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Does lack of sleep raise blood pressure?

The less you sleep, the higher your blood pressure may go. People who sleep six hours or less may have steeper increases in blood pressure. If you already have high blood pressure, not sleeping well may make your blood pressure worse.

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Is it true that sleep deprivation can cause high blood pressure? Answer From Francisco Lopez-Jimenez, M.D. Possibly. Sleep experts recommend that adults get 7 to 8 hours of sleep each night. Getting less than six hours of sleep is known to be bad for overall health. Stress, jet lag, shift work and other sleep disturbances make it more likely to develop heart disease and risk factors for heart disease, including obesity and diabetes. A regular lack of sleep may lead to high blood pressure (hypertension) in children and adults. The less you sleep, the higher your blood pressure may go. People who sleep six hours or less may have steeper increases in blood pressure. If you already have high blood pressure, not sleeping well may make your blood pressure worse. It's thought that sleep helps the body control hormones needed to control stress and metabolism. Over time, a lack of sleep could cause swings in hormones. Hormone changes can lead to high blood pressure and other risk factors for heart disease. Don't try to make up for a lack of sleep with a lot of sleep. Too much sleep — although not as bad as too little sleep — can lead to high blood sugar and weight gain, which can affect heart health. Talk to your health care provider for tips on getting better sleep, especially if you have high blood pressure. One possible, treatable cause of lack of sleep contributing to high blood pressure is obstructive sleep apnea. This sleep disorder causes breathing to repeatedly stop and start during sleep. Talk with your care provider if you feel tired even after a full night's sleep, especially if you snore. Obstructive sleep apnea may be the cause. Obstructive sleep apnea can increase the risk of high blood pressure and other heart problems.

With Francisco Lopez-Jimenez, M.D.

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What is the safest blood pressure medicine for the elderly?

Low-dose thiazide diuretics remain first-line therapy for older patients. Beta blockers, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and calcium channel blockers are second-line medications that should be selected based on comorbidities and risk factors.

Several issues should be considered when using thiazide diuretics in older patients (Table 2). Older patients are more prone to thiazide-induced dehydration and orthostatic changes, so physicians should check for orthostatic hypotension and suggest measures for preventing falls. Serum electrolyte levels should be monitored frequently, and hypokalemia should be treated with potassium administration, the addition of a potassium-sparing diuretic like spironolactone (Aldactone), or the use of a combination product such as triamterene/hydrochlorothiazide (Dyazide, Maxzide).22,23 This is important because in the SHEP trial, older patients with potassium levels less than 3.5 mg per dL (0.9 mmol per L) lost the cardiovascular protective benefit from the thiazide.24 Although poorly studied, their efficacy may be decreased in patients with chronic kidney disease.6,22 Uric acid and thiazides compete for excretion at the level of the renal tubule, so caution is necessary in patients with a history of gout.23 Although thiazide diuretics have been reported to affect serum glucose and lipid levels adversely, there is a decreased incidence of metabolic abnormalities and associated clinical outcomes with low-dose therapy.13,25

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