Is white coat hypertension really dangerous?

[is_something_wrong]

I'm considering posting this in the expert forum, but I want your opinion first.

First: about me:
Male, 29, 188 cm, 85 kg. Eating healthy. Cholesterol 4,5 mmol/l (165 mg/dl). Exercise 90 minutes 3x/week, where 45 min is cardio and 45 min is weightlifting. Non smoker, no alcohol, no illegal drugs. Meds: 12,5 mg metoprolol/day for PACs. Resting heart rate 50. Max heart rate 210. Excellent cardiac function with LVEF 75-80%. Max exercise tolerance 14-15 METs. Normal EKG.

My problem the last months is intense anxiety while measuring blood pressure, which occationally increases the BP to 150-160 systolic / 90-100 diastolic.

It seems I've finally realized that my BP monitor won't bite me, and yesterday my results were:

Supine: 108/60 mmHg - HR 57
Sitting: 106/65 mmHg - HR 62
Standing: 104/75 mmHg - HR 73

Much to my surprise, the cardiologist at the expert forum recommended me to ask for HCTZ to lower my blood pressure, because it's not healthy to have BP in the 160s. I understand that. I told my PCP and he started laughing. He is more concerned that my BP is occationally far too low. My heart rate dips at night (to 35-40) and he believes my BP does the same.

Sometimes I get dizzy while standing up (especially after exercise) and honestly I don't want any lower BP. But I know that I'm stressed from time to time, and my BP is probably higher than 108/60, possibly above 140.

My cardiologist told me that white coat hypertension is normal and should NOT be treated. But the skilled doctors at Cleveland Clinic think otherwise. Who is right?

[Mom2four85]

I remember the first time I took 12.5mg of Toprol - bp dropped from "normal" to 70/40 and hr of 40 and even with a shot of whatever the ER gave me it stayed there for 11 hours while they monitored me. My pvc's went up and it showed I had multifocal runs the entire time.

I am so leery now of any medicine; even OTC stuff.

[r9c]

Yeah agreed with u that meds could make u faint if u do have a normal bp at rest,i remembered last year an appointment at cardiology department,since i was too worried about high bp and pulse rate,i ask do i need some meds to stay a normal bp,the cardiologist said,no one has a constant bp,he says,since then my bp at his office was around 117/75 which he says that good,so he said if he prescribe bp meds,my bp of 117/75 will drops lower which will then make my lightheaded worse,so he rejected the bp meds idea,but however when i was at the A&E,a doctor has different view,seeing that i have sinus tach,and bp of 150/90 he actually tought of giving me a beta blocker but then he ask me did the cardiologist prescribe me beta blockers,i told him no,so he actually says if the cardiologist dosent thinks a meds is required for the bp,so he also dint prescribe any beta blockers.

Personally i cant stand low bp,i measured 90/70 at a neuro clinic,was feeling so awful back then.Overall very confused with this BP stuff,most of the time when i went to the hospital for lightheaded they just check my bp,and if its normal they will keep saying you wont faint from a 117/75 BP :s

[is_something_wrong]

Thanks a lot :)

My worst BP ever measured by a doctor was 170/100. I barely remember it, I was consulting an internist at the ER after I had a run of some sort of tachyarrhythmia (that turned out to be sinus tachycardia, lol). He was measuring the BP while I had to watch the 12 lead EKG monitor, anxiously waiting for a PVC to show up, to "prove" my suspicion that I had VT.

Well, no PVC (or PAC for that matter) showed up, and my EKG was normal, so the BP quicky reduced to 135/80. Still slightly elevated, of course, I was still shaky.

With my super-normal BP results at rest, I guess medications would make me faint. I don't want that..

[r9c]

I ever went to the A&E because of palpitations and dizziness,and upon checking BP and pulse at the triage,the nurse say my bp was a bit high 140/90 maybe i was nervous that time but they immediately ask me to go in and see the doctor and got an ecg done,the doctor did says bp 140/90 was unhealthy if it maintains for several hours a day,so i was kept for 3 hours + observation at the A&E whey every hour they took my Bp,so after 3 hours my bp drops down a bit around 130/80 so they relesed me since ecg was ok with blood test,i question the doctor that do i need any meds to lower down the bp,he said not really as 140/90 isnt that dangerous,he seen patients like 190/90 and that was in a danger for stroke,only then they prescribe meds for that high BP  :D

i also ask the cardiologist whether white coat hypertension should be given meds,he also said not necessary but then if ur worried he says take ur own bp not more than 3 times a day,if all 3 remains high then u shuld discuss with the doctor again.
I think i just got white coat hypertension at the ER.

[Mom2four85]

oh no I believe that too; but I keep my thoughts to myself because it may be considered "politics" hehehe never want to offend anyone or start a war of words so to speak

I'll have to find the article that was on MSN about dr's pushing certain meds because they talk to the pharmaceutical companies and get a nice kickback from it...ok I don't recall the exact wording for it -  but it meant they get "incentives" to use their brand and the reps told them which meds get the higher incentives...

sooo I'm with you on this...I think they know bp and hr rise and fall and can be easily explained as a method of treatment, then bam they have to turn around and treat the opposing symptom :P

maybe I'm way off base but not after reading that article...going to look for it now

[is_something_wrong]

Thanks for your reply,

I really hate conspiracy theories, but I'm about to start believing one of them.

It seems my BP is below 110 systolic, no matter what body position. That is when I'm relaxed. Of course, my blood pressure through the day may be higher, during exercise, after eating (especially salty food), if I'm at work, stressed, if I'm arguing with my girlfriend, and so on..

On the other hand: 2000 years ago I guess we were living in caves and hunting wolves (at least that's what we did in Norway) :p . From what I understand, heart diseases (CAD) are caused by an unhealthy lifestyle. But don't you think people 2000 years ago had somewhat high blood pressure when they were about to get eaten by a wolf or when the temperature in the cave was a bit low?

My point is: Isn't the important thing to have a low blood pressure at rest, and aren't we supposed to have a higher blood pressure with stress? I'm starting to believe that some companies are more interested in selling meds than actually curing us..

Sorry..

[Mom2four85]

that's a tough question and one I asked my cardiologist recently - he told me occasional higher readings were nothing to worry about for me and my bp can be higher but I would say it's up to your personal physician because he's the one who physically sees you; especially if you've seen him awhile.

My concern with about treating HBP that isn't always high is then you have lower bp's as you listed and guess what? the meds may lower even more and will cause more symptoms, then they're going to have to treat the lower bp's with meds also...just seems counterproductive to me....but I'm not a doctor :P

[is_something_wrong]

sorry double posting. please delete this one ;)