Blood pressure and nervousness...

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Specializes in Women's Health- Mother/Baby care.

I've known since college that I have white coat hypertension and experience anxiety when it comes to any sort of "test". I graduated from an accelerated BSN program in July of '07 and then went on to work at a job I just loved in Women's health in Oklahoma. My husband is in the Air Force so we just relocated to Okinawa, Japan in April. I really like it here, but it has been a stressful adjustment at times. You can't spend all day relaxing at the beach ;) I haven't found a job yet, so I have a lot of free time on my hands, which I'm not used to, haha. I am working on an application for a nursing job and am going to be volunteering with the Red Cross soon, which will keep me busier.

Anyway, my birth control prescription is about to run out, so I went to the military clinic last week on one of their refill days to take care of it. They proceed to tell me that they don't have the pills I use and that they might not be able to order it. I ask them for a different brand and they make me an appt for about 2 weeks later (when I'll already be out of pills, haha). So, by this time, I'm a little stressed and ready to leave when I find out that they need to do a physical/health history.... umm alright. Before I even sit down, in the chair, the tech/med asst has a BP cuff on me and I get a reading of like 150/95 due of nervousness. I was not expecting a physical and had just been told that my prescription couldn't be refilled, so I knew that this reading was a product of nervousness. I asked if they could wait a few minutes and redo my pressure when I calmed down. No, they wanted me to come in for a 5 consecutive day hypertension screening. Well, great.

So everyday that I have come into the clinic, I get high readings. Today, I really tried to do some different breathing techniques in the waiting room, but then they move me to a different exam room and the nervousness takes over. First reading was 142/94. Then, the guy talked to me for a minute and the reading in my left arm was 124/82. Finally! Well, then he said "That's really odd? That's a big difference." He seems bewildered when I tell him that I suffer from anxiety when I'm "the patient" and having any kind of test done. He almost couldn't believe that a RN could have this problem. Well sorry, I am human. Then he tells me that more than likely they will want to put me on blood pressure medication.

I just don't know what to do. I speak with the actual doctor next week and I have all of my pressures I've taken at home manually documented. My average BP at home is around 117/79. I also have an Omron monitor that I use to have more "evidence" that I don't suffer from high BP chronically. I even took a reading after I left the clinic to show that it was higher than normal at that particular time.

I'm so very frustrated about this though. I'm in a new place halfway across the world and unfortunately my husband is a pilot and busy (if not deployed) a lot of the time and cannot accompany me to appts like this. We are wanting to start a family while we are here, but now I'm worried about what the OB clinic will say about my situation.

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Somebody obviously missed the class where they told you about things that can effect BP.

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Specializes in Med Surg, LTC, Home Health.

Definitely do not let them put you on medication. Before that happens, doctors should always first recommend quitting smoking, losing weight, exercising daily, a healthier diet, and lowering sodium intake. It doesnt always happen in that order though unfortunately.

I really dont think you have high B/P. Your "nervousness" produces a fight or flight response which causes the adrenal glands to release cortisol and epinephrine, producing an increased heart rate and vasoconstriction. If they want to give you trouble, you just tell them the facts and show them that you know what youre talking about. If that doesnt work, RUN!!

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Specializes in Nephrology, Cardiology, ER, ICU.

Can't offer advice except to say that when you see the doc - tell him the story.

I was a military wife for many, many years (hubby is now retired). It is very stressful moving and having your spouse deployed or TDY. I think you are doing the right thing trying to stay busy. Good luck and take care and thanks for your service too - its not easy being constantly uprooted.

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Specializes in Women's Health- Mother/Baby care.
Definitely do not let them put you on medication. Before that happens, doctors should always first recommend quitting smoking, losing weight, exercising daily, a healthier diet, and lowering sodium intake. It doesnt always happen in that order though unfortunately.

I really dont think you have high B/P. Your "nervousness" produces a fight or flight response which causes the adrenal glands to release cortisol and epinephrine, producing an increased heart rate and vasoconstriction. If they want to give you trouble, you just tell them the facts and show them that you know what youre talking about. If that doesnt work, RUN!!

