Blood Pressure Fluctuations, Tinnitus, and Panic Disorders

Blood pressure fluctuations, tinnitus, and panic disorder?

Hello Doctor, thank you for taking the time to advise me.
A few months ago, I experienced an increase in blood pressure due to taking traditional Chinese medicine, which triggered a recurrence of my panic disorder (I have a history of this and have been on medication).
The tinnitus I have had for a long time has also become much louder (it was previously very mild).
Currently, I am struggling with these symptoms, which are affecting my daily life and sleep.
My blood pressure has been fluctuating, often accompanied by tinnitus, making me worry whether my blood pressure has risen again or if something else is wrong, leading to feelings of anxiety and restlessness.
During this period, I have been taking a heavier dose of medication for my panic disorder.
Before the increase in blood pressure from the Chinese medicine, my systolic pressure was maintained between 100-120 and diastolic pressure between 60-80 for about six to seven years.
Recently, after monitoring my blood pressure for about a month, I found that my current blood pressure readings are as follows:
In the morning: Blood pressure has been between 120-130 for about 10 days, and at other times, it has been between 110-120.

In the evening: Blood pressure has been between 120-130 for about 6 days, and at other times, it has been between 100-120.

I would like to ask the doctor:
1.
I understand that the standard for blood pressure is below 120/80.
Does this mean I have hypertension?
2.
When I measure my blood pressure immediately after getting up and urinating, the systolic pressure is about 10-15 points higher than when I measure it after drinking water, washing my face, and brushing my teeth (about 20 minutes after getting up).
Is this normal? When is the best time to measure in the morning?
3.
I notice that when I sit and wait for 5 minutes to measure (I tend to think about my blood pressure during this time), the numbers are higher (around the 120s).
However, if I walk around and then sit down to measure, the numbers are lower (sometimes differing by more than 10).
Is this normal? Should I trust the reading after sitting for five minutes or the one taken after walking?
4.
I have observed that measuring my systolic pressure while sitting back in a chair yields different results compared to sitting upright without back support, with the latter being lower.
Should I choose the data from the upright position?
5.
I have recently changed my psychiatric medication, and my blood pressure at night is higher than during the day, sometimes exceeding 120.
Could this indicate nocturnal hypertension?
6.
Sometimes, I notice a significant difference between the first and second measurements, with systolic pressure differing by more than 15.
Should I be particularly concerned about this?
7.
I usually measure my blood pressure during the day whenever I have a moment and find that my systolic pressure often ranges from 130-140.
If I am consistently above 130 throughout the day, am I already at risk of hypertension?
8.
My physical and mental condition is poor, with tinnitus fluctuating and blood pressure also varying (mainly systolic pressure).
If my systolic pressure remains between 120-130 long-term, what could be the consequences?
Thank you again for your help!

arun, 40~49 year old female. Ask Date: 2024/03/11

Dr. He Dongjin reply Cardiology

Hello, first of all, you do not have hypertension, and blood pressure fluctuations are normal, especially since you are aware of your panic issues, which can make the fluctuations more pronounced.
In this situation, a daytime systolic blood pressure of 130-140, with a usual range of 120-130, is acceptable.
There's no need to monitor your blood pressure further; let's focus on addressing the panic issues first.
Changhua Hospital cares about you.

Reply Date: 2024/03/11

More Info

Understanding blood pressure fluctuations, tinnitus, and panic disorders can be quite complex, especially when they interrelate. Based on your detailed account, let's address your concerns systematically.

1. Blood Pressure Levels: According to the American Heart Association, normal blood pressure is defined as less than 120/80 mmHg. Your readings of 120-130 systolic are at the upper limit of normal and may be classified as "elevated" or "stage 1 hypertension" depending on the diastolic reading. It’s important to monitor these levels consistently, as fluctuations can occur due to various factors, including stress, diet, and physical activity.

2. Morning Blood Pressure Measurement: It is common for blood pressure to be higher in the morning due to the body's natural circadian rhythms. The best practice is to measure your blood pressure at the same time each day, ideally after resting for at least five minutes. Measuring immediately after waking up can yield higher readings due to the body's transition from sleep to wakefulness.

3. Impact of Anxiety on Readings: Anxiety can significantly affect blood pressure readings. If you find that your blood pressure is higher when you are anxious or waiting, this is a normal physiological response. The best approach is to measure your blood pressure when you feel calm. If walking reduces your anxiety and provides a lower reading, it may be more reflective of your baseline.

4. Posture During Measurement: Blood pressure can vary based on your posture. Sitting upright without back support can sometimes yield lower readings compared to leaning back. Consistency in your measurement technique is crucial; choose one method and stick with it for accurate tracking.

5. Nocturnal Hypertension: If your evening blood pressure readings are consistently higher than your daytime readings, this could indicate nocturnal hypertension. It’s important to discuss this with your healthcare provider, as it may require further evaluation.

6. Variability in Readings: A difference of 15 mmHg or more between consecutive readings can be normal, especially if taken under different conditions (e.g., stress levels, time of day). However, if you notice significant variability consistently, it may be worth discussing with your doctor.

7. Concerns About Sustained High Readings: Consistently elevated readings (130-140 mmHg) can increase the risk of cardiovascular issues over time. It’s essential to manage these levels through lifestyle changes, medication, or both, as advised by your healthcare provider.

8. Long-term Effects of Fluctuating Blood Pressure: Chronic fluctuations in blood pressure, particularly if they trend towards higher levels, can lead to complications such as heart disease, stroke, and kidney damage. It’s crucial to address these fluctuations with your healthcare provider, especially given your history of panic disorder and tinnitus, which can exacerbate stress and anxiety.

In summary, it’s vital to maintain regular communication with your healthcare provider regarding your blood pressure, anxiety, and tinnitus. They may recommend lifestyle modifications, medication adjustments, or further diagnostic testing to ensure your overall health and well-being. Managing stress through techniques such as mindfulness, therapy, or relaxation exercises can also be beneficial in stabilizing both your blood pressure and mental health.

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