?conflict of medication

  I am a 52 y.o. w/f who has been taking atenolol 50 mgs. and 40 mgs.lasix. Recently I was under a good deal of stress and was informed that my pressure was running 180/105 and went up from there! Each time my Cardiologist took it it rose until I told him to stop. I tried to explain the stress I have been under and the fact that "I beleive" I am suffering from "white coat" syndrome because I monitor my pressure at home routinely and it is WELL controled! He on the other hand stated that if the BP was up in his offoce he must beleive that it is also up at other times.
  This being said, he placed me on a starting dose of Avapro, 150 mgs. Several days later I started to have major bouts of depression, very tired, heaviness on my entire left side and also left hand and foot became very cold.I also had frequent palpitations. My head felt like my pressure was elevated but just the oppisite was happening, avg. BP was 116/68. My Internist told me to decrease the medication to 75mgs. and if in a few days I was feeling better then we must assume that these "feelings" were coming from the Avapro. She also stated that she has had other people demonstrate these same "symptoms" however because angiotension II is a new class of medicines there is still very little data available. After 2 days of 75 mgs. I do feel a little better. I am also decreasing the drug again , in order to discontinue it entirely. Now I guess my question is, "is there really anyway one can openly define WHITE COAT SYNDROME" ? If not, what is one to do when taking additional medication that seem to only agravate the body as a whole? I also recently went through a complete physicial and Cardiolyte Stress test, lipid profile etc, everything was great!  Thanks for your help with this matter.
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Dear D.L.,
Q: Is there really anyway one can openly define WHITE COAT SYNDROME ?.  
A: "White coat hypertension" has been described as high blood pressure that is only elevated in the doctor' office due to the stress of seeing the doctor.   Yes, it does exist but no it does not mean that one does not need medication.  The reason for this is that no one (at least no one I know) lives in a totally stress free environment.  Therefore whenever one is stressed their blood pressure will be high.  It is during those high periods that the damage of hypertension is done.  Thus it may be beneficial to see what a "stress" blood pressure is and to treat based on that number.
Here are some additional sites with information on hypertension.
http://www.amhrt.org/Heart_and_Stroke_A_Z_Guide/hbp.html
http://www.ihr.com/medreprt/articles/bloodpr.html
http://www.musc.edu/iash/
http://www.am-osteo-assn.org/ccoop/hibldprs.htm
http://www.mco.edu/whl/know.html
http://www.bloodpressure.com/
http://www.mediconsult.com/hypertension/
http://www-med.stanford.edu/school/DGIM/Teaching/Modules/HTN.html
http://www.merck.com/!!uYfKE0uiyuYfKE0uiy/pubs/mmanual/html/khgnjgcd.htm
http://www.aafp.org/afp/091596/special.html
http://pharminfo.com/disease/cardio_db.html
http://www.pslgroup.com/HYPERTENSION.HTM
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

HTN