Expert: David Richardson - 10/1/2006

Question
I am a 35 year old male, 165 pounds.  My blood pressure is 140/97.  I have been experiencing chest pain in my chest, sometimes from the left, sometimes center for the last few years.  After 2 stress tests, I was told that I had Mitral Valve Prolapse, put on 25 mg of Toprol, and told to come back yearly for a EKG to make sure the valve behaves.  Both stress tests were clear.

I work 2 full time jobs, 7 days a week, and therefore I'm under a lot of stress.  Because of my workload, I attributed the high blood pressure, and constant chest pain to the workload, and now partly to the leaky valve.

The last few days, things have been much worse, and the chest pain and my blood pressure have been in the 140/90 range (up 140/100 range)from the moment I get up, even on the Toprol.  I have a constant headache, fatigue, generally not feeling well.

Shouldn't the Toprol keep my blood pressure down to a more normal level?  Could I be on too low of a dosage?

Is it normal under stress loads to have a blood pressure that high on a constant basis?

Thank you for any advice you can give!  

Answer
Dear Brian,

Toprol may keep your blood pressure down.  Your current dose is low.  I think you should increase to 100 mg a day. 50 twice a day is best but if you can't remember the second dose, take all 100 once a day.  Many people need more than one medicine to keep blood pressure below 130/80.  If 100 mg of Toprol doesn't keep your BP down, check with your doctor.  When you're at you doctor's office, ask if your mitral valve leaks.  Many with prolapse have no leak at all.  If your doctor didn't ask you to get penicillin before dental work, you probably have no leak.  High stress loads probably do raise blood pressure.  You need a vacation, I think.  Sick leave is reasonable, what with your headache, increased chest pain and fatigue.

Please write back if this note doesn't answer all your questions.

David Richardson


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