Risk Factors For Hypertension
Age is a common risk factor for hypertension, as well as gender and family history. And while its a common health condition among American adults, hypertension does not have any visible symptoms or signs of illness. This is why its sometimes called the silent killer.
Hypertension is strongly connected to conditions like heart disease, heart failure, stroke, and even erectile dysfunction. These conditions are also linked to sleep-disordered breathing, also referred to as sleep apnea. Research indicates up to 50% of people suffering from hypertension also have sleep apnea, which is why anyone struggling with high blood pressure can benefit from a sleep test.
The good news is that hypertension is highly treatable with a healthy diet, productive sleep habits, and exercise. If your hypertension doesnt respond well to these lifestyle changes or medication, getting a sleep test to see if you have undiagnosed sleep apnea is important.
What Is The Relationship Between Sleep Apnea And High Blood Pressure
In healthy individuals, blood pressure naturally lowers by between 10 and 20% at night, a phenomenon that is sometimes referred to as blood pressure dipping. People with severe OSA experience blood pressure dips less than 10%, which indicates a non-dipping blood pressure pattern.
People who have non-dipping blood pressure at night face an increased risk for cardiovascular issues. Additionally, many patients with OSA experience a sudden and pronounced elevation of their blood pressure when they wake up in the morning. This morning surge is another factor that may increase risk for cardiovascular disease. OSA doesnt only affect blood pressure at night. Studies show that daytime blood pressure levels also increase with sleep apnea severity.
Sleep apnea is one of the most common sleep disorders in the United States. Of people diagnosed with OSA, it is estimated that around half also have high blood pressure. The good news is that treatment for sleep apnea may aid in lowering blood pressure levels.
If you are suffering from high blood pressure it may benefit you to get checked for sleep apnea. Call one of our sleep medicine professionals today and get on the road to a healthier and happier you!
Fight Or Flight Response
A recent article published in the journal Hypertension examined the science-backed links between poor sleep and hypertension. It showed that short sleep duration, working a night shift and obstructive sleep apnea, a disorder that causes you to repeatedly stop and start breathing while you sleep, are all associated with risk for hypertension.
Although many studies involving hundreds of thousands of adults around the world have confirmed a link between short sleep duration and high blood pressure, its unclear why.
It may be that the body requires a long period of sleep to manage certain hormone levels that help control blood pressure. Or in the case of obstructive sleep apnea, Ms. Kampman says, repeatedly waking up may trigger a fight-or-flight response that raises the heart rate and increases blood pressure.
Normally, blood pressure decreases during sleep. One analysis, published in the journal Chest, says that when blood pressure does not dip enough or fails to dip due to short sleep duration or interrupted sleep, cardiovascular risk increases.
The analysis says many diseases in addition to hypertension are linked with this reduced dipping or non-dipping blood pressure during sleep, such as chronic kidney disease, diabetes, resistant hypertension and obstructive sleep apnea.
In any case, the evidence suggests that regularly sleeping fewer than seven to nine hours a night raises the risk for developing hypertension and other risk factors for heart disease.
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Osa And Resistant Hypertension
OSA is common in patients with resistant hypertension, which is defined as BP that remains uncontrolled with three or more medications. In a prospective evaluation of 41 patients with resistant hypertension, Logan et al found that 96% of the men and 65% of the women had significant OSA . In 71 consecutive subjects referred to the hypertension clinic at the University of Alabama at Birmingham for resistant hypertension, we found that 90% of the men and 77% of the women had OSA . As OSA severity increases, there is an increased need for additional BP medications that is, the more severe the OSA, the less likely BP is controlled with pharmacologic therapy.- A prospective, but uncontrolled CPAP trial demonstrated that CPAP use can have substantial antihypertensive benefit in patients with resistant hypertension. Logan et al reported that CPAP use after 2-month follow-up in 11 patients with resistant hypertension lowered nighttime systolic BP by 14.4±4.4 mm Hg and diastolic BP by 7.8±3.0 mm Hg.
