HIgh Diastolic Pressure

[theolocke]

I am a 31 year old male, 6'4, 195lbs.  I visited a cardiologist in April because of palpitations during exercise.  I had an echo done: trace mitral and tricuspid inefficiency, EF 53%, borderline global hypokinesis (my left ventricular motion is borderline reduced, but structurally normal), sinus tachycardia (I was nervous and I have anxiety).  I had a stress test: Duke treadmill score of 12.5, no significant ischemic ECG changes, resting ECG nonspecific ST wave abnormalities, my HR was high the whole time but maxed out at 203.  I am also hypertensive.  Overall, the doctor said I was fine, he put me on 10mg of Ramipril for my BP.  Two months later I went the emergency room with palpitations during exercise.  Chest x-ray was fine, blood chemistry was fine: sodium 139, potassium 3.6.  During the palpitations I stopped running, in front of my house, and took my blood pressure 189/105.  This time my cardiologist put me on an event monitor.  During the 30 days I had a few PVC's.  He said that was all, but when I flipped through the readings, I also spotted an atrial contraction and narrow complex tachycardia (that occurred while I was running).  My cholesterol came back fine: total 175, HDL 51, LDL 98. I told him that my diastolic sometimes reads high, and my systolic was high in the office, so he put me on 12.5mg of HCTZ, wants me back in 30 with blood chemistry.  Yesterday I was walking vigorously: HR was around 135, bp was 175/101 after I stopped, I felt very anxious.  Is narrow complex tachycardia equivalent to SVT?  If so why didn't he mention it, is it normal for exercising?  Why is my diastolic bp so unstable; I use the machine while standing; is it less accurate standing, and right after jogging?  Am I going to need more tests, or am I being overly anxious about all of this?  I honestly am thinking that I might be a hypochondriac and am considering therapy, I have anxiety issues, but at the same time am worried that something really is wrong.            

[is_something_wrong]

Just be aware that blood pressure readings during exercise (especially if some anxiety is present) can't by any means be compared with blood pressure readings at rest.

On my stress EKG test, my blood pressure changed from 120/80 during rest, to 210/90 at max work load with heart rate of 210 (yes, both the heart rate and the syst BP was 210 for some reason).

Just being anxious about the blood pressure readings can increase the syst BP by 20-25 mmHg (in my case). When I measure my BP (if I'm a bit stressed) I think "oh no, I'm sure it's at least 170, this can't be good!" It turns out to be 140/80. If I measure it again a minute later it's usually 115/70.

This is how our body works. It's really like an engine. You can increase the RPM to 6000 if you need to speed up quickly, but you shouldn't drive at 6000 RPM constantly. We can (and should) increase our heart rate and blood pressure during exercise, but we shouldn't have elevated levels constantly.

[Cleveland Clinic]

It's normal to have sinus tachycardia during exercise.  It is also normal to have some elevation in BP during exercise as well.  Beceause you have HTN as such a young age you should secondary screening looking for atypical causes.  Your doctor should do a full workup for that.  If he doens't I recommend seeing a kidney doctor (nephrologist).  They specialize in secondary causes of HTN.  I think you do have some anxiety about this, but so would I if I were 31 with such high BP. Your heart function is normal and I wouldn't be concerned about the extra heart beats.  Those are normal as well.  It is however so important that you get your BP under control as soon as possible.  Get it sorted out.  See a specialist.

[theolocke]

I should also mention that normally my resting BP, on the meds and not at the doctor's office, is around 115/65.