Anxiety

[kareena]

I have a problem which is really worrisome to me. I fear visits to a doctor's office. At home, my blood pressure and pulse rates are always in the normal range. At a doctor's office, my blood pressure usually runs from 160/170 over 90/100. All doctors normally are concerned about these numbers. I try to tell them I have great anxiety about visiting a doctor; I dread an appointment a week in advance. I don't want to start blood pressure medication because I am afraid it would harm me if I really don't need it. Every experience at a doctor's office is a bad one for me which just reinforces the fear. Also, I fear that my blood pressure will be high during the examination which it naturally is. It is a self-fulfilling prophecy.How do I overcome this? I suffered from hyperthyroidism, and I had the RAI treatment to correct this problem; therefore, I must be monitored by a doctor for the rest of my life. I am forty-nine years ago; I don't smoke or drink nor am I overweight. Any help would be appreciated. Thank you

[cardiogirl]

I suffer from severe medical anxiety.  Within a two year time frame, I had two mistaken lab tests.  One indicated a possible brain tumor (it was wrong) and the other indicated a possible heart attack, during pregnancy, no less (also lab error).  I refused medical help even when I needed it after the last experience, when I was admitted to a cardiac unit in my sixth month of pregnancy and subjected to tests that were awful and so much anxiety that I suffered debilitating panic attacks for six months following the event.

That said, my blood pressure readings (I did follow up with a cardiologist after that, several times, just to be sure I wasn't actually sick) never exceeded 120/80...and many were taken during an actual panic attack.

I'm nearly an expert in cardiovascular disease now, as I spent nearly every day of the remainder of my pregnancy studying it.  And I do know that, while "whitecoat hypertension" does exist, there is still the fact remaining that any increased tension against the vessels can lead to hypertensive complications.  And if it is happening under that stress, other stresses in your life could be causing the numbers to rise.  My mother has similar whitecoat hypertension and has benefitted greatly from a mild blood pressure medication.  Her numbers were quite similar to those you describe.

As far as the anxiety bit of it, only good experiences and time will help you.  I'm very sorry you're going through that, I know how frightening it can be.

Best wishes, I hope this helps some.

[tessa0825]

This is something you might ask your Drs. about. I have had  hypertension for more than 30 years. Recently while on medication, during a coronary office visit my diastolic (bottom)number was to high at 118..I suggested that maybe I was just nervous over the office visit. The cardiologist told me that it has been his experience that (white coat hypertension) almost always only effects the systolic (top) number. Besides, he didn't think I was overly nervous about being there. I have no idea if other Drs. believe in that idea or not...I was started on a different medication in addition to my regular ones and my BP has been controlled ever since. Good luck, Tessa

[Kevin Pho, MD]

Elevated blood pressure readings, even if it just occurs at a doctor's office (i.e. white-coat hypertension) is still associated with heart disease and stroke.  I would still consider blood pressure medication to treat this.

Regarding the anxiety, I would suggest discussion of treatment.  This can involve anti-anxiety medications (i.e. Buspar or benzodiazepines), as well as anti-depressant medications (i.e. Zoloft, Lexapro or Prozac).  Each has been shown to help with anxiety, and these options should be discussed with your personal physician.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b