Blood Pressure Archive

Ask the doctor

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Q. I have high blood pressure and have been checking my blood pressure more often since my doctor added another drug. But lately, my readings have been all over the place. For example, one morning it was 127/70, but then it was 170/100 in the late afternoon. What's going on?

A. You may have a condition known as labile hypertension, which refers to blood pressure that fluctuates far more than usual. Everyone's blood pressure rises and falls many times during the course of a single day, sometimes even within minutes. Many factors contribute to these changes, including physical activity, emotion, body position, diet (especially salt and alcohol intake), and sleep deprivation. However, there is no clear definition or standard criteria to distinguish between normal and abnormal fluctuations.

Some simple steps can help minimize or avoid muscle problems from Crestor and other cholesterol-lowering drugs.

All drugs have side effects. The trick is to weigh the potential for serious side effects against the gain you can get from the medication. The balance sheet for Crestor and other statins looks like this: These drugs cut the risk of heart attack, angina (chest pain), stroke, and death from cardiovascular disease by 30%. They cause muscle pain in under 5% of the people who take them, and these pains often stop by themselves even with continued statin use. The chance of rhabdomyolysis, a potentially deadly breakdown of muscle tissue, is less than one per million statin prescriptions.

When doctors interpret a blood pressure reading, should they also consider the heart rate? My pressure is often higher when my heart rate is close to its usual resting rate and lower when my heart is beating faster than that.

In the 1950s, doctors offered mainly morphine and bed rest — a far cry from the many procedures and medications provided today.

During a round of golf one autumn afternoon in 1955, President Dwight Eisenhower experienced what he assumed was indigestion. After he awoke at 2 a.m. the following morning with severe chest pain, his personal physician administered several shots of morphine. It wasn't until 1 p.m. that afternoon that an electrocardiogram revealed that the president had experienced a heart attack.

Cardiologist Dr. Thomas Lee, professor of medicine at Harvard Medical School, detailed Eisenhower's experience in the Oct. 29, 2020, issue of The New England Journal of Medicine. His piece focuses mainly on how Eisenhower's cardiologist, Paul Dudley White, communicated the event to the public. As Dr. Lee wrote, "Heart attacks became less mysterious and frightening to millions of Americans that day."

Ask the doctor

Q. In last month's Heart Letter, you described some of the ways your heart rate reflects your health. But I've also heard about another measurement, called heart rate variability. Can you explain what that's all about?

A. Heart rate variability (HRV) is a sophisticated measurement of the variation in time between each heartbeat. We know that a heart rate that's too slow, too fast, or irregular can signal a problem, so it's only natural to think that a steady, regular pulse is a sign of a healthy heart. And you might also assume that having little or no difference in the time between each beat (that is, a low HRV) is best.

Listening to music may offer a range of benefits for cardiovascular health.

Music's capacity to evoke emotion is one reason people love listening to it so much. Whether you want to feel energized and uplifted or calm and relaxed, you can probably conjure a few examples of melodies that put you in your desired frame of mind. As it turns out, those mood-related benefits may extend to your heart.

"The beating of your heart and your fight-or-flight system are regulated by your brain. Once you understand that, it makes sense that listening to music that evokes a certain mood might affect the heart's function," says Dr. Andrew Budson, a lecturer in neurology at Harvard Medical School and chief of cognitive and behavioral neurology at the VA Boston Healthcare System.

News briefs

A Mediterranean-style diet is rich in vegetables, legumes, fruits, whole grains, nuts, seeds, poultry, fish, and olive oil, and it's associated with lower risks for heart disease and diabetes. And a "greener" version of the eating style might be even more effective, according to a small, randomized study published online Nov. 23, 2020, by the journal Heart. Researchers — some from Harvard — recruited about 300 sedentary, middle-aged people (mostly men) with high cholesterol or abdominal obesity and divided them into three groups. One received guidance for exercise and a healthy diet; another received exercise guidance and was assigned to eat a calorie-restricted Mediterranean diet; and one group received exercise guidance and was assigned to eat a "greener" calorie-restricted Mediterranean diet with less animal-based and more plant-based proteins (including walnuts and a type of duckweed — an aquatic plant), plus lots of green tea. After six months, people on the "green" diet had lost more weight and inches around their middles, and had bigger drops in cholesterol, than people in the other two groups. "Green" dieters also had steeper declines in insulin resistance, inflammation markers, and diastolic blood pressure (the lower number in the measurement), compared with the other two groups.

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People who practice this mind-calming technique may be less likely to have risk factors linked to heart disease.

Millions of Americans are using modern technology — via apps on their smartphones — to practice meditation, an ancient tradition that helps promote a sense of calm and relaxation. Last year's deluge of stress-inducing news was a boon for the meditation app business, which has evolved into a billion-dollar industry.

Growing evidence suggests that meditation may also improve factors linked to cardiovascular health. The latest comes from a Sept. 15, 2020, article in the American Journal of Cardiology. Researchers studied more than 61,000 people who took part in the two most recent National Health Interview Surveys (done in 2012 and 2017). Nearly 10% of the participants said they practiced some form of meditation. After adjusting for age, sex, sleep, depression, and other possible confounding factors, researchers found people who meditated had a lower prevalence of high cholesterol, diabetes, high blood pressure, stroke, and coronary artery disease compared with people who didn't meditate.