Last month I gave you the opportunity to submit the questions you'd like answered by hypertension expert Dr. Mark Houston. Many of you took advantage of the opportunity and asked a question - thank you! You'll be very pleased with the results of this interview and the answers Dr. Houston provided.
Lisa Nelson RD: It is typically recommended that cholesterol medications be taken prior to bed. Would you explain the reason why? Also, is there a best time of day to take blood pressure medication?
Dr. Houston: Statins work best at night to inhibit an enzyme in the liver when cholesterol production is the highest. Blood pressure medications are best taken at night to reduce the early morning increase in blood pressure which is highest between 3 AM and 10AM.
Lisa Nelson RD: If you discontinue a blood pressure medication how long does it stay in your system?
Dr. Houston: It depends on the duration of action of the medication. Some of the longer acting medications may last for 24 to 72 hours. However most are gone in 24 hours or less. Never stop any blood pressure medication abruptly especially beta blockers and clonidine, as withdrawal may occur with rapid increases in blood pressure, heart rate, headache, chest pain, palpitations and even heart attack or stroke.
Lisa Nelson RD: When someone has uncontrolled systolic blood pressure (diastolic tends to be within normal) what are steps they can take to promote control of systolic blood pressure?
Dr. Houston: Low salt, high magnesium intake, high potassium intake, fruits and vegetables, exercise, weight loss. The best medications for Systolic blood pressure are ACEI, ARB and CCB. Diuretics and beta blockers are less effective. High systolic usually means stiff arteries.
Lisa Nelson RD: Is there a connection between blood pressure and heart rate?
Dr. Houston: If blood pressure increases, normally the heart rate should decrease. However, in some patient with dysregulation of the autonomic nervous system the heart rate may increase with the blood pressure.
Lisa Nelson RD: Blood pressure fluctuation - What causes blood pressure to fluctuate drastically throughout the day? Is it something to worry about?
Dr. Houston: Most people have fluctuations during the day due to the normal circadian rhythm (high in AM and low in PM). Stress, anger, eating, exercise, rest, meditation, coffee are some of the things that will alter blood pressure. About 60 % of patients that drink coffee have increase blood pressure for several hours after consumption.
Lisa Nelson RD: What is the risk of not treating high blood pressure? For example, someone has a blood pressure of 160/100, but they feel perfectly fine. Why should they be concerned and seek treatment?
Dr. Houston: Heart attack, stroke, heart failure, kidney failure, loss of vision, aortic rupture, valve dysfunction, atherosclerosis. Hypertension is the silent killer. At this level the arteries will be damaged over time and all of these complications will occur. At that high level of blood pressure one will decrease life expectancy by about 15 years or more.