Cardiovascular Underwriting: Hypertension and Coronary Disease
Severity, duration, control and organ damage decide how a heart or blood pressure history is rated.
Heart and blood vessel disease causes more deaths than any other group of conditions, so the cardiovascular system takes a large share of every life underwriter's work. Two impairments dominate: raised blood pressure (hypertension), which is common, often silent and usually treatable, and coronary artery disease, where narrowed arteries starve the heart muscle of blood and can cause angina or a heart attack.
Both are judged the same way at heart: how severe the condition is, how long it has been present, how well it is controlled, and whether it has already damaged the heart, kidneys, eyes or brain. Other risk factors (smoking, diabetes, raised cholesterol, overweight, family history) are read alongside, because they multiply cardiovascular risk.
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Tests in Cardiovascular Underwriting
| Test | What it tells the underwriter |
|---|---|
| Blood pressure readings | Systolic and diastolic pressure. More than one reading is taken, and the history of past readings matters more than a single value |
| Resting ECG | Rhythm, signs of an old heart attack, strain or thickening of the heart muscle (left ventricular hypertrophy) |
| Treadmill (exercise stress) test | Whether the heart shows reduced blood supply under effort; used for chest pain or abnormal resting ECG and for large covers |
| Echocardiogram | Heart size, valve function and pumping strength (ejection fraction) |
| Lipid profile | Total cholesterol, HDL, LDL and triglycerides, which predict coronary disease |
| Coronary angiography report | Which arteries are narrowed and by how much, from the treating hospital's records |
| Attending physician's statement | Diagnosis dates, treatment, procedures and follow-up |
Hypertension
WHO defines hypertension as a systolic pressure of 140 mmHg or more, or a diastolic pressure of 90 mmHg or more, on repeated readings. Most hypertension has no single cause (essential hypertension); a small share is secondary to kidney, hormonal or other disease, and the underlying cause then drives the rating.
Raised blood pressure hurts slowly. Over years it damages arteries, thickens the heart muscle and harms the kidneys and retina, and it raises the risk of stroke and heart attack. That is why underwriters treat it as an increasing risk and look hard at age: the same reading is worse news at 30 than at 60, because the younger person has more years of exposure ahead.
What Moves a Hypertension Decision
- Level of the readings
- Higher systolic and diastolic values carry more extra mortality. Both numbers matter.
- Age
- Raised pressure in a young applicant is rated more heavily than the same values in an older one.
- Treatment and control
- Readings brought to normal on stable treatment are favourable. Uncontrolled readings despite treatment, or untreated high readings, are not.
- Target organ damage
- Left ventricular hypertrophy on ECG or echo, protein in urine, raised creatinine or changes in the retina show that damage has started and weigh heavily.
- Other risk factors
- Diabetes, smoking, overweight and abnormal lipids alongside hypertension are often rated in combination.
Coronary Artery Disease
Coronary artery disease is the narrowing of the arteries that supply the heart, usually by fatty plaque (atherosclerosis). It shows itself as angina (chest pain on effort that settles with rest), as a heart attack (myocardial infarction, where part of the heart muscle dies), or sometimes as sudden death with no warning. Treatment includes medicines, angioplasty with stents, and bypass surgery (CABG).
An applicant with known coronary disease has, by definition, an established disease of a vital organ. Most such cases are rated, often heavily, or declined. A recent heart attack or procedure is usually postponed until recovery and follow-up tests show a stable result.
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What Moves a Coronary Disease Decision
Age at first event
More favourable
Older
Less favourable
Younger (premature coronary disease)
Time since the event or procedure
More favourable
Longer, with stable follow-up
Less favourable
Recent
Extent of disease
More favourable
One artery, fully treated
Less favourable
Several arteries, or disease left untreated
Heart function
More favourable
Normal ejection fraction
Less favourable
Reduced pumping strength
Current symptoms
More favourable
None, good exercise tolerance
Less favourable
Ongoing angina or breathlessness
Risk factors since
More favourable
Stopped smoking, controlled lipids, blood pressure and sugar
Less favourable
Still smoking, or uncontrolled risk factors
| Factor | More favourable | Less favourable |
|---|---|---|
| Age at first event | Older | Younger (premature coronary disease) |
| Time since the event or procedure | Longer, with stable follow-up | Recent |
| Extent of disease | One artery, fully treated | Several arteries, or disease left untreated |
| Heart function | Normal ejection fraction | Reduced pumping strength |
| Current symptoms | None, good exercise tolerance | Ongoing angina or breathlessness |
| Risk factors since | Stopped smoking, controlled lipids, blood pressure and sugar | Still smoking, or uncontrolled risk factors |
Other Findings Underwriters Meet
- check_circleHeart murmurs: many are harmless, so the underwriter wants an echocardiogram to tell an innocent murmur from valve disease.
- check_circleRhythm disturbances: occasional extra beats are often of no significance; atrial fibrillation or heart block need more detail.
- check_circleAbnormal ECG without symptoms: may need a treadmill test or echo before a decision.
- check_circleRaised cholesterol on its own: rated mainly when very high or combined with other risk factors.
How IC-22 Tests This
Expect definition questions (angina versus infarction, what an echocardiogram or treadmill test shows, what left ventricular hypertrophy means), and reasoning questions: why age makes raised blood pressure worse, why target organ damage weighs heavily, and why recent cardiac events are postponed. Riders such as critical illness are treated more strictly than the basic life cover for any cardiac history.
Not Medical Advice
This page explains how life insurers assess heart and blood pressure conditions for the IC-22 syllabus. It is not medical guidance. Ratings and postponement periods in real cases come from each insurer's own manual.
FAQs
Can I get life insurance with high blood pressure?expand_more
Usually yes. Blood pressure that is controlled on treatment, without signs of organ damage, is often accepted at standard rates or a modest extra. Very high or uncontrolled readings, or organ damage, lead to heavier ratings or a decline. The decision is each insurer's.
Why is hypertension rated more heavily in younger applicants?expand_more
Its damage builds up over years. A younger applicant with the same readings faces more years of exposure, so the expected extra mortality over the policy term is greater.
What happens if I apply soon after a heart attack?expand_more
Insurers usually postpone the decision until recovery and follow-up tests show a stable result. After that, the case is generally rated according to heart function, extent of disease and risk factors.
What tests do insurers use for heart disease?expand_more
A resting ECG, often a treadmill test, an echocardiogram for heart function and valves, a lipid profile, and the treating doctor's records, including any angiography report.
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