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High BLOOD PRESSURE due to anxiety of taking test.

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I used to have high BP a few years ago. I think it was mainly due to anxiety about measuring the BP (extreme anxiety for the actual test taking situation). Much stronger than ordinary white coat syndrome. Would push it up to 180/105 etc. I am on Enalapril and Amlodipine and testing at home during several years has always been the same pattern. First elevated due to fear of the machine (155/100 and similar) then, after seeing that it was not EXTREMELY high, I started to relax and got it down gradually to about 128/73. This relaxed me very much. It has been like this for several years. Now, I waited longer than usual to test and built up a stronger fear than usual. Got extreme anxiety when measuring, heart racing, dry throat, sweaty palms, nearly trembling etc. The reading was 180/120 (also with arm down the side and not at heart level, which might affect reading too?). This experience was traumatic and has now scared me from taking the BP again, even at home, because I am so extremely scared that my BP will now be "stuck" at that high level and that I am going to die. Catastrophe thoughts. Could you, as a cardiologist, calm me somehow with this? I am trying to think that since I am om the meds I mentioned, I will be well protected *EVEN* if my BP would have gone up?? IF my fears were true (hope they are not) that the medication has stopped working, would this still be treatable with just other medicines? I am so scared of heart diseases etc.

Category: Cardiologist

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Category: Cardiologist
Dr. Vivek Mahajan is online now

Expert:  Dr. Vivek Mahajan replied 4 Days.

Thank you for your query at DoctorSpring.com
I understand your concerns and anxiety.
You're on correct set of drugs which should keep your BP under control. You do seem to have terrible anxiety while the BP is evaluated and such anxiety can lead to very high BP causing an alarm. Up to a point that you have been put on 2 medicines for BP.
Apart from this anxiety symptoms when your BP is evaluated, do you have any other symptoms such as chest pain, giddiness or headache? If you don't, it shows your BP is fine and goes up only when somebody is about to check it. At 180/120 if BP was persistently maintained at that level, you will definitely have symptoms.
So do not worry about BP being stuck at that level. You just need to overcome your anxiety. If you overcome that all your problems will be solved. Rather BP will be normal with no further chances of heart disease.
Hope this was helpful,

Patient replied :

I have no other symtoms than those from the anxiety. In a wider perspective I am a person worried about all kinds of disease. So you can see that those numbers 180/120 scare me. And to the point that I don't dare check again (ever). I just need reassurance. My heart rate was 133 when the bp was 180/120 and normally my heart rate is 60-75. Can it still spike that much even though I am on meds??

Expert:  Dr. Vivek Mahajan replied 3 Days.

Yes even if you do take medicines sudden periods of anxiety will lead to a lot of corticosteroid release in the blood stream leading to increased BP. It is just what happens during exercise. Even if you are on well controlled medicines, your BP will rise during exercise.
So please do not worry.
Your biggest problem is your anxiety. And you need to overcome that.
You can talk to a psychologist who will teach you some meditation and relaxing techniques. I feel this will help you.

Patient replied :

So, you feel that I could just forget about the 180/120?

Expert:  Dr. Vivek Mahajan replied 2 Days.

Yes, you should not worry.
Rather try to avoid anxiety as far as possible. It can in future lead to secondary hypertension.

Patient replied :

Thanks. So the problem now is only: I will never dare to check BP again so we just have to trust that it is lower when anxiety and HR is lower..:?
I have understood that HR and BP are not necessarily related, but you still say that I can be calm if my HR is normal. Could you please explain? Also, since I started medications I feel my pulse at the wrist and neck is softer than before (when relaxed). It still is soft and not 'hammering' (if not anxious). Good sign?

Expert:  Dr. Vivek Mahajan replied 1 Day.

Yes you need to overcome this fear most importantly.
I can assure you, with a normal HR ( 60-75 ) there is really nothing to be worried about.

I can say that if Pulse and BP are both are raised it could be a pointer towards anxiety. Anyways medications can bring your bp back to normal even if you are actually an hypertensive. So take tour medications and practice relaxation.

Dr Vivek Mahajan

Dr. Vivek Mahajan
Category: Cardiologist
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
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