Nervous blood pressure
May 30, 2013 12:58 PM   Subscribe

YANMD. My husband gets very nervous at the doctor, and as a result, even for a routine check up, has very high blood pressure every time the doctor takes it.

He is very fit, exercises often, eats well, and has no risk factors for high blood pressure, so he's fairly certain that being terrified of the doctor's office is the problem.

Should we investigate it further anyway, or is being nervous a real factor in blood pressure? Are there things he could be doing to make him LESS nervous before having his blood pressure taken?

For the record, he's 63 years old, 6 feet tall, 175 lbs.
posted by roomthreeseventeen to Health & Fitness (33 answers total) 2 users marked this as a favorite
Does he talk to the doctor about his nerves?
posted by sweetkid at 12:59 PM on May 30, 2013

Borrow a home BP cuff and take it at home when he's relaxed?
posted by dgeiser13 at 12:59 PM on May 30, 2013 [4 favorites]

Hello White Coat Syndrome. I have it.

Buy an at home Blood Pressure Monitor and keep track of his blood pressure over the course of a month. About the same time every day.

Give the log to your doctor, that's good info.
posted by Ruthless Bunny at 1:00 PM on May 30, 2013 [17 favorites]

Spring for a blood pressure meter (sphygmomanometer ) at your local pharmacy--they are relatively inexpensive and fairly reliable. You will get a reliable reading if you take it at the same time every day--best upon rising, sitting for 5 minutes in a place where one is relaxed. Very simple--I would be surprised if he is hypertensive--you will soon find out.
posted by rmhsinc at 1:03 PM on May 30, 2013

Oops, not to babysit, the latest incident of this happened this morning. His doctor told him that we might want to go to a pharmacy and buy a meter and do it at home.
posted by roomthreeseventeen at 1:06 PM on May 30, 2013

There are also meters you can use for free at most pharmacies. I found that taking it once while nervous, then concentrating on taking some deep breaths and relaxing, then taking it again, yielded a significantly lower result.

Similarly, when they take it now at the doctor's, I close my eyes and concentrate on my breathing, and my readings are much lower than they used to be. Not saying that would work for everyone, but something that simple made a big difference for me.
posted by drjimmy11 at 1:08 PM on May 30, 2013 [1 favorite]

He needs to be seated properly and comfortably while any reading is done, arm in the right position and back and feet supported to allow a relaxed posture and deep breathing, and he should be seated that way for several minutes before the measurement. This is supposed to be standard practice but more often than not when I go to the doctor there is something sub-par about the environmental conditions that can cause a little discomfort or anxiety, but that would probably only make him borderline hypertensive; if the reading is seriously high, start considering that it's more than nerves.

But fit, thin people who eat well can be hypertensive, too - sometimes it's a kidney issue or just genetic. It has happened to me and I'm female and decades younger than your husband.
posted by slow graffiti at 1:10 PM on May 30, 2013 [2 favorites]

Should we investigate it further anyway, or is being nervous a real factor in blood pressure?

Being nervous is definitely a factor. My normal blood pressure is 110/70, but I've had a couple of (minor!) medical procedures done in the last year, and my BP was 140/something both times due to being a little stressed out about the procedures.
posted by Blue Jello Elf at 1:12 PM on May 30, 2013

At the doctor's office my blood pressure gets taken three times per visit because of this. Once by the assistant, then by the doctor when he comes in, and again by the doctor once we've taken care of the visit purpose by which point my pressure has normally gone down.
posted by fluffy battle kitten at 1:13 PM on May 30, 2013

Being nervous is definitely a factor. I was at the Dr today and the nurse told me I had fantastic blood pressure and that most people in my circumstance have higher blood pressure because they are nervous. My husband once went to the doctor thinking he was having a stroke and his blood pressure was through the roof because he was so upset.

Try going to a drugstore that has a blood pressure cuff. Maybe that will help.
posted by bananafish at 1:15 PM on May 30, 2013

I normally measure around 110/70 to 115/75 at home. At a doctor's office, it's 145/90. It's definitely called White Coat Syndrome. The general recc you got is a good one. Get an at-home cuff. The wrist ones by Omicron are cost effective and generally more accurate than the bicep ones.

Measure once or twice a day after he's been sitting and generally relaxed for 15 minutes. Keep a log. Figure out his averages. They should be fine.

