High Blood Pressure
Q: My mom has been on blood pressure meds since I was a teen, and I always have this lurking fear that she's going to have a heart attack or a stroke. I don't want my kids to grow up with the same fear, so I'm careful to eat right, exercise, and get regular checkups. But at my last visit, my doctor handed out the diagnosis I've been dreading: high blood pressure. My best friend is a nurse, so I asked her to take a reading and she said I'm perfectly fine. Could my doctor have misread my numbers?
Dr. Donnica: It's unlikely that your doctor or your friend misread your blood pressure; it's pretty easy to get an accurate reading once you know how. Three factors may explain the difference. First, blood pressure normally varies throughout the day. Second: there's a well known phenomenon called "white coat hypertension," a condition in which the anxiety of a doctor's visit--especially when worried about blood pressure--may increase your blood pressure temporarily. This may explain why you were "fine" when you were with that trusted friend. The third factor is a little trickier, since you didn't tell me your actual blood pressure numbers on either check. Traditionally, health care professionals have defined "high" blood pressure as a reading of 140 over 90 or greater. However, there is reason to believe that in healthy young women, "normal" blood pressure should be lower. Especially given your family history, your doctor may have a "better" goal for you than your friend and they may be interpreting the same reading with a different perspective. Your body position may also affect blood pressure readings. Studies show sitting in a chair with feet on the floor and arm held at heart-level gives a more accurate reading than sitting on an exam table with feet dangling. Even an overly-full bladder may impact that in-office check, since holding in urine can stimulate your involuntary nervous system and trigger a BP spike. To ensure the most accurate reading next time around, be sure that your doctor takes your blood pressure at the beginning and at the end of the visit. She should also take your blood pressure while you're lying down and then standing up to check if you have a condition called orthostatis (where your blood pressure changes based. If your in-office measurement is still too high, your physician may suggest charting your BP at home to arrive at your "real" average.
Donnica Moore, MD
Created: 7/24/2006  - Donnica Moore, M.D.