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Hypertension/BP Spike Due to Great Anxiety


Dear Dr Falkinburg,

I am 45, male, don't smoke and drink, lean and no family history of hypertension. I am prone to anxiety and have started a garlic supplement for general heart health for a year now. I monitor my BP periodically and readings are below 135/85 unless I don't get sufficient sleep. I do have white coat syndrome.

A week ago, I had an anxiety attack due to accumulated stress and went to ER. BP then was 196/107 and pulse rate was 120.  Doctors ordered ECG and comprehensive blood work. All turned out fine. They gave me a tranqualizer to calm me down and 30mins later my BP dropped to 169/83 and an hour later to 130/82. I was prescribed Lasartan 50mg but doctors said to take it when BP spikes again. I have been monitoring my BP at home twice a day  and BP has returned to an average of 130/83 without medication. I tried taking Lasartan once and BP went down to 107/64 and felt a little low.

1. Can diastolic pressure jump so high during great anxiety?

2. Because of the spike, I get anxious when I take BP at home. Can I reduce the frequency of monitoring the BP as I can get paranoid with the BP device?

3. What can I do to avoid such spikes? I am now committed to managing my stress and anxiety, and may discuss with my GP about this soon.

4. Any advice on diet and lifestyle changes would be much appreciated.

Thanks very much.

Good morning, Michael.

Yes, stress and anxiety can raise the blood pressure. This is due to an outpouring of adrenalin that occurs during the anxiety attack.  One of its effects is to increase the blood pressure.

It is very likely the you are "pre-hypertensive" and in the future will develop sustained hypertension. Certainly, non pharmacologic and lifestyle modifications are appropriate for you.

I would suggest that you initiate a low salt diet:

  No added salt at the table or when your food is being prepared.
  Eat no foods on which you can see salt.
  Eat no foods from a can (they are preserved with salt).
  Eat no foods from a vacuum packed plastic wrapper ( bacon, luncheon meats etc).

This approximates a four gram sodium diet, is tolerable, inexpensive and will facilitate the control of your blood pressure.

Mild aerobic exercise will also help you.

This is all I would do for the time being, in terms of treatment, as long as your BP remains below 140/90.  

You should continue monitoring your BP, despite your paranoia.

One last suggestion would be to be screened for a condition called pheochromocytoma.  This is a tumor of the adrenal gland that produces adrenalin  and can raise your BP and cause symptoms of anxiety.  There are screening tests that are performed on blood and urine.  This condition is very uncommon but if present can result is the symptoms that you are having as well as your hypertension.  Your doctor can arrange to for this condition to be ruled out.

Hope this helps.

Please, feel free to follow up if you wish.

Dr Falkinburg  


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Newell R. Falkinburg, M.D. FACP


Any question regarding hypertension or clinical nephrology


35 years of experience in the field of nephrology & hypertension. Emeritus Professor of clinical Medicine at a major medical school and director of Nephrology & Hypertension at a university affiliated medical center.

M.D. Board certified internal medicine Board certified Nephrology & hypertension

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Fellow, American College of Physicians

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