Eve Glazier, Elizabeth Ko | color

DEAR DOCTOR,

I heard about a study that says working overtime gives you high blood pressure. My husband just joined a competitive company, and he’s expected to work a lot of extra hours. He’s already a Type A kind of guy, and I’m worried.

— WORKIN HEART FOR THE MONEY

DEAR MONEY,

You’re referring to the results of research published last December that found a connection between putting in long hours at work each week and an increased risk of developing high blood pressure.

More specifically, the study uncovered a link to a condition known as “masked hypertension.” This is when blood pressure readings in the doctor’s office are normal but then rise to elevated — and even dangerous — levels outside of the clinical setting. That makes diagnosis and treatment difficult and may put someone at higher risk of heart problems and stroke.

In the study, published in the journal Hypertension, researchers in Canada followed 3,500 office workers for five years. Participants in the study wore a device that measured their blood pressure every 15 minutes. The researchers also obtained daily blood pressure readings while the workers were at rest.

The goal was to identify periods of normal blood pressure, sustained high blood pressure and masked hypertension. After adjusting the resulting data for lifestyle factors such as weight and smoking, existing medical conditions such as diabetes, family medical history and job strain, the researchers found a correlation between how much overtime someone worked and their blood pressure.

Overall, the study found a 70% higher risk of masked hypertension among workers who put in 49 or more hours per week as compared to those with a workweek of 35 hours or fewer. They also found that the overtime group had a 66% higher risk of sustained high blood pressure. These are blood pressure readings that remain high and can be measured in a clinical setting.

As little as one to nine hours of overtime was linked to a significant increase in risk of both types of hypertension. The results held true for both women and men.

Analysis of previous research, which also finds a connection between a long workweek and developing high blood pressure, suggests stress and loss of sleep as potential causes. But because the number-crunching in the Canadian study takes those factors into consideration, the authors suspect some other mechanism is at work.

Considering that the study looked at white-collar workers, who spend the lion’s share of their time behind a desk, recent revelations about the adverse health effects of prolonged sitting may hold a clue. These include weight gain, increased risk of developing metabolic diseases like Type 2 diabetes, and, yes, hypertension. It will be interesting to see if these parallel avenues of research converge.

Meanwhile, considering the demands of your husband’s new job, as well as your description of him as a driven Type A personality, we think it would be wise for him to check in with his health care provider.

DEAR DOCTOR,

It seems like gut microbes are part of every kind of health issue now. I just read that having the wrong bacteria causes pulmonary hypertension, which is something our dad had before he died. Is that really true? How can it be fixed?

— THIS AIN’T NO SMALL MATTER

DEAR SMALL,

We’re right there with you in being amazed by the breadth and depth of the role of the gut microbiome in health and well-being. The emerging research these days is fascinating, and it continues to shape and expand our understanding of how the body functions.

In your question, you’re referring to the results of research published last February in the American Heart Association’s journal Hypertension. According to the study, researchers found that a specific assortment of gut bacteria may not only contribute to a certain type of pulmonary hypertension, but also may be useful in predicting its onset.

Let’s start by talking about the condition itself. When someone has pulmonary hypertension, it means that something has caused high blood pressure in the arteries of their lungs. This is in contrast to general hypertension, which is high blood pressure in the arteries throughout the body.

The study that you’re asking about focuses on a specific subset of the disease, known as pulmonary arterial hypertension, or PAH. That’s when progressive scarring damages the walls of the small arteries within the lungs, which makes them stiff and narrow and slows down blood flow.

As blood pressure rises, the right side of the heart has to work harder. Over time, this extra workload taxes the heart and causes it to become enlarged and weakened, which leads to a new set of problems.

Symptoms of PAH include fatigue, shortness of breath, heart arrhythmias, and swelling in the feet, legs, abdomen and neck. Although the condition can arise on its own, it has been associated with congenital heart disease, COPD, chronic liver disease and drug use.

PAH is a serious and progressive disease, and there is no known cure at this time. Because the symptoms are common to many conditions, it can be hard to diagnose in its earliest stages. When PAH is suspected, diagnosis begins with blood tests, chest X-rays, scans of the heart and lungs, and endurance tests.

The condition is confirmed with a procedure known as right heart catheterization, which allows a direct measurement of blood pressure within the main pulmonary arteries. Treatment focuses on managing symptoms with blood thinners, diuretics and supplemental oxygen.

The new PAH findings hint at a radical new approach to the disease. In the study, researchers analyzed stool samples from 18 PAH patients and 12 people with no history of cardiopulmonary disease. According to the study results, the presence of those specific bacteria predicted a diagnosis of PAH with 83% accuracy. It’s a small study, and many questions remain. But if the results are corroborated in future research, this new direction holds promise for new avenues in PAH diagnosis and therapy.

Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.

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