Controlling Your Blood Pressure Archive

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.

What is the test?

People who have leg pain when exercising may need an evaluation to make sure they have normal blood flow through their leg arteries. Normally blood pressure is similar whether it is measured in the legs or in the arms. If blood pressure is lower in the legs, it usually means that cholesterol buildup inside the leg arteries is interfering with circulation. By taking accurate blood pressure measurements at different locations along your legs, your doctors can determine if you have any arterial narrowing and, if so, where.

In order to get accurate blood pressure measurements, your doctor uses a technique called Doppler ultrasound. Doppler ultrasound is a painless way to detect blood flowing through a small artery. It uses sound waves and a type of sonar detection system to make noise when blood flow is detected. For arterial studies of the legs (called segmental Doppler pressures), Doppler ultrasound is used in place of the stethoscope that doctors usually use when taking blood pressures.

In the journals

Need another reason to get your annual flu shot? It could protect you from a fatal heart attack or stroke if you suffer from high blood pressure, according to research presented at a 2019 joint conference of the European Society of Cardiology Congress and the World Congress of Cardiology.

Previous research has found that the inflammation from a flu infection can trigger a heart attack or stroke, and people with high blood pressure are especially at high risk.

Simple breathing techniques may help you to better manage heart-related issues.

Maybe you're already in the habit of taking a deep breath to calm down when you're feeling fed up or frustrated. But a regular practice of focused breathing might offer even bigger rewards.

"Stress directly affects blood flow to the heart muscle, and any technique people can use to lower stress will benefit the heart," says Dr. Kimberly Parks, a cardiologist at Harvard-affiliated Massachusetts General Hospital. Some people turn to yoga, tai chi, or meditation for stress relief. But others aren't interested in trying those techniques. For them, a simple breathing practice may be more appealing, in part because it's easy, it's free, it takes just a few minutes, and it can be done anywhere at any time.

Known as bradycardia, this heart rhythm disorder can cause fatigue, dizziness, and fainting.

The steady beat of your heart depends on a crescent-shaped cluster of cells in the upper right portion of your heart. Called the sinoatrial or sinus node, it emits a tiny jolt of electrical current that triggers the heart to contract and pump blood throughout the body (see illustration). Because the sinus node determines the heart's pace and rhythm, it is sometimes called the body's natural pacemaker.

Just as your skin, joints, and other parts of your body reveal signs of normal wear and tear as you age, so too can the structures inside your heart. "This age-related degeneration can affect the sinoatrial node and other parts of the heart's conduction system," says Dr. Peter Zimetbaum, director of clinical cardiology at Harvard-affiliated Beth Israel Deaconess Medical Center.

Research we're watching

With some smartphones, you can unlock the phone simply by showing your face. One day, a short video of your face may do far more — maybe even measure your blood pressure.

That's the premise of a novel smartphone-based technology described in the August issue of Circulation: Cardiovascular Imaging. For the study, researchers took two-minute videos of 1,328 Chinese and Canadian adults, using an iPhone equipped with transdermal optical imaging. The software measures blood pressure by detecting blood flow changes in a person's face. When compared with readings taken using a traditional blood pressure cuff, the video blood pressure readings were about 95% accurate.

Your blood pressure is one of the best ways to measure overall health and possible risk factors. Do you know your numbers?

There are many important health markers: cholesterol levels, blood sugar levels, weight — to name but a few. But men often fail to use one of the most important: blood pressure.

"Your blood pressure is one of the easiest and simplest measurements and can tell you so much about your current and possible future health," says Dr. Randall Zusman, director of the division of hypertension for Harvard-affiliated Massachusetts General Hospital's Corrigan Minehan Heart Center. "Yet most people don't know their number or check it on a regular basis, so they may not be doing everything they need to lower their risk of a heart attack or stroke."