When time really is of the essence
Taking blood pressure pills at night almost halves the risk of stroke or heart attack
The most significant medical advance of this past year could scarcely be simpler. The practice of taking blood pressure pills at bedtime rather than as customary with breakfast, as reported recently in this paper, markedly reduces, by almost half, the subsequent risk of either stroke or heart attack.
This may sound improbable, but there are two sound reasons why it should be so. First, a raised blood pressure when asleep is more harmful than when awake as it is a more powerful prognostic indicator of subsequent circulatory complications. Next, the widely prescribed types of antihypertensives, the ACE and ARB inhibitors, exert their therapeutic effect by blocking the kidneys’ hormonal system, which has a circadian rhythm that is much more active at night than during the day.
The further considerable advantage of switching to an evening regime is that common side effects such as dizziness and fatigue are less prominent. The obvious exception here are diuretics such as bendrofluazide and lercanidipine that will keep one trooping to and fro to the loo and so should continue to be taken on rising. For those who might wish to know more about this important finding, the relevant paper is available online (Hermida, bedtime hypertension, 2019).
A breath of fresh air
Quietly and rhythmically every day we breathe in and out 20,000 times, inhaling and exhaling 12,500 litres of life-sustaining oxygen-filled air – along with millions of fungal spores, viruses and bacteria. Thus, by necessity, the respiratory system of the nasal passages, sinuses, airways and lungs has several lines of defence against these pathogens, including a systematic process of immunological surveillance latching on to and destroying them before they cause harm.
And very effective it is too, though for some excessively so, which is why the respiratory system is also particularly prone to the commonest of allergic conditions – rhinitis and asthma. Their treatment with steroids, either as a nasal spray or inhaler, works well enough, but for some, their quality of life remains seriously compromised by the constantly blocked nose (and loss of taste and smell) of rhinitis or the wheezy breathlessness of asthma.
The best option here, it has emerged, is drugs known as monoclonal antibodies that block the immune pathway: benralizumab for severe asthma and dupilumab for chronic rhinosinusitis. They are, however, like all new drugs, eyewateringly costly at £12,000 for a year’s treatment. Their availability is thus understandably restricted to those for whom they might be appropriate, who would need to discuss with their family doctor to get a referral to the relevant specialist who can prescribe them.
Going with the flow
This week’s medical query comes courtesy of Mr TB, from Southend, now in his mid-sixties, who, for about five years, has been inconvenienced by urinary frequency (“every waking hour”) and poor flow (“my bladder takes a long time to empty”). But curiously, when visiting Italy for his annual walking holiday, these characteristic symptoms of an enlarged prostate disappear and he can go six hours without “spending a cent”. Why, he reasonably wonders, should his prostate behave so differently “when home and away”?
Teardrop exposed
Finally, further to the tendency of tearfulness in later life, a reader draws attention to how this may be exacerbated by a remediable underlying cause. “At sentimental family occasions, one tear will be followed by many,” he writes – for which, as a precautionary measure, he would keep a facecloth in his car so he could “nip out and clean up”. Having cried inordinately at a family funeral, his doctor referred him to an ENT specialist, whose examination revealed blockage of the ducts draining the watery secretions of the lacrimal glands. These were duly unblocked, since when “I have had no recurrence of the problem, I just blow my nose more frequently”.