Reading the paper from your annual health check

Blood pressure, blood sugar, and cholesterol. What the numbers mean, what the trends tell you, and the two-year drift that catches disease before it lands.

The paper from your annual health check has three sections that matter most: blood pressure, blood sugar, and cholesterol. Read them right and you know most of what you need to know about your cardiovascular future. Read them wrong and “everything within the normal range” can hide a real signal.

What follows is a plain reader’s guide to those three numbers, why each matters, and what actually moves them.

Blood pressure

The two numbers are the pressure in the arteries when the heart contracts (systolic, the top number) and when it relaxes (diastolic, the bottom). Think of it as the force water puts on the inside of a pipe.

The current Japanese Society of Hypertension targets, measured at a clinic:

• Systolic below 140 mmHg
• Diastolic below 90 mmHg

Home measurements should be about 5 mmHg lower — below 135 over 85 — because being at the doctor’s office temporarily raises the number for many people (the “white coat effect”).

Sustained high pressure damages the arterial walls, accelerates atherosclerosis, and drives most of the strokes and heart attacks that happen after sixty. The good news: even a 5-point drop in systolic pressure meaningfully reduces those risks over time.

What actually moves it

• Salt reduction. Cutting daily sodium by 3 grams typically drops systolic pressure 3 to 5 mmHg in the average older adult.
• Aerobic movement. 30 minutes a day, five days a week, drops systolic 5 to 10 mmHg.
• Weight loss. If you’re overweight, a 5 kg loss lowers pressure meaningfully.
• Less alcohol. Even moderate drinking raises pressure over time.
• Sleep. Poor sleep is a real, if underappreciated, blood-pressure driver.

Blood sugar

Two measurements you’ll see most often. Fasting glucose is your morning blood sugar before eating. HbA1c is a rolling three-month average of your blood sugar — the number to trust more, because it isn’t affected by what you had for breakfast this morning.

• Fasting glucose: below 100 mg/dL is normal. 100 to 125 is prediabetes. 126 or higher, on two separate tests, is diabetes.
• HbA1c: below 5.6% is normal. 5.7 to 6.4% is prediabetes. 6.5% or higher is diabetes.

Chronic high blood sugar damages the small blood vessels and nerves throughout the body. What you’d feel, over years: vision loss from retinal damage, kidney impairment, nerve pain in the feet, and sometimes non-healing wounds. The complications are grim, but the disease itself is slow, which means it responds well to lifestyle changes if caught early.

What actually moves it

• Weight loss, again. Sensitivity to insulin is closely tied to body fat, particularly around the abdomen.
• Movement. Any daily activity that uses the muscles reduces glucose. A brisk walk after meals is one of the most effective single habits.
• Fiber. Vegetables, whole grains, beans. Eaten before the carbohydrates, in each meal.
• Cutting sugary drinks and refined starches. This is the fastest change most people can make.

Cholesterol

Three numbers matter. LDL is the “bad” one — it deposits into artery walls and drives atherosclerosis. HDL is the “good” one — it carries cholesterol back to the liver for disposal. Triglycerides are stored fat, and elevated triglycerides are their own risk marker.

• LDL: below 140 mg/dL for people at low cardiovascular risk. Below 100, or even 70, for people with existing heart disease or diabetes.
• HDL: 40 or higher is normal. Higher is better.
• Triglycerides: below 150 mg/dL.

The combination that raises the biggest alarm is high LDL and low HDL — that’s the setup for accelerated arterial disease. Ratios matter as much as absolute numbers.

What actually moves them

• Saturated fat down, unsaturated fat up. Less butter, fewer fatty meats. More olive oil, more fish, more nuts.
• Soluble fiber. Oats, beans, apples, seaweed. Actually binds cholesterol in the gut.
• Exercise. Raises HDL more reliably than any dietary change.
• Reducing sugar and refined starch. Lowers triglycerides directly.
• Losing weight, if applicable. Improves all three at once.
• Statin medications. If lifestyle changes don’t move LDL far enough, and cardiovascular risk is significant, statins are effective and, for older adults with actual disease, well-supported by trials.

How to read the results as a whole

One elevated number is a signal. Two or three moving in the wrong direction together is the picture of metabolic syndrome, and that’s where cardiovascular risk multiplies. If your fasting glucose has crept up over three years, your blood pressure is inching higher, and your triglycerides are elevated — even if none of them are individually in the alarm zone — the trajectory matters.

Compare each result to the previous year’s. Direction over time is more informative than a single reading. Ask your doctor to sit down with you and walk through the trajectory once, so you know what to watch.

Three things people miss

Home blood pressure monitoring

A simple upper-arm monitor at home, used morning and evening for a week each month, is more accurate than the once-a-year clinic reading. It also catches the two problematic patterns — masked hypertension (fine at the clinic, high at home) and white-coat hypertension (high at the clinic, fine at home). If you have a family history of hypertension or the number has been drifting up, buy the monitor.

The waist

Waist circumference matters as much as weight. Men over 85 cm and women over 90 cm are carrying enough abdominal fat to significantly raise metabolic risk. A tape measure at home tells you more about cardiovascular trajectory than the scale does.

The follow-up appointment

Numbers in the yellow zone often mean the health check office will invite you for a specific health guidance program. In Japan, this is called tokutei hoken shido, and it’s covered under the national insurance system. Show up. The program pairs you with a professional who works through diet, movement, and follow-up measurements. People who complete these programs measurably improve their numbers.

The point of the paper

The health check exists so that you can catch drift before it becomes disease. Read the paper. Compare to last year. Change one or two habits based on what you see. Recheck in six months. That is the whole loop, and it works.