Thanks for all of the replies. I really just need some reassurance about this whole thing. I have not even spoken to a doctor yet, but the med assts/techs (a.k.a. military airmen assigned to the clinic) keep telling me "Wow, you do have hypertension! That's really high". Then I try to explain to them that it's nervousness and I get the deer in the headlight look from them and just a "I'm sorry maam... see you tomorrow". It's sooo frustrating. I really miss my doctor from back in the states. If my BP was high at the beginning of the appointment, they would chat with me for awhile or do other assessments, and then check it again and it was always lower. Military clinics apparently don't have time for this. They have me relax in the waiting room and then get me up and walk me to a different room, then immediately take my BP, which pretty much ends all relaxation for me. I don't smoke, my BMI is good, and workout regularly. I'm going to sign up for some yoga at the fitness center if they offer beginner classes. Maybe that will help me to learn some breathing techniques that will combat some of my anxiety at the clinic.

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I'm not saying you should or should not start meds because that would be offering medical advice, but I am a bit concerned. Your BP goes up quite a bit and it's when you are stressed. Unfortunately, your heart/cardio system doesn't care about the cause, it only knows it's being taxed quite a bit. Point being that if your body reacts to stress in such a way, it's probably in your best interest to address stress mgmt. with your PCP--meditation, relaxation, exercise, etc.

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not true.....if someone were to have severely elevated BP they may very well be rushed to the ER or sent out on meds. In a perfect world you would ask for lifestyle changes but the reality is virtually none will make those changes. Yes everyone deserves a chance but not if that chance further risks their health

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Specializes in Women's Health- Mother/Baby care.

So basically you're saying that taking blood pressure medication to make my BP levels normal at the doctor is the best option, possibly resulting in hypotension at home 95% of the time? I'm willing to try anything to improve my situation, but yes, things other than medication may not completely work. This clinic here makes me uncomfortable for some reason. During my last 2 doctor's appts in the US, I felt comfortable with my PCP and my levels were normal. Here, it has been a different story. My husband and I love to be outdoors on little weekend trips, hiking, snorkeling, etc. Having low blood pressure during those times does worry me if BP medication was the route I should happen to take.

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Specializes in Women's Health- Mother/Baby care.

Well, today was my last day of my 5 consecutive day readings at the military clinic. I went for a run this morning and then did some relaxation exercises before I went to the clinic and my BP was so much better- 124/82 and 126/83. I'd still love to get them under 120/80 like they are at home, but it was a big improvement. I have an appt with the doctor tomorrow to talk about all of it, so we'll see what he suggests. At least today showed some signs of improvement :specs:

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no, that's not what i meant. Ideally home BP measurements closely monitored would be best. However, there is also a limit as to how "hypertensive" one could get from anxiety alone. Causing people to become hypotensive at home is a major concern. It definitely sounds like "white coat hypertension" is definitely a major component of what you have and close discussion with your doctor can direct what kind (if any) treatment

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Specializes in Women's Health- Mother/Baby care.
no, that's not what i meant. Ideally home BP measurements closely monitored would be best. However, there is also a limit as to how "hypertensive" one could get from anxiety alone. Causing people to become hypotensive at home is a major concern. It definitely sounds like "white coat hypertension" is definitely a major component of what you have and close discussion with your doctor can direct what kind (if any) treatment

Sorry if I sounded snippy in the previous reply (didn't mean to), but it's been a frustrating week trying to take care of all of this. I'm on a little island in the Pacific, far away from family/friends, new house, cars, culture, job hunting, my first earthquake (yikes) this week, etc. My nerves have been a little up since I arrived here and having to deal with this on top of everything is not what I had planned on. It takes me awhile to feel comfortable in new clinic settings (when I'm the patient) and the military thing is different from the usual family practice settings in the states. I'm hoping that the doctor tomorrow will actually listen to me and not tell me that my situation is "weird" like some of the med assts that work there have been saying all this week. When I told them I had been monitoring my own pressures at home, the guy actually laughed and said "well we can't accept those unless a licensed professional does it". Hopefully tomorrow I'll talk to something other than a brick wall in uniform.

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Specializes in Nephrology, Cardiology, ER, ICU.

Good luck....take care...

I agree that it is very stressful moving into a different culture. We were stationed at Yokota (Tokyo) for three years....like Okinawa, very crowded and much different tculture. Trust me, you will get used to it. Take care.

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