Blood Pressure Variability: When to Worry About Hypertension?

How to determine if you have high blood pressure?

Hello, Doctor.
Six months ago, during a hospital visit, my blood pressure was measured at around 140/90.
The doctor advised me to monitor my blood pressure daily at home.
I measure it in the morning after waking up, before going to bed at night, and occasionally during the day when I have time.
Based on the data I've collected over the past two weeks, my morning and evening blood pressure readings are about 115/75.
However, I've noticed that during other times of the day, my readings can sometimes be as high as 130-150/75-90, and this occurs quite frequently.
This leaves me uncertain about whether I have a blood pressure issue.
Logically, if 130-150 is a common reading throughout the day, should this be considered my baseline, or do medical guidelines prioritize morning and evening readings? What is the difference between a medical diagnosis of "hypertension" and normal "blood pressure fluctuations"? I am quite worried about my blood pressure.
I have also heard that it's best to measure blood pressure in both arms.
I found that when sitting, the difference between my arms is minimal, around 5-10 mmHg; however, when lying down, the difference can be nearly 20 mmHg.
I'm unsure why this happens and whether it is something to be concerned about.
Additionally, I recently measured a diastolic pressure around 120, while the systolic pressure was 85-90.
I'm not sure why this is the case.
I apologize for taking up your time with these questions.
Lastly, although I have undergone many tests—ultrasound, ECG, X-rays, auscultation, and blood tests—all of which were normal, the doctor mentioned I have mild mitral valve prolapse, which is not a concern and does not require medication.
However, I have recently felt that when walking outside, I become easily fatigued and feel like I can't continue after just a few steps.
I'm unsure if this is considered shortness of breath or hyperventilation, as I feel tightness in my nose and have difficulty breathing.
I often worry that I might faint while walking, and I feel my stamina is declining.
My heart rate is usually normal, but I feel my heart racing after climbing just two flights of stairs, and I even experience slight dizziness.
I'm not sure why this happens.
Is it because my blood isn't circulating properly or responding quickly enough?
Recently, I've been doing a popular exercise called "super slow jogging" at home for 30-40 minutes daily, and I feel comfortable during this exercise.
This makes me wonder why I feel discomfort when walking outside or climbing stairs but not during jogging in place.
I would like to know how I can improve this situation, as it has been troubling me for a long time.
Thank you, Doctor, for your assistance!

Niming, 30~39 year old female. Ask Date: 2023/02/16

Dr. He Dongjin reply Cardiology

Hello, measuring your blood pressure in the morning and evening is sufficient.
It's normal for your readings to fluctuate throughout the day due to activity.
If you measure too frequently, it may cause anxiety and lead to dysregulation of your autonomic nervous system.
You've already undergone many tests, including ultrasound, electrocardiogram, X-rays, auscultation, and blood tests, all of which showed no issues, so try not to worry too much.
A systolic pressure of 85-90 and a diastolic pressure of 120 must indicate a problem with the machine; it's unlikely to feel unwell after jogging for 30-40 minutes, so continue with that.
If you experience discomfort while walking outside or climbing stairs, it might be due to anxiety and constant worrying, which can indeed lead to feelings of discomfort.
Therefore, try not to overthink things.
Relax and enjoy your life.
Take care from Changhua Hospital.

Reply Date: 2023/02/16

More Info

Understanding blood pressure variability is crucial for assessing cardiovascular health and determining when to worry about hypertension. Your experience of fluctuating blood pressure readings can be concerning, especially when you observe significant differences between measurements taken at different times of the day.
Firstly, it's important to understand that blood pressure naturally varies throughout the day due to several factors, including physical activity, stress, diet, and even the time of day. The readings you provided indicate that your morning and evening blood pressure is around 115/75 mmHg, which is generally considered normal. However, the occasional spikes to 130-150/75-90 mmHg during other times can be indicative of what is known as "white coat syndrome" or anxiety-related hypertension, especially if these readings are associated with stress or anxiety about measuring your blood pressure.

In clinical practice, a diagnosis of hypertension is typically based on consistent readings taken over time. The American Heart Association defines hypertension as having a systolic blood pressure (the top number) of 130 mmHg or higher or a diastolic blood pressure (the bottom number) of 80 mmHg or higher. Therefore, if your readings frequently exceed these thresholds, it may warrant further investigation and possibly lifestyle modifications or medication.

Regarding your question about which readings to consider as "normal," it is essential to look at the overall pattern rather than isolated readings. If your morning and evening readings are consistently normal, but you experience occasional spikes, it may not necessarily indicate a chronic hypertension issue. However, if you find that the higher readings become more frequent or are accompanied by symptoms such as headaches, dizziness, or shortness of breath, it would be prudent to consult a healthcare professional.

The difference in blood pressure readings between your left and right arms, particularly when lying down, can be attributed to several factors, including anatomical variations or vascular issues. A difference of 5-10 mmHg is generally considered normal, but a difference of 20 mmHg or more may require further evaluation to rule out any underlying vascular problems.

The unusual finding of a diastolic pressure of 120 mmHg with a systolic pressure of 85-90 mmHg is concerning and could indicate a condition known as isolated diastolic hypertension, which can be associated with increased cardiovascular risk. This scenario should be discussed with your healthcare provider for appropriate assessment and management.

Your symptoms of feeling fatigued, experiencing shortness of breath, and having a rapid heartbeat after minimal exertion could be related to several factors, including anxiety, deconditioning, or even cardiovascular issues. It is interesting to note that you feel comfortable while doing "super slow jogging," which suggests that your cardiovascular system can handle aerobic exercise but may react differently to other forms of exertion, such as walking or climbing stairs. This discrepancy could be due to anxiety or a lack of confidence in your physical abilities, leading to a heightened perception of exertion.

To improve your situation, consider the following recommendations:
1. Regular Monitoring: Continue to monitor your blood pressure at different times of the day, but try to do so in a relaxed state. Avoid measuring it when you are feeling anxious or stressed.

2. Lifestyle Modifications: Incorporate regular physical activity, maintain a balanced diet low in sodium, and manage stress through relaxation techniques such as deep breathing, yoga, or meditation.

3. Consult a Healthcare Provider: Given your symptoms and the variability in your blood pressure readings, it would be wise to discuss your concerns with a healthcare provider. They may recommend further testing or adjustments to your current management plan.

4. Avoid Self-Diagnosis: While it is good to be informed, avoid jumping to conclusions based on isolated symptoms or readings. A healthcare professional can provide a comprehensive evaluation and appropriate guidance.

In summary, while occasional spikes in blood pressure can be concerning, they do not always indicate a chronic problem. Monitoring your overall patterns, understanding the factors that influence your readings, and seeking professional advice will help you manage your health effectively.

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