Give the log to the doctor when he next visits. The log should be fine for ongoing discussion. Maybe keep at it by measuring once every couple weeks afterwards and just keep an eye on it.
posted by kalessin at 1:20 PM on May 30, 2013

Not to pile on, but this used to happen to my dad (when he was the age I am now, I just realized...crap). The problem is he definitely had high blood pressure -- but they could never tell if it was getting any better because of his nerves So we got one for home, which gave them a more accurate baseline.

I'd go with the doctor's suggestion and get a home cuff; they are super easy to use these days -- much easier than when my dad was doing it.
posted by MCMikeNamara at 1:24 PM on May 30, 2013 [1 favorite]

My mom gets hardcore White Coat Syndrome. We are a low blood pressure having family, but when she sets foot in the office, hers spikes. (It doesn't help, of course, that 99% of the time she's showing up to the appointment late and rushed and stressed about being late and rushed.)

So they take her BP at the beginning of the appointment and again once the appointment is over and she's packed up and ready to leave. One of them is always normal. Guess which one it is.

Have him ask them to take it twice, one at the end of the appointment.
posted by phunniemee at 1:26 PM on May 30, 2013 [1 favorite]

At the doctor's office my blood pressure gets taken three times per visit because of this. Once by the assistant, then by the doctor when he comes in, and again by the doctor once we've taken care of the visit purpose by which point my pressure has normally gone down.

This is true for me as well. As an aside, mine is always MUCH higher when the tech takes it than when the doctor does. I think that's a separate issue from nerves -- the doctor says that the techs don't often listen long enough. (Not really sure what she means, but she always gets a different, and better reading, than they do.)
posted by mudpuppie at 1:26 PM on May 30, 2013

I've had strangely high blood pressure readings due to anxiety, too. Now that I'm aware of it, I always alert the nurse who's taking my blood pressure that I get nervous, and if it's high or shows a marked increase from my last visit, the doctor will typically take it again at the end of the appointment for a more accurate reading.

Never once has this been an issue, and in fact, I only learned it was possible to get a second reading when a nurse asked if I was upset and offered to do the test again. My impression was that this is a fairly common thing.
posted by serialcomma at 1:41 PM on May 30, 2013

The blood pressure measurement machines in drugstores and the like aren't always accurate - I had a bout of high blood pressure for a bit and did some reading and found out that they need to be recalibrated periodically and usually this doesn't happen with those machines.

I bought an electronic blood pressure cuff for $50 at a pharmacy (it was the best-rated one from Consumer Reports) and I bring it in to the doctor with me sometimes and compare their measurement to its measurement to make sure it's working correctly.
posted by needs more cowbell at 1:44 PM on May 30, 2013

Ask Well at the NYT recently had this to say about it.
posted by Violet Hour at 1:58 PM on May 30, 2013 [1 favorite]

Is the right cuff size being used on him? If you use a normal sized blood pressure cuff on my husband you get a CRAZY high reading. If you use an XL sized one, you'll get a correct reading. I had never heard of cuff sizes before but apparently this is a thing: Mayo Clinic on "Does cuff size affect blood pressure readings?"
posted by lyra4 at 2:10 PM on May 30, 2013

I had pretty bad white coat hypertension when pregnant, and it was the precursor to more serious blood pressure issues. I'd take precautions - you don't want your blood pressure spiking for any reason, including stress.
posted by yarly at 2:10 PM on May 30, 2013 [2 favorites]

Something he can maybe try is to get a heart rate monitor that beeps and see what kinds of relaxing thoughts slow it down, so he can train himself to relax on demand. Biofeedback. This is just off the top of my head and not meant to replace the excellent suggestions already mentioned.
posted by SillyShepherd at 2:17 PM on May 30, 2013

Thanks, all. We will try buying one and bringing it home.
posted by roomthreeseventeen at 2:19 PM on May 30, 2013 [1 favorite]

I close my eyes and think of my cat snoozing next to me, and smelling the awesome cat smell at the nape of her neck. YMMV.
posted by SillyShepherd at 2:19 PM on May 30, 2013 [1 favorite]

Those wrist-cuff BP monitors are not very reliable, or that's what the nurses in my practice complain. IANAD, just their helpdesk guy.
posted by endotoxin at 2:53 PM on May 30, 2013

The other thing is if nerves at the doctor's office cause his blood pressure to rise, does being nervous in other situations do the same thing?

I've got white coat hypertension, but I figure that I've also got office deadlines hypertension, family Thanksgiving Dinner hypertension, and Blackhawks Game 7 Overtime hypertension.

