Diseases & Conditions Archive

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."

Ask the doctors

Q. I recently started experiencing a lot of pain in my hand from osteoarthritis. Can I reverse this condition?

A. You can't reverse osteoarthritis, but there are things you can do to manage your pain and improve your symptoms. Osteoarthritis occurs when the protective cartilage that acts as cushioning between your bones starts to fray and wear down over time. Eventually this enables the bones to rub together, which causes the pain you are experiencing as well as swelling and stiffness that makes it difficult to move your hand freely. Typically, when you have arthritis, the pain and symptoms will be worse at some times than at others. You may experience a flare-up one day and feel better the next. To help reduce the discomfort of a flare-up, talk to your doctor about medication to relieve pain. She or he may recommend an over-the-counter pain reliever. Some people also get symptom relief using a topical pain reliever that is rubbed into the skin. Other strategies that can ease pain are splints or braces, heat or cold therapy, activity modification, and exercises or physical therapy to increase flexibility and strengthen your hand muscles.

In the journals

People who quit smoking decades ago are still at risk for lung diseases like chronic obstructive pulmonary disease (COPD), according to a study published online Oct. 9, 2019, by The Lancet Respiratory Medicine.

Researchers looked at lung capacity — the amount of air in your lungs after taking a deep breath — among more than 25,000 people and analyzed the results based on whether the individuals smoked, had quit smoking, or had never smoked. Previous research has suggested that the decline in lung capacity that occurs with smoking levels off within a few years after people quit.

Infections aren't the only conditions that can cause discomfort.

Certain urinary symptoms are quite common, particularly in women: painful burning with urination, an urgent need to urinate like you can't hold it (urinary urgency), and urinating frequently (urinary frequency).

These symptoms can be caused by any of the following conditions.

News briefs

A research team from Harvard reports that it has harnessed the powerful gene editing tool called CRISPR to recognize and kill viruses. The findings were published online Oct. 2, 2019, by Molecular Cell. CRISPR can alter strands of both DNA and RNA (a molecule related to DNA), which are built like strings of beads. Each bead consists of one of four chemicals called bases. CRISPR can recognize a specific sequence of bases (such as one that is characteristic of a particular virus), latch on to that sequence and cut it, and change the sequence to a different one. This can scramble the genetic sequence of a virus in such a way that the virus no longer can make copies of itself. The Harvard team used this technique to kill several viruses that are made of RNA — including influenza virus — in a laboratory dish. The next step will be to see if the CRISPR technique can also be used to kill viruses in a living animal. That will be much harder. However, if it works, the technique might someday help humans fight viral infections.

Image: © Bill Oxford/Getty Images

Research we're watching

If you suffer from migraine headaches, there's a new option available to relieve your pain. In October 2019, the FDA approved lasmiditan (Reyvow) to treat migraine pain in adults. Taken as a pill, it works for migraines either with or without an aura (a visual disturbance within the hour before migraine pain starts). Lasmiditan is not designed to prevent migraines. Lasmiditan is the first migraine treatment in a class of drugs known as serotonin (5-HT) 1F receptor agonists. In studies, researchers found that it could relieve pain and other migraine symptoms within two hours.

Migraines affect an estimated 28 million women in the United States, according to the American Migraine Foundation, and the World Health Organization ranks them among the top 10 disabling conditions. Pain and other symptoms, which may include nausea, sensitivity to light and temporary vision changes, result in lost work days, reduced productivity, and diminished quality of life for many people.

In the journals

Over-the-counter pain medicines that contain caffeine can be effective at stopping some headaches. But drinking a large amount of caffeinated beverages might actually trigger a headache for some people with migraines, according to a study published in the August 2019 issue of The American Journal of Medicine.

Researchers recruited almost 100 people with migraines who suffered from fewer than 15 headaches per month. For six weeks, they recorded the timing and characteristics of each migraine and their intake of caffeinated beverages.

Eosinophilic esophagitis is an allergic inflammation of the esophagus that most typically develops as an allergic response to certain foods. The exact cause is unclear, but if left untreated it can lead to permanent scarring or narrowing of the esophagus.

Although hard-to-read heart attacks happen to both men and women, they are more common in women. One reason for this is that men's symptoms initially set the standard for recognizing heart trouble. Now a growing body of research shows that women can experience heart attacks differently than men.

Understanding sex differences in heart disease is important. Heart disease is the leading cause of death for women. Although it mostly affects older women, it isn't rare in younger women. One in 10 of all women who die from heart disease or a stroke are under age 65, and this age group accounts for one-third of heart- or stroke-related hospitalizations. Even so, younger women and their doctors don't necessarily suspect a heart attack even when all the signs are there.

Take the lowest dose of NSAIDs and stop using them as soon as possible.

Blood thinners are usually given to people at risk for developing blood clots from conditions, such as abnormal heart rhythms. Use of these lifesaving medications requires caution with other drugs, especially painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) or naproxen (Aleve). But plenty of people take the risk to relieve aches and pains. "Many of the patients who need blood thinners are older and therefore at risk for arthritis, so it's not infrequent for a patient to be on both a blood thinner and an NSAID," says cardiologist Dr. Deepak L. Bhatt, a Harvard Medical School professor.