Controlling Your Blood Pressure Archive

A new study suggests greater health benefits with a lower-than-standard number.

Blood pressure has long been one of the best markers of your health. It is a number you can remember and monitor. High blood pressure (hypertension) is linked to a greater risk of heart attacks and strokes.

About one out of three adults has high blood pressure, which is usually defined as a reading of 140/90 millimeters of mercury (mm Hg) or higher.

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Ask the doctor

Q. I know that sometimes people have high blood pressure only at the doctor's office but normal blood pressure at home. But can the opposite also happen?

A. Yes. This phenomenon—when your blood pressure reading is normal at the doctor's office but high at home—is known as masked hypertension. It's hard to know just how common it is, since doctors don't routinely tell people to measure their blood pressure at home if it's normal in the doctor's office or clinic. The only reason we know it exists is from clinical studies that required people to undergo ambulatory blood pressure monitoring. For this type of monitoring, you wear a portable blood pressure cuff and monitor for 24 hours. The machine records your blood pressure every 20 minutes while you're awake and hourly while you're asleep. In these studies, anywhere from 10% to 40% of the participants were found to have masked hypertension, depending on the exact population evaluated.

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You get the most bang for your buck from keeping blood pressure in the normal range, but don't skip the other things.

Many tasks are required to run a household. There are groceries to shop for, broken things to fix, and windows to wash. But you need to prioritize: it makes no sense to worry about the weeds in the garden if the mortgage payment is overdue.

Ask the doctor

Q. I take my blood pressure medication twice a day. Or at least I am supposed to, but I sometimes forget the second dose because my evenings tend to be really busy. What can I do?

A. One idea is to leave a sticky note on your bathroom mirror or near your bed as a reminder. Or try using an alarm (either a traditional alarm clock or one on a smartphone) that rings close to the time when you normally go to bed. You might also consider taking the second dose with dinner, assuming your doctor or pharmacist says it is okay to take your particular medicine with food.

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Research we're watching

Drinking as little as one sugar-sweetened beverage a day is linked to a slightly greater risk of high blood pressure, a new analysis suggests.

Researchers pooled findings from six studies that included a total of more than 240,000 people. They found a 12% higher risk of high blood pressure among people who drank one or more sugary drinks daily compared with those who drank none. Serving sizes of the beverages varied from 7 to 12 ounces among the different studies.

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News briefs

Initial results of a large national clinical trial suggest that being more aggressive in treating high blood pressure may save lives. Results of the Systolic Blood Pressure Intervention Trial (SPRINT) aren't yet published, so we don't know all of the details. But from information released by the National Institutes of Health (NIH) in September, it appears that aiming for a systolic (top) blood pressure reading of less than 120 mm Hg may reduce the risk of heart attacks, strokes, and heart failure by almost a third, and reduce the overall death rate by 25%. Researchers came to this conclusion after following more than 9,000 middle-aged and older adults with high blood pressure for several years. Half of the participants took an average of two medications and set a target systolic blood pressure of less than 140 mm Hg, the current recommended number. The other half took an average of three medications and aimed for a systolic blood pressure of less than 120 mm Hg. The results in the lower-target group were so impressive that NIH stopped the study early to share the news. Does this mean you should add more pills to your blood pressure treatment? "Not necessarily, because there may be more drug side effects. But if you're aiming for a lower number, I think it will be critical to rely on lifestyle modification, such as stress reduction, diet, salt restriction, and exercise, in addition to medication to lower blood pressure," says Dr. Randall Zusman, a cardiologist and Harvard Medical School associate professor.

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If you're concerned about heart disease, discuss your blood pressure target with your doctor.

Earlier this fall, federal officials stopped a major blood pressure study a full year earlier than planned, based on what they called "potentially lifesaving benefits" from the findings. The preliminary results suggest that in people with high blood pressure, achieving a systolic blood pressure (the first number in a reading) of 120 millimeters of mercury (mm Hg) in-stead of 140 mm Hg can substantially lower a person's risk of heart attack, stroke, heart failure, and death.

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Research we're watching

People who sleep too much or too little may be more likely to have early signs of heart disease, according to a study of more than 47,000 apparently healthy young and middle-aged adults.

The study volunteers filled out sleep questionnaires and underwent tests to assess the arteries in their hearts and legs. Researchers found that people who slept for nine or more hours per night had more calcium buildup in their heart artery walls and stiffer leg arteries than those who slept seven hours per night. These early signs of heart disease were also more prevalent in people who logged five or fewer hours of sleep per night and in people who reported poor sleep quality.

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A landmark study indicates that lowering the top number to 120 mm Hg can reduce the risk of cardiovascular problems and death.

Medical practice usually evolves fairly slowly. Experts meet every five to 10 years to review study findings and make recommendations. But occasionally the results of a single study are so decisive that it is brought to a halt early, the results are announced, and doctors change their advice to patients based on the findings. For example, in 2002 the Women's Health Initiative was stopped three years early when postmenopausal women taking estrogen and progestin were found to be at higher risk of heart disease, stroke, and breast cancer than those who weren't on the hormones. The use of postmenopausal hormone therapy fell 70% in the next few years.

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