You may still want to think about blood pressure medication.
posted by hwyengr at 2:58 PM on May 30, 2013 [4 favorites]

I don't really meditate, but I learned enough of the sitting, deep breathing, calming techniques to lower my blood pressure at the Dr.'s. It's worth the time to practice, I think, and sure beats medication.
posted by Ideefixe at 4:09 PM on May 30, 2013

I just bought this blood pressure monitor, and have been finding my blood pressure differs significantly over the course of a day.

I've also started to try relaxation techniques, now that I have something that can show I'm getting some sort of result out of them.
posted by yohko at 4:11 PM on May 30, 2013

How are they checking his blood pressure? Is it with a machine? For some weird reason, every time I've had my blood pressure checked with a machine, I get a high reading but I have great blood pressure. I even asked a question about it.
posted by MaryDellamorte at 4:46 PM on May 30, 2013

N'thing White Coat Syndrome, aka (Doctor's) Office Hypertension. a couple of things for you two to consider. When you get the machine for home, bring it to the doc's place and take a reading so you can compare it to the doc's reading. This will (in theory) help you identify how far out of whack the home unit is. (Any consumer device is never going to be as good as a professional's.)

Another thing I have known of is a doc can give the patient a portable device that the patient wears for X number of hours, and that unit will record a blood pressure reading every Y minutes or hours. The results are stored so they can be retrieved later. I believe these are used to help distinguish between WCS and true hypertension.

My mother has some really brutal WCS, and they had her wear one of those wearable monitors for a day, and the readings during the day, in her case, came out vastly lower than during any of the in-office measurements, thus confirming WCS.

As always, I am not a doctor, and this is not meant to be medical advice. Speak with a qualified professional regarding any of my comments.

Best of luck!
posted by InsertNiftyNameHere at 5:39 PM on May 30, 2013

I agree with hwyengr- reactive blood pressure like that is still a bit of a problem, since the bad effects of high blood pressure are cumulative. Every moment you are above what you are supposed to be above, you are doing minor damage to your body. So it's probably important to take pressures at home a couple-three times a day (at regular times) and record them.
posted by gjc at 7:27 PM on May 30, 2013

I think we are too quick to blow off "white coat hypertension." I mean, yeah, go get some non-doctor's office measurements. Automatic cuffs don't always read accurate either, particularly if someone already has atherosclerosis or an arrhythmia. A manual sphygmomanometer reading on the left arm in a seated position after 5 minutes of rest with feet flat on the floor and the cuff held at the level of the heart is the gold standard.

But here's what I tell my patients: all those studies that taught us that treating blood pressure was a good thing to do -- those were mostly done in doctor's offices, too. And statistically, those people who had elevated pressures at the time of measurement in the doctors office regardless of what the pressure did at home were more likely to have strokes, kidney disease, and die earlier. And in addition, those people who were able to make their pressures look better with blood pressure medication when they were checked in the doctor's office, had fewer strokes and fewer deaths.

It's possible that intermittent elevations in stressful situations is just as bad as blood pressure that's high all the time. We don't really know.

We do know that if you are in the group of people who have 2 consecutive elevated readings separated by 2 weeks in a doctor's office and you take an Ace inhibitor, a thiazide diuretic, a beta blocker, or more recently, a calcium channel blocker, you are likely to spend fewer days in hospitals and you are likely to live longer. This is accepted fact at this point. Whether you can safely separate out White coat syndrome is really just a theory or suspicion, an idea that has adherents and detractors, and some weak data on both sides.

What do you want to do with this information?
posted by Slarty Bartfast at 11:42 PM on May 30, 2013 [3 favorites]

I've had this problem intermittently myself. I even had some problems taking BP at home or at pharmacies because I would get anxious about having a high reading as the machine did its thing in those settings as well. Sadly, "white coat syndrome" (this is what my doctor calls it) has kept me from giving blood many times during Red Cross blood drives as well.

I've had some success distracting myself during BP testing -- for example using my home BP cuff I get more normal readings if I get it going then breathe calmly and read a book while it tests.

I also find that when I am meditating regularly, I am better equipped to use / recall the calm mental states I get meditating at times of stress like this. Good luck! I know how frustrating this is.
posted by aught at 7:15 AM on May 31, 2013

I had high blood pressure readings until I realized I was subconsciously holding my breath while the readings were being taken. Once I remembered to breathe normally, my readings dropped to normal.
posted by monotreme at 10:36 PM on May 31, 2013

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