Managing Anxiety, Heart Palpitations, and High Blood Pressure: A Guide

Cardiac issues, blood pressure, anxiety, and panic disorder?

Dear Doctor, I have generalized anxiety disorder, autonomic nervous system dysregulation, and panic disorder.
Over the past two years, I have experienced episodes of tachycardia (suspected to be anxiety-related) that did not occur in the previous five years.
During these episodes, my heart rate accelerates, and I feel weak and fatigued.
I have also noticed that by suddenly shifting my focus or goal, my heart rate gradually decreases.
My heart rate often approaches 100 bpm.
I have worn a 24-hour Holter monitor, but no issues were detected.
My blood pressure is consistently above 140/110 mmHg (without taking any antiarrhythmic medication).
When I experience palpitations or impending tachycardia, I quickly take Entresto (10 mg, once or twice).
I would like to ask the doctor if my blood pressure indicates hypertension or if it is anxiety-induced, and whether I need medication to control it.
What should I do in case of an emergency during a tachycardia episode? Could this blood pressure lead to other issues, such as stroke or shock? I have the medications prescribed by my neurologist on hand and only take them when I feel unwell.
My prescribed medications are Entresto 10 mg three times a day, Xanax 0.25 mg twice a day, and Klonopin once a day.
I have been dealing with these conditions for seven years.

Long Tairang, 30~39 year old female. Ask Date: 2016/05/23

Dr. Ding Shuyan reply Psychiatry

Hello, the medication prescribed by the doctor is very effective.
You need to take it regularly every day, especially the Kiyu fruit.
After about a month, you will see the results, and you will regret having suffered from illness for these past few years! It turns out that the medication is so useful! Wishing you all the best.
Sincerely, Dr.
Ding Shuo-Yan.

Reply Date: 2016/05/23

More Info

Managing anxiety, heart palpitations, and high blood pressure can be a complex and challenging process, especially for individuals with a history of anxiety disorders and panic attacks. Your situation, characterized by generalized anxiety disorder, autonomic nervous system dysregulation, and episodes of tachycardia, requires a comprehensive approach that addresses both the psychological and physiological aspects of your health.

Understanding Your Blood Pressure and Heart Rate
Based on the information provided, your blood pressure readings of 140/110 mmHg indicate that you are experiencing hypertension. According to the American Heart Association, hypertension is defined as having a blood pressure reading of 130/80 mmHg or higher. Therefore, your readings do classify you as having high blood pressure, which can be exacerbated by anxiety and stress.

The Connection Between Anxiety and Hypertension
Anxiety can significantly impact your cardiovascular health. When you experience anxiety or panic attacks, your body enters a "fight or flight" mode, leading to the release of stress hormones like adrenaline. This response can cause an increase in heart rate and blood pressure. In your case, the episodes of tachycardia (rapid heart rate) and feelings of weakness may be directly related to your anxiety levels. It is important to recognize that while anxiety can cause temporary spikes in blood pressure, chronic hypertension can lead to serious health issues, including stroke and heart disease.

Managing Anxiety and Blood Pressure
1. Medication Management: It appears you are already on medications such as Entresto (sacubitril/valsartan), which is typically used for heart failure but may also help with blood pressure management. However, it is crucial to discuss with your healthcare provider whether your current medication regimen is appropriate for your specific situation. You may need adjustments or additional medications to better control your blood pressure.

2. Lifestyle Modifications: Incorporating lifestyle changes can significantly improve both anxiety and hypertension. Regular physical activity, a balanced diet low in sodium and rich in fruits and vegetables, adequate hydration, and sufficient sleep are essential. Mindfulness practices such as yoga, meditation, and deep-breathing exercises can also help reduce anxiety and stabilize blood pressure.

3. Cognitive Behavioral Therapy (CBT): Engaging in therapy, particularly CBT, can be beneficial in managing anxiety. This type of therapy helps you identify and change negative thought patterns and behaviors that contribute to anxiety and panic attacks.

4. Monitoring and Emergency Response: Since you have experienced episodes of tachycardia, it is essential to have a plan in place for managing these situations. When you feel your heart racing, try to practice deep-breathing techniques or grounding exercises to help calm your nervous system. If your heart rate does not stabilize or if you experience severe symptoms, seek medical attention immediately.

5. Regular Check-Ups: Regular follow-ups with your healthcare provider are crucial for monitoring your blood pressure and overall health. Discuss any changes in your symptoms or concerns about your medications during these visits.

Potential Risks
Your elevated blood pressure, if left unmanaged, can indeed lead to serious complications such as stroke, heart attack, or other cardiovascular issues. It is vital to address both the psychological aspects of your anxiety and the physiological aspects of your hypertension to reduce these risks effectively.

Conclusion
Managing anxiety, heart palpitations, and high blood pressure requires a multifaceted approach that includes medication, lifestyle changes, therapy, and regular monitoring. It is essential to work closely with your healthcare provider to develop a personalized plan that addresses both your mental and physical health needs. By taking proactive steps, you can improve your quality of life and reduce the risk of serious health complications.

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