27 Year Old Male New GP is Concerned About Lifelong Hypertension & AFib

I recently started seeing a new General Practitioner who came very highly recommended by family and friends.  I love her, she's a hippie who went to medical school.  As a rule her staff said it would be in my best interest to begin with a physical, to which I agreed.  Full labs, CBC, EKG, EEG (unusual for a GP), and blood pressure, etc.  She was quite alarmed by my blood pressure, and she detected AFib.  I proceeded to inform her that the AFIb is news to me.  But, my whole medical life my blood pressure has always been what medical professionals would consider high.  Even when I was a kid I remember the Pediatrician closely monitoring it and chalking it up to genetics and pediatric hypertension.  We're talking anywhere from 150/90 to 200/110.  It can be 120/80, also.  I never, ever had any side effects whatsoever.  I'm 6'1" and 150lbs, healthy, non-smoker, cannot tolerate stimulants of any kind, and a rare alcohol user.  Throughout my teens and early adulthood I've been referred to Cardiologists who have done long term holter monitor tests, event monitor, stress tests, echocardiograms, and several electrophysiology studies.  Endocrinologists to determine if there is anything amiss with my adrenals and endocrine system. Every time everything came back completely normal.  I do have very severe panic disorder for which I take Xanax PRN.  I've always considered my hypertension to be my unique flaw.  Its never held me back nor have I ever felt; "Well, I shouldn't do this activity or I should take it easy..."  I don't even think about it.  My point is my new GP is very alarmed.  She gave me a clean bill of health as long as I promised to comply with Propranolol 40mg taken at bedtime, Pradaxa 75mg twice daily, and she increased my Xanax, but insisted that I keep it a PRN "as needed drug".  She explained the benefits of Propranolol for anxiety and panic disorder and indeed warned me never to take the two drugs together, i.e. don't take your propranolol and Xanax before bed.  My ultimate question is this really necessary?  Isn't this much ado about nothing?  It is quite clear she is caring and is coming from a great place.  I feel that she is starting me on a prophylactic drug regimen which will grow as the years go on due to a fear unfounded or not that I may have a severe cardiac event.  She has recommended an Electrophysiologist for which she personally called to get me scheduled ASAP.  If I had all of these tests in my teens and early twenties and nothing has changed, what gives?  Also, my old GP did not seem phased by it as he examined my medical records and I saw him 3 months before switching GP's and he said everything is stellar and told me to enjoy my elliptical trainer.  Sorry for the long post, any input would be great.  I don't want to be 30 and have to take a drug to get up, get it up, use the restroom, eat food, exercise, etc.  Thanks in advance!

[michellepetkus]

If she saw afib on your ekg it does pose a higher risk for you for throwing a blood clot and having a stroke.  That said, she is a GP and not a cardiologist so I think it prudent to go and see this Electrophysiologist and get properly diagnosed so you aren't taking meds you don't need. He will prescribe what he thinks is best for your situation. And considering you have life long high BP and anxiety issues it doesn't seem like a bad idea to me to get checked out by a cardiologist so just go and get looked at.  It is in your best interests.  Take care and keep us posted on how you are.

[Jerry_NJ]

Good advice, but I'd start with a cardiologist and see if he/she thinks an EP is needed, i.e., do you really have atrial fibrillation, or any "electrical" disorder.

As for your statement: "considered my hypertension to be my unique flaw" I say "nuts", high BP is high BP and it can, maybe we can say will if left untreated, cause heart enlargement and worse... yes and AFIb.  

Didn't your doctor suggest taking an aspirin while waiting for a check up by a heart specialist?  I think the over-the-counter advice is don't take more than a few days without approval by your doctor, but if you do in fact have AFib I'd run the risk of stomach problems with the aspirin for the heart benefits, including the first/simplest mitigation of clot formation.  

I don't think there is any connection between high blood pressure and AFib, unless the HBP has already enlarged the left atrium... I'd doubt that is the case.  I don't associate high blood pressure with anxiety either, but I could be wrong on that point, just of the top of my head. Anxiety can cause heart rhythm problems (AFib? I think not that, but PVC a likely outcome).

I frequently don't remember drug names and what they are, are you taking a beta blocker to lower your BP?  I think it is a likely next step if you haven't already started.  

Good luck, hope you get the PB down to normal and find the atrial fibrillation doesn't exist.  If you GP saw it on an EKG, that would be proof.

[JitteryJerseyian]

Jerry,

My new GP has consulted with a Cardiologist in her Alumni circle and to answer your question.  Yes, I'm currently taking the following meds as of 10 days ago.

Propranolol 40mg - 1 tablet at bedtime (Beta-Blocker)
Pradaxa 75mg - 1 tablet twice daily (Anticoagulant)
Xanax 1mg - 1 tablet three times daily PRN (as needed for panic and anxiety)
Apririn 81mg - 1 tablet daily

This regimen was cleared after my labs turned out perfect.  My GP is keeping regular contact with me.  I am seeing the Electrophysiologist on the 24th.  Thanks for everyone's concern and recommendations.  I know that cardiovascular issues and often be very silent asymptomatic killer.  I intend to get this completely straightened out and handled.  I will not fall victim to a life of polypharmacy.

[abc85]

Good luck with this!  Your high BP is definitely something that needs to be addressed and treated as it can lead to numerous problems down the road such as heart problems, strokes, and kidney disease.  It sounds like going to see the EP is definite next step as well to determine if you do actually have a-fib as you are pretty young for it but it would be something to have treated if you do have it.  High blood pressure can lead to a-fib and is actually considered by many doctors to be the most common reason why people develop a-fib.  I believe that most who develop it from high BP develop more of a silent a-fib and don't necessarily feel symptomatic. Do any others in your recent family have the same issue with hypertension from a young age?