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Hi, My Question Has To Do With Blood Pressure And

Posted on Sun, 29 Mar 2020

Question: Hi, my question has to do with blood pressure and anxiety. I have had an anxiety disorder for 30 years or so (I am 73). Part of it is White Coat Syndrome, which makes me very anxious around hospitals, doctors, etc. One of the ways the anxiety manifests itself is with elevated blood pressure reading when it is measured during a doctor's visit. My blood pressure is normal (approx. 135/75) when I measure myself it at home. When my physician, or anyone else measures it, or if I am having a procedure like a colonoscopy, it can be as high as 195/100, depending upon how anxious I am. I do use Xanax, which is helpful, but unless I take enough sedative to be very sleepy, the BP can still be quite elevated. After the procedure, if I check it at home, it again returns to normal within a day or so. This has been ongoing for decades and I have actually developed a conditioned response to having my BP measured. I am about to have an endoscopy done in about a week, and I am concerned about the elevated BP. Is this situation potentially dangerous, and is there anything I can do about it?

Follow up: Dr. Ilir Sharka (0 minute later)

Hi, my question has to do with blood pressure and anxiety. I have had an anxiety disorder for 30 years or so (I am 73). Part of it is White Coat Syndrome, which makes me very anxious around hospitals, doctors, etc. One of the ways the anxiety manifests itself is with elevated blood pressure reading when it is measured during a doctor's visit. My blood pressure is normal (approx. 135/75) when I measure myself it at home. When my physician, or anyone else measures it, or if I am having a procedure like a colonoscopy, it can be as high as 195/100, depending upon how anxious I am. I do use Xanax, which is helpful, but unless I take enough sedative to be very sleepy, the BP can still be quite elevated. After the procedure, if I check it at home, it again returns to normal within a day or so. This has been ongoing for decades and I have actually developed a conditioned response to having my BP measured. I am about to have an endoscopy done in about a week, and I am concerned about the elevated BP. Is this situation potentially dangerous, and is there anything I can do about it?

Answered by Dr. Ilir Sharka (57 minutes later)

Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Welcome to Ask a Doctor service!

I passed carefully through your question and would explain that these spikes in blood pressure values due to White Coat Syndrome are not harmful and don't need to be treated.

If your blood pressure values are normal most of the time, there is no reason to panic.

Anyway, I agree with you that these spikes may be harmful during medical procedures like endoscopy.

For this reason, one possible treatment option would be Xanax.

Another treatment option would be a betablocker before the procedure like propranolol 40mg.

You should know that propranolol can help reduce anxiety and also reduce the heart rate and blood pressure values.

Besides, during the procedure you will also be on a superficial anesthesia, to help reduce the discomfort and the pain.

I would also recommend avoiding caffeine and salt intake in order to reduce blood pressure values.

Hope you will find this answer helpful!

I remain at your disposal for any further questions whenever you need!

Kind regards,

Dr.Ilir Sharka Cardiologist

Above answer was peer-reviewed by : Dr. Prasad

Answered by Dr. Ilir Sharka (0 minute later)

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ilir Sharka (43 hours later)

Hi, Dr Sharka,
I believe you answered my earlier question (Feb 6, 2020) about anxiety and blood pressure. I was looking for a second opinion. Are there any other specialists available to answer the same question, or did you consult with any of your colleagues about the answer you provided?

Thanks,
Bob Burton

Follow up: Dr. Ilir Sharka (0 minute later)

Answered by Dr. Ilir Sharka (3 hours later)

Brief Answer:
My answer as follows:

Detailed Answer:
Dear XXXXXXX

Although I am a specialist of this field with many years of experience, before answering to your question, I consulted with other colleagues and the specific medical literature, related to your medical problem.

If you have any other questions, please don't hesitate to me again!

Hope to have answers to your query!

Wishing good health,

Dr.Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar