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High Blood Pressure

Labile hypertension and blood pressure fear

10/22/2007

Question:

I am a 45 yo female. My blood pressure is variable sometimes from day to day and I get generally whilst sitting, readings range of 118/79 to 135/91. My standing pressure is generally a bit higher but within the range. My pressure lying down is rather low being around a range of 93/60 to 125/80. I do occassionally get some high readings at home like 166/100 and panic and then compulsively check, but the readings come down quite quickly these days. At the doctors, my readings are around 150/96 but my GP says that I drop about 20 systolic points between readings. He says I have labile hypertension fuelled by my constant worry and checking my blood pressure .I`ve gone through many tests and they all come back that I have GAD and health anxiety.

My questions are: - 1) Is there a correct way to check and what should I be on the lookout for, is it an average over a period of time. I am awfully confused as different seating and arm and body positions seem to have different results and since I am obsessed about my readings I take them under a variety of conditions and when I see one high reading - I panic.

2) - I am afraid of medication side effects and I have a family history of diabetes- I am not diabetic. What is the best way to safely treat the blood pressure without any pressure spikes?

3) My biggest fear is that if the readings are usually taken under rest conditions, surely there are spikes in pressure during the day (with or without medication) which even a 24 hr ambulatory machine won`t be able to pick up as my BP is labile from one day to another. What if one of these spikes one day causes a cardiovascular event so is there a safe medication that can guarantee no such spikes occur?

My apologies if my questions are long and confusing but this blood pressure fear is ruining the quality of my life.

Thank you

Answer:

It appears that your average blood pressure is around 120 to 130 systolic, which is normal.  Blood pressure varies over time in all people.  Short bursts of high blood pressure are also normal.  If they are self limited, they are probably harmless.

In your case, you can go by your average home blood pressures.  You may have some apprehension or anxiety while in the doctor's office ("white coat hypertension"), but you do not need treatment at present.  However, you should have your blood pressure rechecked periodically (e.g. every six months).

If you remain concerned about your blood pressure, you can consider 24 h ambulatory monitoring (ABPM).  ABPM provides a more detailed and accurate picture of a person's baseline blood pressure.

For more information:

Go to the High Blood Pressure health topic, where you can:

Response by:

Max C Reif, MD Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati