hypertension

1. What are the most current guidelines and criteria for treating mild hypertension?  

My hypertension seems extremely labile--at home it is in the mid 130's/80's, at work consistently 150's/90's, yet after very mild exercise yesterday (5 minutes of walking uphill) it was 198/102, accompanied by chest pain for a few minutes.

I am just beginning the process of being worked up for this (up until 6 months ago my usual BP was in the 100/50-60 range, work or home).  I am concerned if I am put on antihypertensives my pressure will be too low at home.  
I am 42, of normal weight, nonsmoking, nondrinking and vegan.  Family hx of MI and stroke.  Of course I am getting medical attention, but my doc seems extremely unconcerned about the blood pressure part of this.  He is way more concerned about the chest pain than I am.  (incidently, normal EKG and excellent lipid profile).  I would just like some factual info on what the medical indications are for treating hypertension.  Could the extreme shifts in BP be causing chest pain?  I know from posting before that there are many causes, and we will eventually get to the bottom of it, but in the meantime do you think I should be treated for hypertension?

[CCF-M.D.-CRC]

Dear christie,

First of all I would not call blood pressures up to almost 200 mild!  This is very high and should be of concern to both you and your doctor.  The first step of course is lifestyle and diet modification and I assume you are already doing that.  The most current reports (New England Journal of Medicine last month) is that "mild" high blood pressure actually is more serious that we used to think.  I think the trend now is to start medical therapy at lower pressures than previously.  Given your pressures and family history you are probably about due to start medication.  The best high blood pressure medication (e.g. beta-blocker, ACE inhibitor) for you will be decided by your doctor.

[cosmicbabe]

Hi ...Can someone please tell me how you are getting to post a question on this site??? I have tried soooo many times and nothing....I even got up early to try like at 7 am eastern time..

[Richard W.]

Since your blood pressure has increased dramatically, I wonder why the good doctor didn't suggest you look for a primary reason, such as kidney obstruction.  If so you could fix the problem permanently and avoid medication.

[little debbie]

It trully is difficult to post a question most of the time. I have tried at 3AM sometimes...so all I know is keep trying

[briane]

Both times I have posted a question I did it a little after 7:00 a.m. central time and I got in.  I don't know if it is always that way.