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High Blood Pressure

Is medication appropriate

02/22/2008

Question:

I`m confused. I`m female, 49, not overweight, don`t smoke, don`t drink, but live a fairly sedentary lifestyle. I get chest pressure daily (helped with nitroglycerin), lasts a little while... goes away and comes back later. BP in Dr.`s office is generally high 160ish over 90ish. At home, BP usually below 120/80 in morning and evening. During the workweek or a busy weekend, in most afternoons, it hovers around 130ish/82ish (give or take). Afternoon BP can go just as high as what is measured in the Dr.`s office, but comes down when resting. My chest pressure doesn`t seem related to BP, just feels like someone`s pushing in on my sternum and choking me. The pressure concerns me. When stressed for a duration of a few weeks, I get sharper pains, sometimes burning. Pains/pressure not helped by antacids and I have no history of stomach problems. Nuclear stress test was negative; Echocardiogram indicated minimal valve prolapse. Should I be concerned about the chest pains? Could they just be stress? Also, the regularity of the afternoon rise of BP has me wondering if medication is indicated. Should I be taking medication or not. I`m not one for taking meds I don`t really need, so here I sit wondering if I need them. Thanks.

Answer:

Hello and thank you for your question(s).

First and foremost, if you have diagnosed hypertension, as it appears from your stated values, then you should absolutely be implementing life-style modification (i.e. exercise, diet high in fruit and vegetables while low in fat and salt, reduction or elimination of alcohol, and cessation of smoking if applicable), as well as pharmacological therapy, if life-style modification alone does not bring you into normal blood pressure range. 

Unfortunately, I would need to know a lot more of your medical/surgical history to be able to better formulate an appropriate response to your inquiries (e.g. why are you taking nitroglycerin). 

To be succinct, you first need to determine your blood pressure status (i.e. normotensive, pre-hypertensive, hypertensive), and if you currently have any cardiovascular disease processes or associated risk factors.  Given the tests that you have undergone, there is probably some suspicion of underlying cardiovascular disease, however as you report your test to have been negative, I am uncertain as to your current state.

Once your cardiovascular status has been determined, you should consult with your cardiologist or hypertension expert and determine the best course of action and which pharmacological agents if any are appropriate for you.

I hope this has helped and I wish you the best.

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Response by:

Kaine C Onwuzulike, MD, PhD Kaine C Onwuzulike, MD, PhD
Resident of Nuerological Surgery
School of Medicine
Case Western Reserve University