Experts agree that high blood pressure and high cholesterol increase the risk of having a heart attack. So you might think they also agree on when you should take drugs to control them. But early in 2017 the American Academy of Family Physicians and the American College of Physicians issued more lenient quidelines for blood pressure in people 60 and older: They don’t need drugs until their systolic, or upper, blood pressure number is above 150. But the American Heart Association and the American College of Cardiology recently lowered their cut of to 130. And last year, the U.S. Preventive Services Task Force said that people who don’t have very high cholesterol levels can still benefit from cholesterol lowering statin drugs.
Here’s our expert quide through the maze
1.Focus on your overall risk
Though blood pressure and cholesterol levels are important, other factors play a role, too: age, gender, race, whether you smoke or have diabetes, and more. ”Everyone 40 and over should know their overall risk of having a heart attack or stroke,” says Marvin M. Lipman, M.D., CR’s chief medical adviser.
2.Don’t rush to drugs
If your 10-year risk is greater than 10 percent, or if your LDL (bad) cholesterol level is over 190, you should start on a statin. But if your risk is between 7.5 and 10, it may be worth trying lifestyle changes first. That means stopping smoking, losing excess weight, being active, consuming a heart healthy diet, drinking alcohol in moderation only, and getting blood sugar levels under control. If that doesn’t lower your risk enough after three to six months, consider a statin, even if your LDL isn’t elevated. The same strategy applies to blood pressure. If it’s a bit elevated (150 to 160 for people 60 and older; 140 to 150 for others), consider drugs only if several months of diet and lifestyle changes weren’t enough. Regular exercise can lower your systolic pressure by up to 9 points. And every 11 pounds of excess weight lost can reduce it by 2.5 to 10 points. And avoiding excess sodium (anything beyond 2,400 mg in a day) can lower it between 2 and 8 points.
3.Get the right medication
Statins are thought to work not only by lowering LDL but also by stabilizing plaque deposits in the arteries, making the deposits less likely to rupture and send blood clots through the body. People with a history of heart attack or stroke, or at very high risk of one (greater than 20 percent), should start with higher doses of a potent statin: 40 to 80 mg of atorvastatin (Lipitor and generic) or 20 to 40 mg of rosuvastatin (Crestor and generic). Other people who need a drug should start with lower doses of those or other statins: 40 mg of lavastatin (Mevacor and generic). Doctors use several different types of drugs to lower blood pressure. For people with levels above 150 it can take a combination to control the problem. It’s usually smart to start with the oldest, safest, and least expensive drug: diuretics, or water pills, such as chlorthalidone or hydrochlorothiazide. If that doesn’t work, you may need to switch to or add an ACE inhibitor, calcium channel blocker, or other kind of drug.