What Causes Labile Hypertension
When labile hypertension is suspected, a 24-hour ambulatory blood pressure monitor may be used to confirm the diagnosis. Then the work of pinpointing the underlying cause begins. Serious detective work often is required. We look at the patients overall health, lifestyle and medications, says Dr. Lioudis.
When a medication or lifestyle choice is the precipitating factor, making appropriate changes can cause labile hypertension to disappear.
Underlying medical conditions are a bigger concern, since they may be harder to treat.
We look for sleep apnea, cardiovascular disease, kidney disease or a problem with the adrenal glands, as any of these can cause blood pressure to fluctuate,says Dr. Lioudis.
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How Does Sleep Apnea Treatment Affect Blood Pressure
There are a number of treatment options for OSA. Treatment not only improves sleep quality but could also help manage hypertension. The most common and effective treatment is called continuous positive airway pressure .
CPAP treatment involves wearing a facemask attached to a machine that pumps air into the lungs at night. It works by preventing the airway from collapsing, which improves sleep quality in people affected by OSA. Studies investigating the effects of CPAP in patients with hypertension and OSA have shown that treatment with CPAP lowers blood pressure during the day and at night, especially in patients with severe OSA. CPAP also reduces catecholamine levels.
Some patients have a hard time adjusting to the CPAP facemask at night. Consistent, proper use of CPAP is important in order to effectively manage OSA and hypertension. Mouthpieces are one alternative to CPAP and are designed to help maintain an open airway during sleep. Research is needed to determine if mouthpieces also lower blood pressure in people who experience high blood pressure and OSA. Certain surgical procedures are also done to treat OSA in selected patients.
Sleep And Blood Pressure
During normal, healthy sleep, blood pressure drops by around 10-20%. This is known as nocturnal dipping, and research highlights its role in cardiovascular health.
Poor sleep, whether from a lack of sleep or sleep disruptions, is associated with non-dipping, meaning that a persons blood pressure doesnt go down at night. Studies have found that elevated nighttime blood pressure is tied to overall hypertension .
In fact, nocturnal blood pressure has been found to be even more predictive of heart problems than high blood pressure during the day. Non-dipping has been tied to an increased risk of stroke and heart attack. Its also been linked to kidney problems and reduced blood flow to the brain.
Raised daytime blood pressure has been identified as a consequence of sleep deprivation in multiple studies, but it doesnt affect all people equally. The link between lack of sleep and high blood pressure is highest in middle-aged adults. People who work long hours in high-stress jobs and people with other risk factors for hypertension are more likely to have raised blood pressure after chronic poor sleep.
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Sleep And Heart Health During Pregnancy
Pregnancy places additional strain on the heart and some women develop cardiovascular problems during pregnancy. High blood pressure, for example, can begin or worsen during pregnancy with potential complications for both the mother and her baby.
Insomnia, sleep apnea, and other sleep difficulties affect many pregnant women, and these issues have been associated with a higher risk of cardiovascular problems both during and after pregnancy. Ongoing research studies are working to identify ways to improve sleep during pregnancy with the goal of also reducing hypertension and other cardiovascular issues.
Change In Mental Status
This can be a difficult symptom to deal with because when we become confused we may not be able to respond with appropriate judgment. Its important that people who are usually around you are able to recognize the signs of changes in mental status: muddled thinking, changes in speech, unusual behavior and even simply reduced activity. There are many other possible causes for this symptom besides hypertension, including stroke or possibly an unreported head injury, so always seek medical attention if you experience changes in consciousness. Make sure that family members and caregivers know what to watch for, and know that any sign of quickly changing mental status is an emergency that requires immediate medical response.
