Many people find themselves being told, “your blood pressure is pretty high today!” You might be at the dentist’s office for a filling, in the emergency room getting stitches after an avocado mishap, or maybe you’re at your annual physical appointment. If you’ve never had high blood pressure you might be surprised at this news! Sometimes my own patients will call my office after such an event, “Doc, should I be on blood pressure medication?”
When we get these calls our typical answer is: maybe, but maybe not. Blood pressure is a dynamic measurement, affected by many things including adrenaline and other stress hormones. If you measure the blood pressure of healthy people who are in stressful circumstances, you will often find it to be high. This can certainly be true in health-care settings – have you ever felt stressed or anxious when you are hurt in the ER or sitting in a dental chair? I will advise these patients to come into our office and check their blood pressure under less duress; oftentimes it will be normal and reassuring.
Sometimes, though, the stressful circumstance is our primary care office, the very place we try to screen for high blood pressure. Some patients have elevated blood pressure in their primary care provider’s office but not at home or elsewhere; this is often referred to as “white coat hypertension.” The only way to know for sure, though, is to check blood pressure at home or outside the clinic visit.
If a hypothetical adult patient, who is feeling well and has never before had hypertension, comes to their annual physical and has a blood pressure of 155/90, the first step is to repeat it after a period of 5-10 minutes of quiet rest. If it is still elevated we will arrange to check resting blood pressures at home or in a series of lower stakes visits to the clinic with a nurse.
The diagnosis of hypertension and decisions about treatment should be made if the average of those resting blood pressures are above the threshold for recommended treatment. Of course, if a patient truly does have hypertension we want to initiate lifestyle interventions and possibly medication to reduce the long-term risk of poor health outcomes. But when it comes to high blood pressure, it is rarely an emergency, and often collecting more data is better.
Richard P. Holm, MD passed away in March 2020 after a battle with pancreatic cancer. He is founder of The Prairie Doc. For free and easy access to the entire Prairie Doc library, visit www.prairiedoc.org and follow Prairie Doc on Facebook. Kelly Evans-Hullinger, M.D. is part of The Prairie Doc team of physicians and currently practices internal medicine in Brookings, S.D.