Reducing the risks of cardiovascular disease

The risk of cardiovascular disease can be reduced in a range of different ways, including:

• stopping smoking
• maintaining resting blood pressure below 140/85 mmHg
• maintaining low blood cholesterol level
• maintaining a normal BMI/low waist-to-hip ratio
• taking more excercise
• moderate or no use of alcohol 

Controlling blood pressure
Changes in diet and lifestyle would be recommended. Medications are also available to reduce high blood pressure. These would normally be prescribed for people with sustained systolic pressure over 160mmHg or sustained diastolic pressure of 100mmHg. People with sustained blood pressure over 140/90 mmHg and who show evidence of CVD may also be treated.
3 main types of drugs are used to treat high blood pressure, ACE inhibitors, calcium channel blockers, and diuretics. 

ACE inhibitors
ACE inhibitors are effective antihypertensive drugs which reduce the synthesis of angiotensin II. This hormone causes vasoconstriction of blood vessels to help control blood pressure. The ACE inhibitors prevent the hormone being produced from an inactive form, angiotensin I, thus reducing the vasoconstriction and lowering blood pressure. Also, for anyone with kidney disease the drug may reduce the risk of kidney failure. Patients intolerant to ACE inhibitors will be prescribed an alternative, which affects the angiotensin II receptors.
Side effects include a dry cough, dizziness due to rapid lowering blood pressure, abnormal heart rhythms and a reduction in the function of the kidney. 

Calcium channel blockers
Calcium channel blockers are antihypertensive drugs that block the calcium channels in the muscle cells in the lining of arteries. For the muscle to contract, calcium must pass through these channels into the muscle cells. Failure of calcium to enter the cell prevents contraction of the muscle, the blood vessels do not constrict, and this lowers blood pressure. In people with heart failure, taking some types of calcium channel blockers can make symptoms worse or be fatal, so they may not be prescribed to people who have had a heart attack. Side effects include headaches, dizziness, swollen ankles due to a build-up of fluid in the legs, abnormal heart rhythms, flushing red in the face and constipation.

Diuretics
Diuretics increase the volume of urine produced by the kidneys and thus rid the body of excess fluids and salt. This leads to a decrease in blood plasm volume and cardiac output (volume of blood expelled from the heart in a minute), which lowers the blood pressure.

A few people taking diuretics may have some side effects, such as dizziness, nausea or muscle cramps.

Most people take 2 of these drugs to control blood pressure, usually an ACE inhibitor in combination with one of the others.