Blood Pressure Archive

High blood pressure can damage the brain in several ways. Treating this common problem can protect your mind as well as your heart.

High blood pressure seldom causes any symptoms. But over time, the excessive force and friction of blood pushing against the inner walls of the arteries can damage blood vessels throughout the body. And while the biggest threat may be to your heart, your brain can also suffer.

Even slightly elevated blood pressure in middle age has been linked to a 30% higher risk of dementia two decades later. But taking blood pressure drugs may help people avoid that risk, according to a study in the May 19, 2020, issue of JAMA.

Researchers are beginning to better understand if, when, and how to address this condition, which is linked to a newly recognized type of stroke.

In the womb, all fetuses have a foramen ovale (Latin for "oval hole") between the heart's right and left upper chambers (atria). This opening allows blood to take a shortcut within the heart rather than following a longer path through the lungs, which cannot work until they are exposed to air. After birth, when a newborn baby takes his or her first breath, the foramen ovale begins to close. Most of the time, it seals completely within a few months.

But in about a quarter of people, that doesn't happen. This anatomical variation is called a patent foramen ovale (patent means open) or PFO. Most people never know they have it, because a PFO doesn't cause any signs or symptoms. For the most part, the condition is harmless.

Studies of drugs, diets, and devices all come with their own unique set of challenges.

The best way to know if a new medical treatment truly works is with a randomized controlled trial — the "gold standard" of research studies, also known simply as a clinical trial. Volunteers are randomly assigned to receive either the new treatment or the comparison, which may be a placebo (an inactive therapy) or a treatment that's already available.

As the nation's top cause of death, cardiovascular disease has been at the leading edge of evidence generation, says Dr. Robert Yeh, director of the Smith Center for Outcomes Research in Cardiology at Harvard-affiliated Beth Israel Deaconess Medical Center. "We probably have more evidence for cardiovascular treatments than for any other field of medicine," he says. Among the studies with the greatest impact were the clinical trials that heralded new therapies to treat heart attacks. These include clot-dissolving drugs in the 1980s, followed in the 1990s by artery-opening angioplasty procedures, which remain the standard of care today. Stents, the tiny mesh tubes used in these procedures, have also been extensively studied in clinical trials (see "Testing devices: Different dilemmas").

Ask the doctors

Q. I read that taking a hot bath might have cardiovascular benefits. Is this true?

A. It's possible. Past research has found that your body experiences some of the same changes during a warm bath as it does during exercise, including better blood flow, a higher heart rate, and stronger heart contractions. And now, a study published online March 24, 2020, by the journal Heart has shown that middle-aged people in Japan who took a daily bath in either warm or hot water had a 28% lower risk of heart and blood vessel disease than people who didn't bathe in the tub more than twice a week. The daily bathers also had a 26% lower risk of stroke than those who tub bathed less frequently. The study authors analyzed questionnaires filled out by some 30,000 people and then followed them for 20 years. However, note that this study was observational and relied on people to report their bathing activity accurately. It also isn't clear if bathing was the only factor associated with the reduction in cardiovascular problems.

Sesame seeds may be most familiar as a topping on bagels, burger buns, and breadsticks. The tiny, tear-shaped seeds have a nutty, slightly sweet flavor that's enhanced when they're baked or lightly toasted in a skillet. Most are off-white or tan, but you can also find black varieties, which are popular in Asian cuisine.

Sesame seeds contain lignans and phytosterols, plant compounds that may have cholesterol-lowering effects. They're also a decent source of calcium and magnesium, two minerals linked to better blood pressure control.

Research we're watching

Frail, older people with health problems may live longer if they take the blood pressure medications their doctors prescribe, according to a study published in the August 2020 issue of the journal Hypertension.

Previous research suggests that in general, older people benefit from blood pressure drugs. But trials usually don't include people with multiple medical conditions, because those health problems make longevity findings challenging to interpret.

Research we're watching

Ticagrelor (Brilinta), a drug that helps prevent blood clots, was approved in 2011 for treating people who had experienced a heart attack or acute coronary syndrome (a sudden loss of blood flow to the heart). Now, the drug can be prescribed to a broader group of people. In June 2020, the FDA expanded ticagrelor's approval to reduce the likelihood of first heart attack or stroke among high-risk people with coronary artery disease.

The expansion is based on results from a multiyear study of more than 19,000 people with coronary artery disease and diabetes at high risk for a heart attack. Participants who took aspirin plus ticagrelor were less likely to experience a heart attack, stroke, or death from heart disease compared with those who took aspirin alone.

Research we're watching

People with chronic pain may be more likely to have a heart attack or stroke than those without chronic pain, according to a study published online May 7, 2020, by the journal Pain Medicine.

From 2001 to 2005, researchers identified 17,614 Taiwanese people who had used pain relievers for at least three months. The most common causes of pain were spinal disorders, arthritis, and headaches; the pain relievers included both over-the-counter drugs and prescription opioids. For the comparison group, researchers used 35,228 people without chronic pain who were matched by age and sex to those in the first group.