Hypertension crisis - how worried should I be?
July 30, 2020 10:34 AM   Subscribe

Today in the course of an unrelated medical visit (a consultation to start HRT for gender transition), I had my blood pressure measured. Every measurement was between 150 - 170/110+. The nurse was concerned and is going to write to my GP. I'm trying to get an appointment with my GP but they're not seeing anyone until at least next week, maybe Thursday. I have a monitor and measured my BP when I got home, where it's averaging out (over a few hours) at 150/105-110 with a pulse of 100+. I feel absolutely fine (besides this fun new anxiety) and have no other medical problems that I'm aware of and none of the symptoms that Dr. Google is telling me are the point where I should be calling an ambulance. Do I need to take action now or can this wait a little while?

Some further deets:

- My cholesterol is also high and I've been anticipating having to go on meds for it for a while. Other blood work in June came back fine, no problems.
- I'm medically obese according to my BMI (5'2" and 77kg), but my diet isn't bad. I don't drink or smoke, I consume dairy sparingly and most of my meals contain vegetables or fruits. I could probably stand to get more exercise and eat less fat/meat in general, which I will be doing going forward. I have been trying to drink more water than usual and am finding myself peeing more and also feeling more thirsty in general.
- I absolutely have a family history of these issues. My mother had a heart attack in January, other family members on her side (my grandfather and uncle) have had heart attacks/strokes, I'd say it's almost certainly a genetic condition.
- I do get anxious but haven't really had major issues with it. I'm a student so haven't been working (and haven't really left the house tbh) since lockdown started.
- When I get my blood pressure checked, it always hurts a lot (including on my home monitor - perhaps indicating the cuff is too small?). I did go to A&E last year because I had an anxiety attack and the urgent care read my high BP and sent me to the hospital immediately, but by the time I was seen (8 hours later) the doctor just tried a larger cuff on me, got a normal reading, and sent me home.
- My GP is currently doing phone calls only. Any in person tests would (presumably) have to take place at the hospital.

What I need to know is: is there any action I should be taking RIGHT NOW besides what I'm doing (getting the earliest possible GP appointment, measuring my BP a couple of times a day, trying to eat better in the meantime and somehow not stress out about this)?
posted by fight or flight to Health & Fitness (13 answers total) 1 user marked this as a favorite
- My GP is currently doing phone calls

That's the answer to your question.
posted by JimN2TAW at 10:43 AM on July 30, 2020 [1 favorite]

Response by poster: I'm not sure what you mean, JimN2TAW? The earliest I can speak to them (via phone) will be Monday if I'm lucky, if not Thursday. I can't call them and get through to a doctor now.
posted by fight or flight at 10:46 AM on July 30, 2020

Ugh. I think if you managed to get your GP on the phone, with that blood pressure reading, your GP would probably send you to a hospital anyway. Here in the USA we have walk-in clinics, do you have that where you are? That would likely be my first stop in a situation like this. Otherwise, can you ring your local hospital before you go, and ask the triage desk? At my local hospital they are currently taking phone calls to do triage before you come in, to figure out where to send you (ER waiting room, immediate room, Covid waiting room, etc) and that might be an option as well. If the hospital thinks you are having a hypertensive crisis, they could have a room ready for you upon arrival.
posted by juniperesque at 10:56 AM on July 30, 2020

Response by poster: We don't have walk-in clinics here (London, UK) outside of hospitals, at least not ones within easy travelling distance. There is a non-emergency phone service which is set up to triage people in this sort of situation, which I'm probably going to call shortly to be honest, if only to put my mind at rest.

Oh and I forgot to add in my post: I'm in my early 30's & white (iirc that can rule stuff out).

OK, going to stop threadsitting now, sorry!
posted by fight or flight at 11:06 AM on July 30, 2020

The earliest I can speak to them (via phone) will be Monday if I'm lucky

OK then, I didn't see that in your question. I apologize for the digression. Sometimes people ask for advice on line instead of from their own doctor who knows the case better than anyone on line. I'm glad that wasn't the case here.
posted by JimN2TAW at 11:06 AM on July 30, 2020

Best answer: (including on my home monitor - perhaps indicating the cuff is too small?)

I think you need to buy a BP monitor which is claimed to fit your actual arm size. Using too small a cuff can result in unrealistically high readings. Many home BP monitors don't work above a 12" upper arm size, which you don't even have to be very overweight to exceed. Measure your upper arm and read the fine print on the box or in the online description carefully to make sure it's intended for people with your actual arm size.

My understanding is that the cutoff above which you must seek emergency care right now is a resting BP reading of 180 systolic or 110 diastolic, or higher.

