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High Blood Pressure

Questions on beta blockers and others

02/18/2008

Question:

I suffer from GAD and worry incessantly over my blood pressure. My baseline blood pressure is on average between 115 to 135 systolic ; 75 to 90 diastolic sitting down at home.. If I lie down and take a reading on the side I sleep, the readings are usually around 84 to 94 systolic; 52 to 60 diastolic. Lying on my back would give up to a 10 point increase. I usually do the first reading after around 5 sec on putting on the cuff to get the worst case reading and most of them are around the above stated readings. At the doctors the readings would be 157 then 144 , sometimes 170/100. I also suffer from constant neck stiffness which doesn`t help the anxiety and I think contributes to the white coat effect. I had a stress test done recently and at maximal Heart rate my blood pressure went to 160/90.

How is it possible that my blood pressure shoots up more during anxiety than when my heart rate is at maximal capacity? Is it hyperventilation that causes these rises? I know when I am tense, I have restricted shallow breathing.

A 24 hour ambulatory revealed that I was borderline hypertensive and required just monitoring at this stage. I was really stressed during this test. I see no logic in this test as it is only one 24 hour snapshot of one`s blood pressure and what good is it if as mentioned in another log that it is normal for people to have the first reading to be usually significantly higher than the second and third reading. I just don`t understand why the 24 hour ambulatory is apparently labeled the gold standard of diagnosing hypertension, Could you please explain how this test can be reliable for anxious patients? Isn`t it sustained hypertension one is worried about so why bother about the 24 hr snapshot??

I want to go on a medicaton to stop this white coat effect, atenolol was suggested to curb the effects of the anxiety from the adrenaline. I went on betaloc a couple of years back ( 1 dose at night) and I suffered from side effect like sleeping problems and went into depression ( I went on Remeron to treat the depression ) had breathing problems and was tired most of the time. But my pressure at the doctors was fine. Will atenolol cause similar problems or am I better off taking something like Atacand? I don`t want to go on any calcium channel blockers either. Or are there any other ways to treat this white coat effect or does one just accept and live with it knowing that one could stroke out from this??

I have a strong family history of Type 2 diabetes and I have heard that beta blockers seem to trigger diabetes. I also read that dieuretics in the past were thought to trigger diabetes as well. Does atenolol cause diabetes? I also read somewhere that blockers cause more stroke in patients and have been downgraded in the treatment of hypertension. What is the status on this?

How many times a day or week should one check if one is borderline hypertensive; shouldn`t you take a reading after a stressful day (how else would one know the worst case );

Thank you and looking forward to a response.

Answer:

Several points:

The optimal blood pressure is 120/80 or lower.  A person whose blood pressure is around 120 systolic is in a low risk group.

It is important to remember that blood pressure is simply a risk factor for cardiovascular disease.  The higher the average blood pressure, the greater the risk.  Because blood pressure fluctuates during the day, changes with activity or stress level and with changes with body position, precise data don't exist.  We know that a baseline office blood pressure, taken according to standard methods, correlates well with risk.  24 h ambulatory blood pressure correlates better, but it is also not perfect.  Recent data have shown that home measurements by the patient may correlate even better with risk than 24 h ambulatory readings.

Every person is different, and all our risk assessments are based on aggregated data.  In your case, you may not gain much by measuring your blood pressure more than twice a week.  If you average systolic stays over 130 mmHg, you should consider taking medication.  Atenolol is short acting and no longer recommended for the treatment of hypertension.  Nebivolol is a longer acting beta blocker with few side effects.  Another possibility is Atacand, which has virtually no side effects and has good track record in reducing cardiovascular disease.

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