Written by
Louise W Lu, PhD, MPH, BMLS
Reviewed by
Alexandra V Goldberg, Registered Dietitian
In our previous blogs, we explored two fundamental questions:
Is 130/80 High Blood Pressure? The Truth About Blood Pressure Guidelines Around the World
Stricter Blood Pressure Guidelines for Asians? — Could Save Your Life!
Did You Know? High Blood Pressure Isn't Just a Number — It's a Vascular Aging Accelerator!
Many people believe high blood pressure is only concerning when accompanied by symptoms like dizziness or headaches. However, hypertension acts as a “silent corroding force”, gradually damaging the artery walls, leading to atherosclerosis and plaque formation — all of which can begin long before any symptoms appear.
Jump to Sections:
What Is Atherosclerosis and What Are Plaques?
Atherosclerosis is a form of arteriosclerosis (hardening of the arteries), characterised by a narrowing and stiffening of the arteries due to a buildup of plaque — a mix of cholesterol, inflammatory cells, and fibrous tissue. This process limits blood flow and can affect oxygen delivery to vital organs and tissues.
Think of it like your arteries turning from soft rubber hoses into brittle plastic pipes with sludge stuck inside.
If this happens in coronary arteries, it can cause heart attacks; in cerebral arteries, strokes; and in peripheral arteries, muscle weakness and cramping, especially in the legs.
✔ Chest pain (angina)
✔ Leg or arm pain, especially during activity
✔ Fatigue or shortness of breath
✔ Cramping in the buttocks when walking
✔ Palpitations or irregular heartbeat
✔ Confusion or weakness if blood flow to the brain is restricted
How Does High Blood Pressure Make It Worse?
High blood pressure (hypertension) is a major contributor to the progression of atherosclerosis. Here's how:
- It damages endothelial cells, making artery walls rougher and more susceptible to plaque formation.
- It increases oxidative stress, triggering chronic inflammation.
- It speeds up LDL cholesterol accumulation and plaque hardening.
- It disrupts natural repair systems, allowing damage to compound over time.
✔ Each increase of about 12–15 mmHg in midlife systolic blood pressure is linked to:
• 2.5× higher risk of atherosclerotic cardiovascular disease (ASCVD)
• Nearly 4× higher risk of stroke
This makes early screening and prevention even more crucial for Asian populations.
Does Atherosclerosis Cause High Blood Pressure — or the Other Way Around?
The answer: Both.
High blood pressure accelerates atherosclerosis by damaging blood vessel walls.
Atherosclerosis contributes to high blood pressure by making arteries stiffer and narrower, increasing vascular resistance.
Together, they create a dangerous feedback loop.
Who’s at Higher Risk?
You may be especially vulnerable if you:
- Are over 40 and haven't done vascular screening
- Have family history of stroke, heart attack, or diabetes
- Have slightly elevated BP (≥130/80 mmHg)
- Are sedentary, overweight, or have high cholesterol
- Are East or South Asian, based on emerging ethnicity-specific research
How Is Atherosclerosis Diagnosed?
There are many ways to detect atherosclerosis — from basic physical exams to advanced imaging. Here's a quick comparison of common diagnostic tools:
| Test | What It Detects | What It Looks Like | Who Should Consider It |
|---|---|---|---|
| Physical Exam | Initial signs like weak pulse, bruit, or slow wound healing | Doctor uses stethoscope and palpation | Anyone over 40 or with risk factors |
| Blood Tests | Cholesterol levels and risk factor markers | Blood draw sent to lab for lipid panel | All adults over 35, especially with family history |
| Doppler Ultrasound | Blockages and narrowed arteries using sound waves | Ultrasound probe on skin, shows flow and blockages | People with suspected stroke risk or leg symptoms |
| Ankle-Brachial Index (ABI) | Compares blood pressure in arms vs. legs to detect blockages | Blood pressure cuffs on arms and ankles | Anyone with leg pain, cold feet, or diabetes |
| Magnetic Resonance Angiography (MRA) / CT Angiography (CTA) | Images of large arteries to identify narrowing or blockage | MRI/CT machine scan with/without contrast | Those with family history or borderline symptoms |
| Coronary CT Angiography (CCTA) | Visualises calcified plaques in coronary arteries | CT scan with iodine-based dye | Patients with moderate risk but no symptoms |
| Left Heart Catheterisation | Provides detailed images of heart arteries with contrast dye | Catheter inserted into artery, dye injection | Patients with known CAD or pre-surgical assessment |
| Electrocardiogram (ECG/EKG) | Measures electrical activity and rhythm of the heart | Electrodes on chest and limbs | Anyone with chest discomfort or irregular heartbeat |
| Exercise Stress Test | Assesses heart function under physical stress | Patient walks on treadmill or pedals bike | People with unexplained fatigue, dyspnea, or angina |
Protecting Your Arteries Starts Before You Feel Anything
Atherosclerosis doesn’t scream for attention — it creeps in silently, often for decades. And high blood pressure? It’s not just a risk factor; it’s the spark that accelerates plaque buildup and artery damage, especially in East and South Asians.
If your blood pressure is even slightly elevated, or you’ve never done vascular screening after age 40, now is the time to take action. Don’t wait for symptoms like chest pain, fatigue, or leg cramps — by then, your arteries may already be significantly narrowed.
The good news?
Early detection, lifestyle changes, targeted supplementation, and regular monitoring can stop the damage before it’s too late.
Stay proactive. Ask your doctor about appropriate tests. Review your blood pressure and cholesterol. And most of all, treat your arteries like your most precious asset — because they are.
Up next: We’ll explore science-backed strategies to stop and slow atherosclerosis — through diet, exercise, supplements, and smart prevention.
