Inconsistently high blood pressure

[katastrophe]

This might be a bit of an essay, please stick with me!

In the last 2-3 years, every time I’ve had my blood pressure checked at the doctors or a hospital clinic it has been quite high (around 140/90). About a year ago I asked my GP about it as I have a strong family history of high BP (and stroke, as a result) and I was advised to buy a home blood pressure monitor and check three times a day for a week, which I did. The readings were slightly above average, but in the ok range (I think my average was 125/83, so my GP said it was likely just raised in clinic because of health anxiety, and to keep an eye on it going forward. I don’t think I have health anxiety, and up until 3 years ago I actually had consistently low blood pressure in clinic readings, but I was reassured that it was lower in my home readings, and didn’t think much more about it.

Last week during a trip to A&E (for sudden floaters/flashes in my eyes, I felt physically fine) it was initially read as 195/120 and triage nurse was a little concerned, particularly as I had visual symptoms. During my visit it dropped to 165/105 and then 133/99 on discharge, which they were happy with. Out of interest I took it on my home monitor when I got back (30 mins later) and it was 115/75.

So I have a lot of questions. Should I be concerned about the huge spike during a relatively untraumatic trauma? How would I know if my home monitor is accurate? And is it possible to have health anxiety without actually feeling anxious?

I’m not sure if I should raise it with my GP again, particularly as all my home readings have been fine. I don’t want to waste my time or his, but at the same time, I don’t want to miss something which could be a problem for me in the future, given my family history. Thank you if you made it all the way through that, and any advice would be gratefully received!

There's something called White Coat Hypertension - people develop high blood pressure as a physiological response to the stress of the doctor visit. I think it's fairly common.

If the GP is unconcerned, I wouldn't worry. If you keep taking your blood pressure at home, you will worry every time it's high, you will take it again, it will go higher, and around and around.

Just keep going to all your check-ups, and take steps to prevent high blood pressure - don't smoke, get exercise, good diet, keep a lid on the stress, normal weight, limit the alcohol, good sleep habits. Hope all goes well for you.

Thanks for your comment. White coat hypertension is what the GP said, but I’m confused because I don’t feel like I worry about my health and I don’t mind going to the doctors. I have a couple of long term conditions which are so mild they don’t even need treatment so my clinic appointments in the last few years have just been monitoring - nothing to worry about at all. Plus when I was first diagnosed 20 years ago and had lots of horrible, invasive testing that I did worry about, my BP was consistently low so it seems strange that would be the reason for it to be raised now?

I'm pretty sure that blood pressure increases with age.

And I wonder if it's possible that the stressful invasive testing in the past has sort of primed your body to react to a medical visit as if something stressful would occur even though you know rationally that it's just an ordinary visit.

I have the same issue and very similar readings, having had low blood pressure for years. It always amazes me that I can have 3 days of normal blood pressure readings then get these spikes where it’s too high.

I do know that if I’m dehydrated or not feeling great then it rises and it can also be a lot higher in the morning.

Perhaps you’re right! It’s just really odd. I don’t really see myself as an anxious person so it threw me off.

That’s interesting - mine also seem to be spikes, but consistently slightly raised on every medical visit.

I have just realised that my dad has a medical grade monitor as he’s had a lot of problems with his BP so I might try that one out next time I’m at their house to see if the one I bought is actually accurate. That will at least answer one of my questions!

A white coat effect isn't necessarily associated with feeling anxiety. I have noticed it is often health care professionals who have higher readings when consulting GP or nurse.

Ask if you can have a 24 hour monitor. DH had one recently from the pharmacy. Your GP surgery should offer it too.

Oh really? That’s how the doctor described it to me and I couldn’t help feeling like that didn’t describe me at all. So it could be the issue?

Thanks, I’ll look into this.

I am exactly the same. Am having a 24 hour monitor on Friday. GP not massively concerned, but DF died of a heart attack when 56, DM had a TIA at 58. Grandparents had heart issues including bypass surgery. Mine fluctuates massively and I get huge spikes. Let's see what Friday says.

Your reading in A&E was high, but came down fairly quickly before you left. That's a good sign. If you're dehydrated, poorly or stressed out, it's normal for your blood pressure to rise--it's making sure blood is reaching your essential organs. When the crisis resolves, it should go back down.

Most people will have some fluctuation throughout the day. Blood pressure tends to be lowest in the morning and rises throughout the day. It will have peaks when you exercise or after you eat, and valleys when you rest or have a hot bath.

The 24 hour monitor is useful for tracking those fluctuations throughout the day. What they are looking out for is a pattern where the blood pressure doesn't go back down to a normal range. So hovering around 150/100 the whole time is more worrying than a single reading of 160/120 that resolves itself.

Hopefully the doctor can get you a 24 hour monitor and set your mind at ease. Keep hydrated and avoid too much salt in the meantime and no licorice.

Thanks - that’s really helpful.

Oh good luck with it. I hope you get some answers.

I’m the same, lots of family history with strokes and cardiac issues in 50s/60s. I’m early 40s so if there is going to be an issue I’m hoping to get ahead of it before it gets to that stage rather that waiting to see if things get bad.

Thank you, this is reassuring. I’ll speak to my doctor about a 24hr monitor when I can.

I'm exactly the same, OP. Was told to take home readings but they started going up from the stress of it!!

I know that one! 😄

@AIfunguy I also found the 24 hour monitor stressed me out! Got a shock every time it went off and hardly got any sleep, which probably isn't ideal for BP

@katastrophe Just to let you know that I took my 24 hour monitor back today. My average BP over the day was 122/72. I almost fell off the chair when he told me. Definitely worth you getting one as it may reassure you.

That’s brilliant new, I bet you’re relieved.

If I ever manage to get through to the doctors, I’m going to ask about one.

@katastrophe you should be able to get one from a pharmacy if you meet the criteria. This is the criteria my local pharmacy use:

Patients eligible for this service are as follows:
1)Adults aged 40 years old or over, who do not have a current diagnosis of high blood pressure. (Patients aged between 35 and 39 may also access this service at the discretion of the pharmacist on duty.)
2)Adults of any age, who do not have a current diagnosis of high blood pressure, but who have a family history of high blood pressure.
3)Adults of any age, with or without a diagnosis of high blood pressure, referred for a one-off blood pressure check by their GP practice or optician.
4)Adults of any age, with or without a diagnosis of high blood pressure, referred for 24 hour blood pressure monitoring by their GP practice.