Question about blood pressure?

[Deb]

I have ALWAYS had a rather low blood pressure, anywhere from 90/50 to 110/65, they used to not let me donate blood because the b/p would be too low.  Of course, I was younger then.  Now I am a 41 yr old woman.  My family history includes everybody with high blood pressure.  Lately I've not been feeling too well, I've had lots of periods of tachycardia and shortness of breath and PVCs as many as every other beat, but echo showed a normal heart so I am not to worry.  However because of the continued chest pain with exercise that resolves with rest, a family history of heart disease, a new murmur heard at the exam, and continued mild tachycardia at rest, they decided to do a Cardiolite stress test and do a new echo....fully believing it to be nothing but just to be safe.  The thing I don't understand is lately I've had periods of wide blood pressure elevation.  Please note I have never had "white coat hypertension" before.  Nonetheless my b/p has been 185/120, 175/110, 170/90 on at least three occasions in
doctors offices.  I have recorded it on several occasions at grocery stores in the neighborhood of 145-155 / 85-95 using the automatic blood pressure machines.  By the same token, just as often it is 126-139 / 76-90.  Is there any significance to this variability?  The doctors have generally not commented on the pressure taken in their offices when it was so high except that once asked if I was nervous.  Usually the nurse will say your blood pressure seems to be high today and then the doctor comes and looks at the chart and says nothing.  For now I am assuming that since a good portion of the time it appears the blood pressure is within normal range, that means it is ok?  Do you concur?

[Cleveland Clinic, MD]

A blood pressure of greater than 140/90 on three separate occasions is enough to make a diagnosis of high blood pressure.  Given your family history I would suspect you will need to start taking medications.

[Deb]

Sorry, I should have mentioned the Cardiolite tests and echo will not be done until November....I did have an echo in the ER a month ago that was ok but it appears the cardiologist feels it was poor quality, hence the new one being ordered.  Thanks.

[christine m. smith]

Hi Deb:
   I have had the same thing happen to me, although the elevated readings not quite as high as yours. 159/105, then 120/86, then 175/95, etc. etc. Like you I have always had low to normal readings, especially the diastolic. I have never had "white coat hypertension" before this started happening. And if the elevations are anxiety induced, I wondered if frequent stress (such as in a stressful job) could be doing this to me regularly, and if so, was it harmful. My pcp put me on a beta blocker, atenolol, to blunt these responses. I have been taking it for a year now and still don't know if I really have hyptertension. (without the medication) I hope you get a better understanding of this than I have!

Chris S.

[Cleveland Clinic, MD]

It is not the presence of low readings that concern doctors (unless they are accompanied y symptoms such as lightheadedness) but the fact that there are repeated high readings.  This is by defination high blood pressure and needs to be treated.

[Deb]

Is high blood pressure typically treated with beta blockers.  When they were thinking of treating the arrhythmia they decided it was far better not to treat it because I have a history of severe unstable asthma.  I have been requiring prednisone tapers a couple times a month due to the severity of the asthma.  Are there other options should these continued episodes of high blood pressure readings continue?  I've had yet another reading in the 170s/110s.  I think the fact these keep occuring in different doctor's offices is why nobody really mentions it....I suppose if it occurs repeatedly in any one docs office maybe they will say something about it.
Deb

[christine m. smith]

Thank you doctor!  No one has actually come out and said that this is by definition, high blood pressure and I always wondered if I should really be on this beta blocker. Like Deb, my readings were taken in many different situations. The first high reading was in a high anxiety situation (pre-op) and the second when I was hassled. Since this often happens in my job, I wondered if I was having these periods of hypertension in similar situations. Doing my family history I discovered that my paternal grandmother,her father, and each of her 3 brothers all died of strokes so I was a little worried. Deb, my doctor said that beta blockers can aggravate asthma. Thanks again.

[Cleveland Clinic, MD]

Beta-blockers are one choice but can cause problems in persons with asthma and other lung disorders.  There are many choices of medications and sometimes several different ones must be tried before the best one is found.