Controlling Your Blood Pressure Archive

Ask the doctors

Q. I had a fainting spell the other day. Should I be concerned? What should I do?

A. Fainting, which your doctor may refer to using the medical term syncope, is not uncommon. Experts say as many as one in three adults experiences at least one fainting spell over time. In most cases, it's not related to a serious medical condition, but if you faint, you should always get an evaluation by a doctor to rule out more serious causes, including heart-related problems.

Timing may improve potency and help you cope with side effects.

We all want our medicines to be as effective as possible, and that requires effort on our part. It may be necessary to avoid taking pills with certain foods or drinks, and to check that medications won't interfere with each other.

And in some cases, it may be important to take a drug at a particular time of day. This approach, known as chronotherapy, is gaining attention as research suggests a relationship between when we take medications and how well they work.

Ask the doctor

Q. I've taken blood pressure medicines every morning for many years, and they keep my pressure under control. Recently, my doctor recommended taking them at bedtime, instead. Does that make sense?

A. It actually does make sense — based on recent research. For many years, there have been at least three theoretical reasons for taking blood pressure medicines before bedtime. First, a body system that strongly affects blood pressure, called the renin-angiotensin system, has its peak activity during sleep. Second, circadian rhythms cause differences in the body chemistry at night compared with daytime. Third, most heart attacks occur in the morning, before medicines taken in the morning have a chance to "kick in."

Research we're watching

A long work week may raise your blood pressure, according to a study published online Dec. 19, 2019, by Hypertension. Researchers found that among more than 3,500 Canadian workers, those who worked 49 hours a week or more were more likely to have high blood pressure than workers who were on the job fewer than 35 hours a week. Blood pressure was measured at the start and end of the five-year study as well as once midway through. Readings were taken by both a trained technician and a wearable monitoring device. Even after adjusting for other factors, the 49-hour-plus workers were 70% more likely to have a type of high blood pressure called masked hypertension (normal blood pressure readings at doctor visits but high outside of that setting) and 66% more likely to have sustained hypertension (defined as consistently high blood pressure readings both in and outside of the doctor's office). People who worked 41 to 48 hours a week also had higher blood pressure than those who worked fewer than 35 hours a week.

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Chronic stress is associated with an increased risk of heart disease, heart attacks, and strokes. These strategies can help you manage it.

People often complain about stress, but it's actually a natural reaction with an essential purpose.

When the body senses danger, it starts its fight-or-flight response. Your nervous system releases hormones like adrenaline and cortisol, which jolt the body into a protective mode. Your heart pounds faster, muscles tighten, blood pressure rises, breathing quickens, and your senses sharpen.

In the journals

People with high blood pressure may benefit from taking their antihypertension medication at bedtime instead of the morning, according to a study published online Oct. 22, 2019, by the European Heart Journal.

The researchers looked at about 19,000 people (most of them men) who took blood pressure medication. Participants took their daily dose either upon waking or before going to bed. Everyone's blood pressure was checked over 48 hours once a year for six years.

Ask the doctors

Q. I have a very stressful job, and recently my blood pressure readings started going up. Could my job stress be the reason why?

A. Yes, chronic stress can affect blood pressure. Several hormones affect your heart's rhythm, including epinephrine and norepinephrine. When these hormone levels rise, your heart starts to work harder. Stress hormones can also constrict your blood vessels, causing temporary blood pressure spikes.

Taking these medications at bedtime rather than in the morning may make them more effective.

Many people take their medications as part of their morning ritual, along with a cup of coffee and the daily newspaper. But for blood pressure drugs, evening may be a better option. Last year, a large study found that taking blood pressure drugs before bed may lower the risk of serious heart-related complications more than taking the drugs in the morning (see "Benefits of bedtime blood pressure dosing").

The concept of chronotherapy, or adjusting medication dosing to a specific time of day, isn't new. There's not a great deal of evidence to support the practice with cardiovascular drugs, but it makes sense, says Dr. Naomi Fisher, director of the Hypertension Specialty Clinic at Harvard-affiliated Brigham and Women's Hospital.

Several new technologies and medications that may benefit the heart are moving into cardiology care.

As regular readers of the Heart Letter know, our features tend to focus on lifestyle advice and currently available therapies for heart disease. As the new decade begins, we're also looking to the future. Editor in Chief Dr. Deepak L. Bhatt selected five promising new developments in cardiovascular research that you may be hearing more about in the coming years.

1. Digital stethoscopes

First developed more than 200 years ago, the instrument doctors use to listen to the heart and lungs has undergone some high-tech improvements in recent years. The latest digital stethoscopes feature specialized microphones and sensors that filter, buffer, and amplify sounds from the heart. The sounds are then converted to a digital signal and sent wirelessly to a smartphone, where the patterns can be visualized and further analyzed. Some models are so sensitive they can detect turbulent blood flow in the arteries of the heart, possibly enabling doctors to detect coronary artery disease. Studies assessing that potential use are currently under way.

Research we're watching

Treating high blood pressure may do more than prevent heart attacks and strokes. In older adults, intensive blood pressure lowering may also conserve brain function, according to a new study.

Published online Oct. 14, 2019, by the journal Circulation, the study included 199 adults ages 75 and older, all with a systolic blood pressure value (the first number in a reading) of 150 or higher. Their brain scans also showed lesions in the brain's white matter, which contains nerve fibers that send signals from one part of the brain to another. The lesions, which reflect damaged small blood vessels, have been linked to a propensity for thinking and memory problems. About two-thirds of people over age 75 have white matter lesions, as do most people over age 90.