Ask a doctor on the topic of Internal medicine

High blood pressure: Diet or psyche?

August 8, 2017 | 80,00 EUR | answered by Dr. med. Frauke Gehring

Hello,

it's about my blood pressure again (or still). A long story. But the heart is definitely healthy.

In January, my blood pressure was extremely high, fluctuating, and also with high/fluctuating pulse.

It turned out to be psychosomatic, which led to me having panic attacks (I didn't know how much stress the heart can handle and then became additionally afraid), diagnosis panic disorder and psychiatric stay.
Roughly a dozen stressful situations including deaths, beginning of retraining/career change (several weeks of trial and subsequent decision) - were probably too much. That makes sense.
(Unfortunately, my left arm/shoulder pain was misinterpreted there, it was related to a bicycle accident and not the panic)...

I am calm again now. My pulse is back to where it used to be, around 60.
My blood pressure has also improved significantly but not yet at the level before this crisis.
Now without blood pressure medication at around 130/70 or 140/80 during the day at rest.

Sometimes my blood pressure also goes up to 160/90, with a slight increase in pulse. I feel like it has something to do with eating - I notice it after big meals or lots of sweets - that is, not every day. It is not accompanied by sudden fears. It gets better on its own, but overall it takes one or two hours during which I am more restless.

Since the crisis in December/January, my lifestyle has changed significantly.
I have been doing significantly less sports since the end of last year and gained 10 kg, weighing 95 kg at under 1.80m... so my BMI is around 29. Even my blood sugar was slightly elevated...

So far, I have received the following reactions from doctors:

1)
A company doctor (first mandatory appointment) completely attributes the elevated blood pressure to my psyche, my "anxious personality disorder" and says that the psychological stress is too great. She advises me to take psychotropic drugs, possibly permanently. (tried only once, don't see the need)

At this point I say: Where is the suffering that would prompt me to take such medications? I completed a degree without my heart acting up, whereas the retraining isn't. My daily life is currently going very well, I am now very active in interacting with people/planning my future, even an internship abroad is planned. I have never been so positive. I only had panic attacks associated with fear of death twice, and that was in January.

2)
My neurologist (due to epilepsy) says that it all comes from my currently unhealthy eating habits and that I have processed the psychologically stressful situations from back then.

3)
My general practitioner says it could be both, losing weight would only make a small difference, up to about 10 mmHg.

Sports are slowly starting again and the diet is getting better again. I have the impression that this is having a positive effect.
But the conflicting statements of the doctors are making me insecure.

I feel quite powerless when it's attributed to the psyche and they say "it will be fine...". It feels wrong, especially when the blood pressure suddenly rises only after very large meals/sweets.

Does it really change so little if I change my lifestyle again?
Can you really eat so unhealthily that your blood pressure temporarily rises after eating, or is it just in my head?
I think that an organ is sick or overloaded because of my diet... intestines, stomach, liver, kidneys.... unfortunately, there is so much information on the internet.

Currently, I have no outstanding worries that could psychologically burden me. With the retraining, the apartment, social environment, and "salary" are secure for two years, it even allows me to save money. Things couldn't really be going any better.

Dr. med. Frauke Gehring

Good evening,

I don't see any problem here at all. Normal blood pressure values refer to values at rest, measured after 10 minutes of sitting without exertion. You already have the desired normal values. When you exert yourself, or when you digest a hearty meal, the body demands more blood flow. During physical exertion for the muscles, during the need to digest larger amounts for the intestines and other internal organs. So the pulse increases to ensure the higher pressure, and you have observed a completely normal, physiological phenomenon that we all exhibit.

I assume your concern arises from knowing that the pressure is elevated. Of course, it will decrease again once the digestion is done, you will measure normal values and be reassured.

Even if it feels "wrong": it is normal! What is wrong is the associated restlessness, but for me, that is not a reason to take psychopharmaceuticals. I would only recommend them if constant anxiety is ruining your life, which doesn't seem to be the case here. However, psychotherapy would be helpful in accepting the physiological body reactions.

Losing weight tends to lower blood pressure by about 10 mmHg, but of course, it also increases in slim people after hearty meals; they just eat less hearty, so the demand doesn't rise as high.

My conclusion: It would do your soul and body good to eat healthier and lighter, and to also move a lot. Weight loss will also relieve the organs and improve the values. However, your blood pressure is the least of your worries here, and you shouldn't drive yourself crazy by constantly monitoring it and googling diseases.

All the best!

Warm regards, Dr. Gehring