Ask a doctor on the topic of Internal medicine

High blood pressure due to fear of measuring

February 2, 2016 | 30,00 EUR | answered by Dr. med. Frauke Gehring

Hello Doctor,

I am a sometimes very anxious person and take Venlafaxine and Notrilen in higher dosages for anxiety and depression. At other times, I am more of a funny guy and sometimes a bit of a daredevil. However, when it comes to illnesses, I am really a scaredy-cat. Even as a teenager, I was on the path to becoming a hypochondriac.

A few days ago, when my new primary care physician measured my blood pressure, I had values of 185/115 due to my "white coat syndrome" (in connection with the very pretty medical assistant), which would be much too high in the long run. Although my doctor said it's not that dramatic if I have higher readings only during measurements due to a "white coat hypertension" - which I have always thought as well - he surprisingly said it wouldn't be quite appropriate to dismiss the issue that easily, since I might also have too many anxieties in my daily life, leading to high blood pressure too frequently.

I must say, however, that I don't have many problems with noticeable anxieties in my daily life. Even when driving or in work stress, I feel fine and hardly ever get upset. I also enjoy riding motorcycles without fear, and my driving style is often (unfortunately) quite daring.

Only when I get fixated on something that could severely affect my health, I feel slight anxieties, which are then temporarily replaced by a cramp-like feeling in the left hemisphere of my brain, leading to a depressive state. These phases sometimes don't occur for days, and then sometimes almost daily for a few hours. However, my blood pressure has always been okay in this state, as the normally felt emotions seem to be somehow blocked.

Due to today's blood pressure measurement, as expected, I had the same values (185/115), and my doctor convinced me to undergo a long-term measurement. Since these devices work on the same principle as regular blood pressure monitors, it's impossible for me not to notice the process, which led me to assume that I would show a mild to moderate panic reaction during each measurement.

Until recently, I didn't feel like I responded with much anxiety to measurements, and the values for the last two years were always around 160/100. However, during the removal of kidney stones while under anesthesia (with the administration of tranquilizers), according to a nurse, my readings were at a maximum of 150/??.

I have been wearing the long-term monitoring device at work for 4 hours now, and I not only feel anxious during each measurement but I am also constantly on edge, feeling like I am facing an important exam. It's just terrible. :-(

Additionally, I am afraid that even after the test, due to the likely high values, I might become "crazy" due to the risk of a stroke, etc., and then spend the whole day feeling anxious without the monitor. Unfortunately, I am familiar with such reactions. Moreover, this situation would probably also lead to problems falling asleep, which have caused me to fall into episodes of anxiety and depression for weeks before taking antidepressants.

After a comprehensive blood test and abdominal ultrasound, my doctor also said that everything is fine, even my cholesterol levels are excellent, and I should actually live to be 100 years old. However, with my elevated blood pressure, maybe only 70.

I am a 56-year-old male, 182 cm tall, and around 88 kg. I engage in endurance sports at the gym four times a week and weight train twice a week.

Aside from the two antidepressants, in recent weeks, I have been taking a proton pump inhibitor every few days for frequent heartburn. Since the excess stomach acid seems to be related to my coffee consumption (about 4 cups from the espresso machine), I am currently working on reducing it. I do not take any other medications regularly, and as far as I know, aside from my "injured" head, I do not have any chronic illnesses.

My specific questions:

a) Is this long-term monitoring even useful if I clearly feel anxious during the measurement or even feel anxious all day?

b) A year ago, I bought a wrist blood pressure monitor rated "GOOD" by Stiftung Warentest, but due to my "measurement phobia," I haven't used it in a while. Would it be helpful if my girlfriend takes my blood pressure with it at night?

Thank you in advance for your efforts!

Dr. med. Frauke Gehring

Hello,

"White coat hypertension" is certainly a possibility, but even with great anxiety and a very attractive medical assistant, the values should not rise too high. Therefore, it could be that you have a mild stress-induced hypertension, and a 24-hour monitoring is absolutely necessary.

You can certainly subtract about 20 points from many values, but you should still see if your blood pressure rises too high when you are under pressure. In that case, a gentle blood pressure medication would be advisable, as stress or exercise should not cause too strong of an increase.

If in doubt, a stress test would be useful, as you eventually forget about the stress when you exert yourself. This will also show whether the blood pressure response is appropriate or excessive.

I consider self-monitoring at night to be too emotionally taxing, I would not recommend that.

All the best!

Sincerely, Dr. Höllering