Controlling Your Blood Pressure Archive

If your blood pressure is high, taking blood pressure medicines can lessen your odds of having a heart attack or stroke. Yet new research suggests they might also increase your risk of falling and fracturing a hip or getting a head injury. The study included nearly 5,000 people over age 70 with high blood pressure.

During the three-year follow-up period, 9% of the participants had a fall. People who were on moderate-intensity blood pressure drugs were more likely to get a fall injury than those who weren't on the medicines, according to the study, which was published Feb. 24, 2014, in JAMA Internal Medicine. The risk increased regardless of the type of blood pressure drug people took. And those who had fallen before and hurt themselves were more likely to fall again. The authors said blood pressure medicines can cause side effects such as dizziness and balance problems, but it's hard to determine from the study whether it's the medicines—or the high blood pressure itself—contributing to the falls. If you're taking a blood pressure drug, talk to your doctor about fall prevention, but don't just drop these important medicines, because their benefits for reducing heart risks often outweigh their risk for falls.

Q. Is it true that snoring raises your blood pressure? I'm a snorer, and I worry that it puts me at risk for other conditions.

A. Severe snoring can be a sign of obstructive sleep apnea (OSA). If you have OSA, then your breathing is blocked temporarily many times per night. That causes oxygen levels in your lungs and blood to start falling. Your brain sees this happening and sends adrenaline into your bloodstream. This stimulates the breathing center in your brain. It also makes your heart beat faster and raises your blood pressure. Fortunately, treatment for OSA can lower blood pressure.

All medicines are associated with both benefits and risks. A new study finds that all medications to treat high blood pressure in older adults seem to be associated with an increased risk of serious falls. Researchers published their findings in the Feb. 24, 2014, JAMA Internal Medicine. They found that exposure to moderate or high doses of any medication to treat high blood pressure was associated with a 30% to 40% increased risk of falls with serious injury, compared with no use of the medications. That sounds like a large risk, but over three years, these were the risks of serious falls: 9.0% in those not taking blood pressure medicine, 11.6% in those taking moderate doses, and 10.9% in those taking higher doses. The association was stronger in people who had fallen and suffered an injury in the past. But there were no clear differences in injury risk between the drug classes, including diuretics, angiotensin-receptor blockers, beta blockers, ACE inhibitors, and calcium-channel blockers.

"These drugs do, after all, lower blood pressure, which could cause people to be lightheaded and even faint when suddenly standing after sitting. There is no question that treating blood pressure leads to reductions in the risk for stroke and heart disease, so if you feel lightheaded when standing, don't stop your medications. But tell your doctor about it, and exercise caution when standing up suddenly," says Dr. Thomas Lee, a cardiologist and internist at Harvard-affiliated Brigham and Women's Hospital.

People who follow a vegetarian diet tend to have lower blood pressure than their meat-eating counterparts, according to a study in JAMA Internal Medicine. Vegetarians avoid meat and eat mainly plant-based foods like vegetables, fruits, grains, and legumes (beans and peas). Some include dairy products and eggs (and in this study, fish) in their diets.

The study included 32 observational studies of people who chose their own diets. Compared with meat-eating omnivores, the vegetarians had systolic blood pressure about 7 mm Hg lower, on average, and diastolic blood pressure about 5 mm Hg lower. The researchers also pooled findings from seven clinical trials in which participants were assigned different diets. Those who followed vegetarian diets also had lower blood pressure on average than people who ate different diets.

Q. I check my blood pressure at home regularly. My readings are all over the place and different from the reading at my most recent doctor visit. Why is my blood pressure so erratic?

A. There can be many reasons for erratic blood pressure readings. For one thing, blood pressure naturally fluctuates over the course of a day. It is generally lowest when you're sleeping and peaks during the day. If you check your blood pressure at different times, you may be seeing that natural variation. Blood pressure is also affected by physical activity, eating, caffeine, and stress.

A recent study in PLoS Medicine found that measuring blood pressure at home identifies people potentially at risk of heart problems, despite having pressures that were lower or even normal when measured in the doctor's office. This "masked hypertension" may affect 10% of people, preventing doctors from spotting those who might benefit from lifestyle change or medication.

In the study, masked hypertension was defined as blood pressure readings over 135/85 when measured outside the doctor's office. Technically, 135/85 is considered "pre-hypertension." The generally accepted trigger point for needing blood pressure medication is 140/90.

Some evidence suggests calcium-channel blockers have an association with breast cancer and kidney problems.

The lower-is-better rule doesn't just apply to cholesterol.

Once upon a time, in a land not far away at all, a healthy blood pressure was thought to be 100 plus your age. That simple rule of thumb has gone the way of hats for men, cordiality in politics, and affordable health insurance. It was replaced in 1977 by a cutoff of 160/95 separating "normal" from high blood pressure. That cutoff continues to drift downward, steadily eroding what we think of as normal or healthy blood pressure.

Q. I'm a cancer survivor and take a calcium-channel blocker for high blood pressure. I recently read that these medications can cause cancer. But it's the only drug that's worked well for me. Should I stop taking it?

A. No. It's true that a large study found that women who took calcium-channel blockers (CCBs) for 10 years or longer had more than double the odds of having certain forms of breast cancer, including the most common type, invasive ductal breast cancer. Common examples of CCBs include amlodipine (Norvasc), felodipine (Plendil), nifedipine (Adalat), and diltiazem (Cardizem). But the findings don't prove the medication caused the cancers.