I am not an anti-salt person in general, but for the moment, while you're waiting, you might want to reduce your sodium intake as much as possible, avoiding prepackaged foods and restaurant food, and increase your potassium intake (carrot juice, dried apricots, cooked greens, skim milk, and orange juice are good sources), aiming for something like 4000 mg of potassium per day. Try to get some gentle exercise, such as walking. Wait until you have been sitting quietly for a while before testing your BP.
posted by chromium at 11:18 AM on July 30, 2020 [4 favorites]

I don’t know anything about BP figures but any time you’re concerned about something like this outside of GP hours, calling the NHS non-emergency number on 111 is the thing to do - I’d just do that now rather than waiting for other suggestions and doing it in a while. It’s worth doing it outside GP hours because at some points during the Covid crisis they’ve only been taking calls from people with Covid symptoms during GP office hours, so you’re more likely to get help from them if you phone this evening than if you wait until tomorrow daytime (sorry, that might be out of date advice but was my experience of calling 111 during the day on a weekday a couple of months ago).

They’ll tell you precisely what you want to know ie. whether you can wait and speak to your GP next week, or whether you need to see someone urgently (in which case they’ll make the appointment and tell you where to go).
posted by penguin pie at 11:18 AM on July 30, 2020

Response by poster: My understanding is that the cutoff above which you must seek emergency care right now is a resting BP reading of 180 systolic or 110 diastolic, or higher.

That's what I've read too. My high (consistently between 105 - 110) diastolic readings are what's concerning me, given this advice.

But good tip about the BP cuff, for some reason I hadn't thought to actually measure and my arm is slightly above the "ideal use" point of the cuff. I'll order a larger cuff!

calling the NHS non-emergency number on 111 is the thing to do

I've just spoken to them and they said that if I've already seen a nurse today and she wasn't alarmed enough to send me to A&E then there's nothing to worry about, which made me feel a little foolish. The person I spoke to said she was going to pass my details on to a pharmacy service that can offer a little more actual medical advice, they should (hopefully) call me back soon.

Sorry to flail, Mefites. What's both soothing and alarming is that if I hadn't had that appointment I'd be walking around for however long with these levels, completely unaware. Yikes.
posted by fight or flight at 11:33 AM on July 30, 2020 [2 favorites]

If you're in London like your profile suggests, you may want to try GP at Hand. It's the digital NHS service, and lets you schedule a video call with a GP generally within an hour or two, and can prescribe straight to your pharmacy. It's a real game changer.
posted by teststrip at 1:13 PM on July 30, 2020 [1 favorite]

One of my family members has "white coat syndrome" and his stats spike horribly at the doctor but are fine at home. Until we figured this out doctors got alarmed and gave him medication etc. Now they seem to make an extra effort to relax him which helps at least some of the time.
posted by meepmeow at 3:08 PM on July 30, 2020 [1 favorite]

Just FYI as you said you're planning to start gender affirming treatment soon:
If you're MtF transitioning the spironolactone or UK equivalent will almost certainly help reduce your blood pressure.
If you're FtM transitioning testosterone may worsen it (and your cholesterol unfortunately) so make sure your primary care doc is aware of both your BP and your transition plans if they are not the ones actually prescribing the hormones.
posted by genmonster at 12:24 PM on July 31, 2020

FWIW my blood pressure once measured ~50 points (!!!) above my normal range at a doctor appointment after I'd been engaged in a heated Facebook argument on my phone while waiting for the nurse to call me back. So emotions like anger etc can definitely cause a huge temporary spike.

Nthing getting an at-home blood pressure cuff that fits. Take a few different readings throughout the day including when you are feeling calm and content to see if your baseline is really that high or if you were maybe just subconsciously super stressed about something during you appointment.
posted by Jacqueline at 3:58 AM on August 2, 2020

Response by poster: An update:
- The day after I posted this, I was continuing to monitor my BP (with a new, larger cuff) and got readings of 180-190/150+ multiple times over the course of an hour, so took myself to urgent care just in case, where I was carefully and kindly reassured that this wasn't urgent. They ran some blood/urine tests and took an EKG just in case, but it was all fine (unsurprisingly). I also got my BP measured multiple times while I was there and while my heart rate and diastolic (and cholesterol) were high, everything else was fine. At one point (lying down) it was 140/88!
- The experience was embarrassing but reassuring. I did some more research and found that at home BP monitors are notoriously oversensitive and can be wrong a lot of the time, which is why they're not used to diagnose anything. This calmed me down enough to accept that I'm not, like, Immediately Going To Die.
- I had my phone call with my GP earlier and she's prescribing me an ACE inhibitor and statins for the high cholesterol, since based on my family history and my personal history of high readings, she agrees that it's probably not going to be fixed by lifestyle changes alone.
- I'm also generally going to be trying to drink more water, eat a bit healthier, and will be looking into getting some therapy for the aforementioned (and obvious) anxiety.

Thanks for being patient with this hypochondriac, mefites!
posted by fight or flight at 10:18 AM on August 3, 2020 [3 favorites]

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