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Restless Legs Syndrome And Periodic Limb Movements In Sleep And Hypertension
Epidemiologic studies have suggested that a relationship may exist between self-reported restless legs syndrome and hypertension. Ohayon and Roth examined RLS prevalence in a cross-sectional population study of 18,980 subjects aged 15 years in five European countries through a telephone interview. Hypertension was significantly associated with RLS and made an independent significant contribution to RLS but not to periodic limb movements in sleep . Of note, the diagnosis of PLMS was not made by polysomnography but by the validated Sleep-EVAL system questionnaire, which has a for diagnosing PLMS of 0.84. Likewise, Phillips et al examined RLS prevalence and correlates as part of the 2005 National Sleep Foundation Poll, a telephone interview of 1,506 randomly selected adults in the United States. Hypertension was associated with RLS . Ulfberg et al examined by questionnaire a random population sample of 4,000 men living in central Sweden, finding that subjects with reported RLS symptoms more frequently reported hypertension . Examining the 3,433 men and women enrolled in the Sleep Heart Health Study, Winkelman et al also noted only a weak association of RLS with hypertension after adjusting for age, sex, race, and BMI.
Obstructive Sleep Apnea Can Cause High Blood Pressure
When you periodically stop breathing in your sleep, your body releases stress hormones. The American Heart Association explains that, with obstructive sleep apnea, these hormones can lead to high blood pressure, stroke, and heart disease.
âSlowed or disrupted breathing causes blood oxygenation to decrease, which triggers the brain to send signals to increase blood pressure and heart rate in an attempt to increase oxygen getting to the bodyâs tissues,â Jenna Liphart Rhoads, PhD, RN, CNE and advisor at NurseTogether, tells WebMD Connect to Care.
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What Are The Best Sleeping Positions For High Blood Pressure
Not everyone agrees on the best sleeping positions for high blood pressure, but sleep specialist, and medical director of the Martha Jefferson Hospital Sleep Medicine Center, W. Christopher Winter, says that sleeping on the left side is the best sleeping position for high blood pressure because it relieves pressure on blood vessels that return blood to the heart. These vessels are located on the right side of the body and may become compressed slowing your circulation if you sleep on your right side. Sleeping on your left side is important for pregnant women concerned with high blood pressure. Because the growing baby presses against internal organs and may cause circulation issues, sleeping on the left side will help with circulation and may prevent high blood pressure.
According to research conducted by Yasuharu Tabara and his colleagues from the Ehime University School of Medicine in Ehime, Japan, sleeping face down may be the key to lowering blood pressure while you sleep. Results of their study indicated that blood pressure may drop more than 15 points when you change from sleeping face up to face down.
Sleep Apnea And High Blood Pressure
Obstructive sleep apnea occurs when the soft tissues at the back of the throat relax and block the airway during sleep. Researchers think these pauses in nighttime oxygenation may activate the bodys fight-or-flight mechanism, which raises the blood pressure. Interestingly, however, the use of continuous positive airway pressure devices to maintain nighttime breathing do not necessarily improve hypertension in people with both and high blood pressure. Nonetheless, if you have both OSA and hypertension you should adhere to the treatment plan for improving your sleep apnea, as this may have a positive effect on your blood pressure.
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Sleep And Heart Failure
Heart failure is when the heart doesnt pump enough blood to supply the body with the blood and oxygen that it needs to function properly. An observational study of over 400,000 people found strong associations between sleeping problems and heart failure.
In that study, people who slept less than seven hours per night had an elevated risk of heart failure. Heart failure was also more common in people who had other indicators of unhealthy sleep including insomnia symptoms, daytime sleepiness, snoring, and being an evening person. The more of these signs of unhealthy sleep that one person had, the higher their likelihood of heart failure.
What Causes High Blood Pressure
High blood pressure usually develops over time. It can happen because of unhealthy lifestyle choices, such as not getting enough regular physical activity. Certain health conditions, such as diabetes and having obesity, can also increase the risk for developing high blood pressure. High blood pressure can also happen during pregnancy.
