silent killers’ because there are no visible symptoms when levels are raised and if left untreated can lead to a heart attack or stroke.

During their annual Get Tested Day campaign on 21 June, the Heart and Stroke Foundation SA (HSFSA) would like to remind you to have your cholesterol and blood pressure checked. By knowing your numbers and assessing your risk now, you can significantly reduce the chances of developing cardiovascular disease or of having a second event.

CHOLESTEROL

The most common cause of high blood cholesterol levels is eating too much fat, especially saturated and trans fats. However some people have high cholesterol levels even though they follow a healthy diet (e.g. people who have a rare hereditary condition called familial hypercholesterolaemia, or those who have an under-active thyroid gland, long-term kidney problems or who drink too much alcohol).

Who should get tested and how often?
All adults over the age of 20 should have a fasting lipogram once every five years, but more often if your total cholesterol is above 5mmol/L, you’re a man over age 45 or a woman over 50 or if you have other risk factors for heart disease and stroke. For a fasting blood test you would need to fast (usually for at least 9 hours) before the test.

The process of atherosclerosis (build up of fatty plaque in arteries) starts in childhood and progresses slowly into adulthood. So some children may need to have their cholesterol checked as well - particularly those from high-risk families (who have parents with high cholesterol, or parents/grandparents with heart disease at 55 years or younger).

“Good’ or “Bad” cholesterol and Triglycerides
Not only do you have to be aware of your total cholesterol level, but you also need to know your HDL and LDL cholesterol numbers and your triglyceride level. Your blood cholesterol consists mainly of two kinds of cholesterol. LDL (low-density lipoprotein) is the “bad” cholesterol because when too much of it circulates in the blood, it can slowly build up in the walls of the arteries to the heart or brain. HDL (high-density lipoprotein) is the “good” cholesterol that helps to remove “bad” cholesterol from arteries and prevent fatty blockages. Triglycerides are a type of fat made in your body and also comes from food. People with high triglycerides often have a poor cholesterol profile (high total cholesterol, high LDL cholesterol and a low HDL cholesterol level).

These are the levels you should aim for:
· total cholesterol below 5 mmol/L (if you have CVD or diabetes, then below 4.5 mmol/L)
· LDL cholesterol below 3 mmol/L (if you have CVD or diabetes, then below 2.5 mmol/L)
· triglyceride level less than 1.7 mmol/L
· HDL cholesterol above 1 mmol/L for men and 1.2 mmol/L for women

How can cholesterol be lowered?
To keep your cholesterol levels in the low-risk range, you would need to choose a heart-healthy diet (low in saturated fat, trans fat and cholesterol), do at least 30 minutes of moderate vigorous physical activity five days of the week and stay away from tobacco products. If lifestyle changes alone don’t lower your cholesterol level, speak to your doctor about medication. If you’re already on medication, remember that you still need to follow a heart-healthy lifestyle and take your medication exactly as prescribed.

BLOOD PRESSURE
In the majority of people, the cause of high blood pressure is not known. In fact, you could have high blood pressure for years without knowing it. Even though you may not know the cause, you can take steps to control it and reduce your risk for stroke, heart disease, kidney failure or problems with your eyesight. Some people may be “salt sensitive,” so eating a lot of salt (or sodium) worsens their high blood pressure. Salt increases fluid retention in your body and puts an added burden on your heart. As little as one extra gram of salt could raise blood pressure as much as 5 mmHg in people who are salt sensitive. It is important to cut down on your salt/sodium intake e.g. in canned foods, baking soda, cheese, dried or cured foods and even certain medications!

Who should get tested and how often?
All adults should have annual blood pressure checks especially if they have stressful occupations or a family history of hypertension. All patients who have been diagnosed with hypertension, should have regular blood pressure checks as directed by their doctor. It may be a good idea to have blood pressure levels checked from an earlier age, as even children as young as 6 can have high blood pressure. Children should start having their pressure checked from their teen years, especially if they are overweight.

At what level is blood pressure high?
Ideally, your blood pressure should be lower than 120/80 mm Hg. Readings from 120/80 – 139/89 mmHg are considered pre-hypertension. A systolic blood pressure (top reading) of 140 or higher or a diastolic pressure (bottom reading) of 90 or higher is considered high and should be evaluated by your doctor. Avoid complications from high blood pressure by aiming for levels:
· Less than 140/90 mmHg
· Less than 130/80 mmHg (if you have CVD or diabetes)

How to decrease blood pressure levels
To keep your blood pressure in a healthy range, you need to maintain a healthy weight, eat a diet low in salt and saturated fat, eat adequate potassium-rich foods (fruit, vegetables, nuts, low fat or fat free milk), get 30 minutes of physical activity on most or all days of the week and limit your alcohol intake to no more than one drink a day for women or two drinks per day for men.

What should you know about high blood pressure medication?
If lifestyle changes don’t get your blood pressure down to a normal level, your doctor may prescribe medication, which you will have to take EXACTLY as recommended. Remember that high blood pressure is a lifelong disease – it cannot be cured, but it can be managed by taking your blood pressure medication EVERY DAY - not just under certain “conditions” (such as when you’re feeling bad or stressed). Decreasing the dosage or not taking the medication at all is dangerous (your blood pressure will rise, putting you at risk for heart attack, stroke, heart failure and kidney failure).

Be aware of the possible dangers of taking certain cold, cough and flu medications. Decongestants have been reported to increase blood pressure and may interfere with blood pressure medications, so choose cold and flu medications that don’t contain decongestants. Also be careful of various herbs or herbal supplements which can cause fluctuations in blood pressure and interact with antihypertensive medication. Some medications that may interfere with the effectiveness of antihypertensive drugs include steroids, nonsteroidal anti-inflammatory drugs (NSAIDs), diet pills, cyclosporine, erythropoietin, tricyclic antidepressants, monoamine oxidase inhibitors and oral contraceptives. If in doubt, consult your doctor or pharmacist about drug interactions and before taking any over-the-counter medication or supplements.

Contacts
The Heart and Stroke Foundation SA provides screening of blood pressure, cholesterol, glucose as well as Body Mass Index (BMI) via the Corporate Wellness Programme. Contact Eshaam Mohidien at 083 302 4661 or email to find out more about the benefits of this Programme. For more detailed advice about lowering your cholesterol and blood pressure levels, or general heart health contact the Heart Mark Diet Line on 0860 223 222, email or visit www.heartfoundation.co.za.

Written by Erika Ketterer, Registered Dietitian at the Heart and Stroke Foundation S.A.