the Connection Between Anxiety and High Blood Pressure: A Patient's Journey

I hope to gain a better understanding of my body's condition?

Hello Doctor: In December 2009, I measured my blood pressure and found it to be very high, around 200.
I was suddenly alarmed and rushed to the hospital for treatment.
I work in sales and had no prior issues, though I smoked for 10 years but quit a year ago.
My weight is relatively high, around 84 kg at a height of 164 cm, and there is no family history of hypertension.
After being admitted to the hospital, I underwent an electrocardiogram, blood tests, and an echocardiogram, which revealed mitral valve prolapse.
I was then prescribed 5 mg of a medication (likely a beta-blocker) to take once daily.
However, this led to increased tension and anxiety, so I was also prescribed Xanax 0.25 mg to take once in the morning and once at night.
Over two months, I lost weight, dropping to around 65 kg, and started walking for exercise.

In February of this year, after not taking my anxiety medication, I suddenly experienced chest tightness, shaking, difficulty breathing, and tension, causing my blood pressure to spike to 190, prompting another emergency visit.
The doctor administered an injection, and after lying down for about 30 minutes, my blood pressure dropped to 140, allowing me to be discharged.
Since then, I have continued taking my medication without daring to stop.
Recently, in April, my blood pressure averaged around 123/85 (with a low of 116/76 and a high of 140/95), which fluctuates.
I discussed with my doctor the possibility of reducing or stopping the medication, and the doctor agreed.
However, after stopping the medication, my blood pressure has gradually increased again, ranging from 130/85 to 147/98 (I also reduced my anxiety medication by half a dose, but experienced a resurgence of anxiety symptoms, so I resumed taking it after three days).

Questions:
1.
Did I stop the medication too quickly? Is it okay to take 4.1 mg of blood pressure medication now?
2.
Is high blood pressure causing my anxiety, or is my anxiety causing high blood pressure?
3.
Should I undergo more detailed examinations?
I would appreciate your guidance.
Thank you.

A-Hua, 30~39 year old female. Ask Date: 2010/05/27

Dr. He Dongjin reply Cardiology

Dear Ah-Hua, I believe that the instability in blood pressure is likely caused by anxiety.
Could you please suggest to the doctor to adjust the dosage of Concan (0.5 mg) and to prescribe half a dose of an anti-anxiety medication? I think the situation could improve.
Changhua Hospital cares about you.

Reply Date: 2010/05/27

More Info

Understanding the connection between anxiety and high blood pressure is a complex issue that many patients face, as evidenced by your journey. It is essential to recognize that anxiety and hypertension can significantly influence each other, creating a cycle that can be challenging to break.

Firstly, it is important to understand that anxiety can lead to physiological changes in the body, including increased heart rate and elevated blood pressure. When you experience anxiety, your body releases stress hormones like adrenaline, which can cause your heart to beat faster and your blood vessels to constrict, leading to higher blood pressure. This is often referred to as the "fight or flight" response. In your case, when you first discovered your high blood pressure, the shock and fear likely exacerbated your anxiety, creating a feedback loop where anxiety led to higher blood pressure, which in turn increased your anxiety.

Your history of smoking, although you have quit, may have also contributed to your initial hypertension. Smoking is known to damage blood vessels and increase heart rate, which can lead to elevated blood pressure. However, your weight and lifestyle changes, such as exercising and losing weight, are positive steps toward managing both your blood pressure and anxiety.

Regarding your medication, it is crucial to follow your doctor's advice when it comes to adjusting dosages. Stopping medication suddenly or reducing the dose too quickly can lead to withdrawal symptoms or a resurgence of anxiety, which may explain your recent spikes in blood pressure. It is generally recommended to taper off medications gradually under a physician's supervision to minimize these risks. If you are currently taking half a dose of your blood pressure medication and experiencing fluctuations in your readings, it may be wise to consult your doctor about possibly returning to a full dose or finding a suitable alternative.

As for the question of whether high blood pressure causes anxiety or vice versa, the relationship is often bidirectional. High blood pressure can lead to anxiety due to health concerns and the fear of potential complications, while anxiety can cause spikes in blood pressure due to the physiological responses mentioned earlier. This interplay can create a challenging situation for patients, as managing one condition may inadvertently affect the other.

In terms of further evaluations, if your blood pressure remains elevated or if you experience new or worsening symptoms, it may be prudent to undergo additional testing. This could include monitoring your blood pressure over a 24-hour period (ambulatory blood pressure monitoring) to get a clearer picture of your blood pressure fluctuations throughout the day and night. Additionally, further cardiac evaluations, such as an echocardiogram or stress test, may be warranted, especially given your history of mitral valve prolapse and episodes of chest discomfort.

In conclusion, managing anxiety and high blood pressure requires a comprehensive approach that includes medication management, lifestyle changes, and possibly therapy to address anxiety. Regular follow-ups with your healthcare provider are essential to monitor your progress and make necessary adjustments to your treatment plan. Remember, you are not alone in this journey, and many patients experience similar challenges. Seeking support from mental health professionals can also be beneficial in developing coping strategies for anxiety, which may, in turn, help stabilize your blood pressure.

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