You can manage your blood pressure to lower your risk for serious health problems that may affect your heart, brain, kidneys, and eyes.
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Treating Kids Sooner Can Protect Their Future Heart Health
Sleep apnea reduces the quality of sleep at night, causing daytime drowsiness.
Children with sleep apnea have an increased risk of developing high blood pressure in their teens, a new study has found. High blood pressure is a major risk factor for heart disease.
Sleep apnea is a common disorder that causes people to briefly stop breathing during sleep. It typically happens multiple times during a single night’s sleep. While it mostly affects adults, about 10% of school-age children also suffer from sleep apnea. Nearly half of these children will outgrow the disorder. The other half must deal with a potentially chronic and progressive health problem.
While it mostly affects adults, about 10% of school-age children also suffer from sleep apnea.
The researchers, supported by the National Institutes of Health, began by testing several hundred children aged 5 to 12 for sleep apnea. A small proportion of those tested were diagnosed with the disorder. Eight years later, the researchers evaluated all the children again. They were tested for both sleep apnea and high blood pressure. The results showed that children who continued to have sleep apnea in their teens were nearly three times more likely to develop high blood pressure than children who never had sleep apnea. Children who were initially diagnosed with sleep apnea but had few or no symptoms by the time they became teens did not show an increased risk of high blood pressure.
: National Heart, Lung, and Blood Institute
What Can I Do To Get Better Sleep
- Stick to a regular sleep schedule. Go to bed at the same time each night and get up at the same time each morning, including on the weekends.
- Get enough natural light, especially earlier in the day. Try going for a morning or lunchtime walk.
- Get enough physical activity during the day. Try not to exercise within a few hours of bedtime.
- Avoid artificial light, especially within a few hours of bedtime. Use a blue light filter on your computer or smartphone.
- Dont eat or drink within a few hours of bedtime avoid alcohol and foods high in fat or sugar in particular.
- Keep your bedroom cool, dark, and quiet.
Work with your health care team to identify obstacles to good sleep, including other medical conditions.
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What Can I Do To Prevent Or Manage High Blood Pressure
Many people with high blood pressure can lower their blood pressure into a healthy range or keep their numbers in a healthy range by making lifestyle changes. Talk with your health care team about
- Getting at least 150 minutes of physical activity each week
- Not smoking
- Managing stress
In addition to making positive lifestyle changes, some people with high blood pressure need to take medicine to manage their blood pressure. Learn more about medicines for high blood pressure.
Talk with your health care team right away if you think you have high blood pressure or if youve been told you have high blood pressure but do not have it under control.
How Do I Know If I Have High Blood Pressure
Theres only one way to know if you have high blood pressure: Have a doctor or other health professional measure it. Measuring your blood pressure is quick and painless.
Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure monitoring.
High blood pressure is called the silent killer because it usually has no warning signs or symptoms, and many people do not know they have it.
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Whats Considered High Blood Pressure
A blood pressure reading consists of two numbers:
- Systolic pressure. The first or top number tells you what the pressure is in your arteries during heartbeats.
- Diastolic pressure. The second or bottom number tells you what the pressure is in your arteries between heartbeats.
According to the American Heart Association , a normal or healthy blood pressure reading is less than 120/80 millimeters of mercury . The following categories define blood pressure readings that are above this level.
- Elevated. This is a systolic number between 120 and 129 mm Hg and a diastolic number less than 80 mm Hg.
- Stage 1 hypertension. Stage 1 is a systolic number between 130 and 139 mm Hg or a diastolic reading between 80 and 89 mm Hg.
- Stage 2 hypertension. Stage 2 is a systolic pressure thats 140 mm Hg or higher or diastolic pressure of 90 mm Hg or higher.
- Hypertensive crisis. This is a systolic pressure over 180 mm Hg or diastolic pressure over 120 mm Hg. Blood pressure in this range requires medical attention right away.