Should You Return to the Doctor for Elevated Blood Pressure Readings?

Should I return for a follow-up if my hypertension spikes significantly?

Hello Doctor: I have been taking antihypertensive medication and measuring my blood pressure regularly in the morning and evening for over a year.
My highest readings have been around 130s/80s.
However, I started feeling something was off on the evening of January 5th when I measured 136/83, which seemed high, and upon measuring again, the systolic pressure jumped to the 150s.
This caused me anxiety (as it has already affected my kidney function, I am particularly concerned about elevated readings).
The next morning, January 6th, when I measured my blood pressure, I felt overwhelmed when the cuff inflated (similar to white coat syndrome), and the reading soared to 180s/90s.
This only happens when I measure at the hospital during follow-up visits.
Now, my readings at home have also been elevated, which is quite distressing.
In the following days, I tried to measure multiple times daily (attempting to mentally accept the inflation of the cuff) and occasionally took half a tablet of Alprazolam to calm my nerves.
As of this morning, January 9th, my readings were 175/101/69, and after resting for five minutes, the reading was 144/99/68.
Therefore, I would like to ask the doctor...
1.
Given this situation, should I return for a follow-up to adjust my medication? I just had a follow-up on January 4th, and there were no significant issues with my blood pressure, so my medication remained unchanged.
2.
Should I wait for the weather to warm up in the next few days before trying again? Especially since a cold front has hit today, January 9th.
Thank you! Medication list: Hypertension: 1.
Carvedilol ==> half a tablet in the morning and evening 2.
Amlodipine ==> half a tablet in the morning Hyperlipidemia: Lovastatin ==> one tablet in the evening Diabetes: Metformin ==> half a tablet in the morning Myocardial infarction prevention: Aspirin ==> one tablet in the morning.

josephy, 40~49 year old female. Ask Date: 2018/01/09

Dr. He Dongjin reply Cardiology

Hello, due to your fear of elevated values, measuring your blood pressure may increase your anxiety.
It is recommended that you refrain from measuring your blood pressure for now.
If you are still concerned, you can adjust your Carvedilol dosage from half a tablet in the morning and evening to one tablet in the morning and one tablet in the evening.
There should be no need for a follow-up appointment for medication adjustment.
Take care from Changhua Hospital.

Reply Date: 2018/01/09

More Info

It sounds like you're experiencing a concerning situation with your blood pressure readings, especially given your history of hypertension and the medications you are taking. Let's break down your situation and address your questions.

Firstly, it's important to recognize that blood pressure can fluctuate due to various factors, including stress, anxiety, weather changes, and even the time of day. The phenomenon you're experiencing, often referred to as "white coat syndrome," occurs when patients exhibit elevated blood pressure readings in a clinical setting due to anxiety about being in a doctor's office. This can lead to a cycle of worry and further elevated readings.

Given your recent readings, particularly the spike to 175/101 mmHg, it is advisable to consult your doctor sooner rather than later. Here are a few reasons why:
1. Medication Adjustment: Your current medications may need to be reassessed. Since you mentioned that your blood pressure was stable before and has now increased, it could indicate that your current regimen is no longer sufficient. Your doctor may consider adjusting the dosage or adding a new medication to better control your blood pressure.

2. Monitoring for Complications: Elevated blood pressure can lead to complications, especially concerning your kidney function, which you noted has already been affected. Regular monitoring and timely intervention are crucial to prevent further damage.

3. Psychological Factors: The anxiety you are experiencing about your blood pressure readings can create a feedback loop that exacerbates the situation. Discussing this with your doctor can help you explore strategies to manage anxiety, such as relaxation techniques or possibly adjusting your medication for anxiety if deemed appropriate.

4. Environmental Factors: You mentioned that the weather has been cold, which can also influence blood pressure. Cold weather can cause blood vessels to constrict, leading to higher blood pressure readings. However, this should not be the sole reason to delay seeking medical advice, especially if your readings remain high.

5. Home Monitoring: Continue to monitor your blood pressure at home, but ensure you are doing so under optimal conditions. Sit quietly for at least five minutes before taking a reading, and try to measure at the same times each day. Keep a log of your readings to share with your doctor, as this can provide valuable insight into your blood pressure patterns.

In conclusion, given the significant changes in your blood pressure readings and the potential implications for your health, it is prudent to schedule an appointment with your healthcare provider. They can provide a comprehensive evaluation and determine the best course of action to manage your hypertension effectively. Remember, managing high blood pressure is a collaborative effort between you and your healthcare team, and timely communication is key to achieving optimal health outcomes.

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