Controlling Your Blood Pressure Archive

News briefs

Here's more incentive to keep your blood pressure under control: a large study published online Dec. 14, 2020, by the journal Hypertension suggests that high blood pressure hastens decline in cognitive abilities (thinking skills). Researchers analyzed two health assessments, taken about four years apart, of more than 7,000 middle-aged and older people in Brazil. The assessments noted changes in a number of cognitive skills, such as memory, language, and concentration. Regardless of age, people with high blood pressure had faster declines in cognitive performance, compared with people who had normal blood pressure. The researchers classified blood pressure as high if the top number was 130 or higher and the bottom number was 80 or higher. But even people with a top number between 120 and 130 experienced faster cognitive decline than people with normal blood pressure. The silver lining: the researchers found that treating high blood pressure at any age appeared to reduce or prevent accelerated cognitive decline. High blood pressure can be controlled with medications as well as pill-free approaches, such as losing weight, exercising, eating a heart-healthy diet, reducing alcohol intake, managing stress, and quitting smoking.

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Cardiovascular problems can conspire to put a damper on sexual enjoyment. Talking to your doctor and your partner can help.

A physical connection with your romantic partner is often an important part of a fulfilling relationship. But when it comes to matters of the heart, the health of your heart matters.

"A satisfying sex life depends on physical health, psychological well-being, and the quality of the relationship," says Dr. Jan Shifren, who directs the Massachusetts General Hospital Midlife Women's Health Center. Heart disease and related conditions can influence all three of those factors in both men and women. Here's a look at the range of those effects and some possible solutions.

In the journals

Do you know if you have hypertension (high blood pressure)? And if you do, are you treating it effectively? Study findings published online Sept. 9, 2020, by JAMA found that people's awareness and control of their high blood pressure have both dropped in recent years, especially among older adults.

The study pulled data from the National Health and Nutrition Examination Survey. It found that the number of people who knew they had hypertension fell 8% from 2013 to 2018. Among those who were aware of their condition, more than half did not manage it adequately. In particular, adults ages 60 and older were less likely to control their high blood pressure than younger people. Lack of engagement could be a factor. Researchers noted that among people who hadn't been to their doctor in the past year, fewer than 10% had controlled their blood pressure.

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.

Q. When doctors interpret a blood pressure reading, should they also consider the heart rate? I am a 78-year-old man and have had high blood pressure (under control) for more than 40 years. I frequently monitor my blood pressure at home, resting for five minutes before I take the reading. My blood pressure is often higher when my heart rate is close to its usual resting rate (about 50 beats per minute) and lower when my heart is beating faster than that. Can the body's demands that cause higher blood pressure be partially satisfied by a faster heart rate?

A. First, let me congratulate you on monitoring your blood pressure at home. This is a great way for you to take control of your high blood pressure, and a good step toward preventing a stroke. Knowing that your blood pressure at home is under consistent control is more important than getting isolated readings at the doctor's office. You are also resting before taking the reading, and this is important to avoid spuriously high readings that happen when someone rushes around, and then sits down quickly to take a blood pressure reading. (Readers interested in monitoring their blood pressure at home can watch a video of how this is done at www.health.harvard.edu/128.)

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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Bananas are one of the most popular fruits in the United States, perhaps because they're affordable (about 58 cents per pound, on average) and available year-round.

Among all fruits, bananas are one of best sources of potassium, with about 450 milligrams (mg) per banana. Healthy adults not on certain medications should aim for 4,700 mg of potassium daily, although few Americans meet this goal. A high potassium intake may help reduce high blood pressure and has also been linked to a lower risk of stroke and possibly heart disease.

Research we're watching

Couples who live together tend to have similar health habits. But only about one in five couples falls into the "ideal" category for heart-healthy habits and risk factors, suggests a study in the Oct. 26, 2020, issue of JAMA Network Open.

Researchers looked at health data on 5,365 couples from diverse racial and economic backgrounds throughout the United States. Most were in their 40s and 50s. Based on risk factors from the American Heart Association's Life's Simple 7 (smoking status, body mass index, exercise, diet, total cholesterol, blood pressure, and fasting blood sugar), researchers categorized individuals and couples as poor, intermediate, or ideal for each factor and over all.

Your partner's flawed health behaviors may be harming your heart.

It's been said that the longer couples stay together the more they look alike. As it turns out, the resemblance may be more than skin-deep. A study published online Oct. 26, 2020, by JAMA Network Open found that couples' health behavior and heart disease risk factors also look alike — for better or worse.

"We know, even from personal experience, that couples share similar behaviors that can affect health, but it was surprising to find the high levels of shared unhealthy behaviors within couples," says the study's lead author, Dov Shiffman, a senior scientific fellow at the medical testing company Quest Diagnostics.

New findings challenge the widespread belief that aggressive blood pressure treatment may trigger a condition linked to fainting and falls.

When doctors treat older people with high blood pressure, they often worry about a condition that causes blood pressure to plummet when a person stands up from a seated or lying position. Known as orthostatic hypotension (hypotension means low blood pressure), it affects as many as one in five people ages 65 and older.

Because orthostatic hypotension can make you feel dizzy or lightheaded after standing, it may lead to fainting and falls — with possibly serious repercussions. This concern leads some doctors to ease up on prescribed blood pressure medications. But a new study suggests that practice actually might do more harm than good.