Stroke. Vision loss. Sexual dysfunction. The (long) list of health challenges and conditions linked to high blood pressure can’t be ignored.
Angina is another item on the “at-risk-of” list for those with hypertension. But what are the different types of angina you should be aware of? What’s more, is it possible to establish a clear cause and effect of angina and high blood pressure, or is this one of those chicken-and-egg situations?
Let’s dive in and find out.
First Things First, What Is Angina?
Angina is a specific type of chest pain that occurs when there isn’t enough blood flow going to the heart.
The leading cause of angina is coronary artery disease (CAD). In turn, the leading causes of CAD are broken down into two categories:
The factors we can control:
- Being overweight
- Chronic stress
- High blood pressure
- High cholesterol
- Physical inactivity
And the factors we cannot control:
- A family history of heart disease
- Age (risk of CAD increases with age)
- Sex (men are at more risk of CAD)
Day-to-day events or circumstances can also make angina flare up. One of the most common triggers is being in cold weather. Exposure to cold temperatures is known to bring about angina in around 40% of people with CAD.
Another trigger is eating a large meal. The dangers of overeating are well-established, with the average serving size of a meal having risen by 138% over the past 50 years. It’s thought that consuming a lot of food in one sitting can increase heart rate and blood pressure, and cause changes in blood flow that make angina-related pain more likely.
Angina vs. Heart Attack – How to Tell The Difference
The trouble is, if you feel a twinge or tightness or pressure in your chest, it’s not easy to tell what the source of the problem is.
Is the pain due to angina? A strained muscle? A chest infection? A heart attack?
Go online and you’ll see medical articles listing 27 different potential causes of chest pain. That’s… a lot. During an episode of angina, accompanying symptoms to look out for include:
- Feeling sick
- Shortness of breath
Understandably, people are most concerned about knowing how to tell the difference between angina and a heart attack. The initial symptoms may be hard to distinguish from one another. However, chest pain from angina will typically ease after a few minutes of rest. This is not likely to be the case during a heart attack.
Don’t hesitate to call your local medical emergency number (for example, 999 in the UK) if you are not sure.
How Can High Blood Pressure Cause Angina?
Having high blood pressure can cause angina due to how it changes the structure of the coronary arteries.
Rather than getting lost in the complex physiology of it all, here’s a quick six-point summary of what you need to know:
- The coronary arteries are an essential supply of blood to the heart.
- Having high blood pressure can damage the walls of these arteries over time.
- When the artery walls are compromised, plaque formation starts to narrow the vessels. This is called atherosclerosis.
- Layered with plaque, the artery walls become narrow and rigid.
- Narrower, less distensible arteries restrict the flow of blood to the heart.
- When the arteries become less effective at bringing enough oxygen-rich blood to your heart muscle, it causes the pain/discomfort sensation that is termed angina.
Before we continue, here are a couple of other articles you may wish to explore after this one:
- How to Lower High Blood Pressure Naturally, Without Medication
- 10 Surprising Myths & Facts About Blood Pressure Readings
Can Angina Cause Hypertension Too?
No. While it is associated with hypertension, angina is identified as a symptom, not a cause.
But here’s another important question to ask. Can angina ever occur in people who do not have high blood pressure?
Well, the majority of angina cases are a result of plaque in the coronary arteries. By no means all, though. Rarer cardiac conditions (in which plaque cannot always be seen in scans) may also cause angina.
- Coronary artery erosions
- Coronary microvascular dysfunction
- Female-pattern CAD
- Spontaneous coronary artery dissection (SCAD)
- Vasospastic (Prinzmetal’s) angina
What’s The Most Common Type of Angina?
The two most well-known types of angina are:
- Stable angina
- Unstable angina
The most common of these is stable angina. And you’re right, the clue is in the word! In this case, the pattern of angina has remained stable for two months or more. People with stable angina will notice there’s a pattern to the frequency, length, and triggers of their chest pain.
For those with unstable angina, there is a clearly worsening pattern of symptoms or symptoms that do not stop. The pain may also persist despite rest or medication. This demands urgent medical attention.
Two additional, more infrequent forms of angina are:
- The microvascular type, which affects the small blood vessels of the coronary arteries
- The variant type, which leads to a sudden spasm and narrowing of a coronary artery
Is It Possible To Treat Angina Pain?
Yes, it is. Once you have been diagnosed with angina following an ECG, chest X-ray, or other tests, there are a few treatment options on the table.
The three main categories of treatment are:
- Lifestyle improvements
The most appropriate path forward will depend on the type and severity of your angina. While there’s no cure for coronary heart disease itself, medication can improve symptoms and help your heart to function better.
You may be given medicine to:
- Treat attacks when they happen
- Prevent further attacks
- Reduce the risk of heart attacks and strokes
Common anti-anginal medications include nitrates to relax the blood vessels, beta blockers to slow your heart rate, and statins to lower blood cholesterol. Make sure to speak with your doctor, who will be able to prescribe the best medication for your symptoms.
In addition, important lifestyle factors to pay attention to include:
- Controlling your blood pressure
- Eating more healthily
- Increasing exercise
- Reducing stress
- Quitting smoking
Together, medicine and lifestyle improvements can make a big difference, limiting the effects of angina on your quality of life.
If they don’t ease the symptoms, surgery may be recommended as the next step. For example, coronary angioplasty or coronary artery bypass surgery can be offered to those with severe angina to widen blocked arteries, as well as improve oxygen and blood supply to the heart.
Tracking The Effects of High Blood Pressure On Angina
As noted, high blood pressure can cause angina. Therefore, it’s a smart move to track any fluctuations in blood pressure over time to see if it may be at the root of recurring chest pain.
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Disclaimer: If you are concerned about your blood pressure, it is best to speak to your doctor. They can advise on the best way to manage your blood pressure.
Risk Factors for Coronary Artery Disease: Historical Perspectives, July 2017 – https://www.ncbi.nlm.nih.gov/articles-PMC5686931
Exposure to extreme cold lowers the ischemic threshold in coronary artery disease patients, February 2010 – https://www.ncbi.nlm.nih.gov/articles-PMC2851392
What could cause chest pain?, July 2022 – https://www.medicalnewstoday.com/articles-321650
Heart disease and high blood pressure, September 2020 – https://www.bloodpressureuk.org/your-blood-pressure-heart-disease-and-high-blood-pressure
Overeating and Your Heart, October 2022 – https://www.nm.org/healthbeat-nutrition-overeating-and-your-heart
Angina With Normal Coronary Arteries, April 2022 – https://www.verywellhealth.com/chest-pain-with-normal-coronary-arteries
Angina treatment: Stents, drugs, lifestyle changes – What’s best?, May 2021 – https://www.mayoclinic.org/diseases-conditions-in-depth-angina-treatment-20046240
NHS, Coronary angioplasty and stent insertion, October 2022 – https://www.nhs.uk/conditions-coronary-angioplasty