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High Blood Pressure

HIgh blood pressure and murmur

01/21/2009

Question:

I am a 24 year old female. I went for a complete physical today. Previously, I haven`t had a physical exam since I was 13. There were a few concerning things that came up.

First, my blood pressure was high. The first time she measured it she said it was too high to even bother and decided to re-test it at the end of the appointment. I laid down and took some deep breaths to calm down and it ended up being 142/60. I know there can be a "white coat effect" so my first question is: How high can blood pressure be elevated due to anxiety? I did feel very nervous. I could feel my heart racing and my blood pumping.

Secondly, she heard a systolic heart murmur (grade 4/6). She thought it may be due to the fact that my heart was beating so fast.

She has asked me to monitor my blood pressure at home over the next month and to return in a month to see her. She also is sending me for an echocardiogram.

I just want to know how worried I should be. Can this all be explained by anxiety in the doctor`s office?

Thank you very much for your time.

Answer:

A blood pressure of 142/60 is certainly too high.  Your blood pressure should be no higher than 130/80, and preferably 120/80 or lower.  Anxiety in a doctor's office can increase blood pressure.  This is called the "white coat effect", and occurs in about 20% of all patients.  The best way to deal with this is to measure blood pressure at home, or getting 24 h ambulatory blood pressure monitoring.  It is important to make an accurate diagnosis of hypertension to avoid unnecessary treatment, but also to treat patients with high blood pressure in a timely fashion.

The echocardiogram is the right test for you.  A normal echocardiogram would confirm that your heart murmur is indeed harmless.

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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