Anxiety = High BP = Fail = More anxiety – anyway out of the loop?

[QQ Tester]

Hello,

I went for my initial class one medical a couple of weeks back at Gatwick. All was fine, even my ‘over the limit’ myopia, until the final test of the afternoon; Blood Pressure. I knew it would be high as for as long as I can remember I’ve had an irrational fear of anything medical. It’s totally crazy I know but whenever I visit the doctors, dentist or even the opticians I feel fairly stressed. Anyway, my BP was 160/90 which is too high for the CAA (quite rightly) so it’s now up to me to prove that my BP is normally within the acceptable range. The doc at the CAA was helpful and recommended that I send him either a 24 hour BP test report or three readings (taken on different days) from the nurse at the local GP’s surgery.

To my questions then:

Has anyone else had to go through this process and if so how did it go?

I understand that the 24 hour test uses the same principle as the doctors gauge i.e. an inflating pressure cuff – as it tests my BP every 30mins won’t I simply get stressed when it starts to inflate giving another false reading?

I’d appreciate any of your thoughts on the above,

Thanks – QQ

[mazzy1026]

I can relate to you in a similar way in that whenever I go to the GP for blood pressure or something similar, purely because of the situation I think my BP rises a little. I dont know a way out of this other than to try and remain calm and take deep breaths and relax a little etc - but as you know this is difficult.

Why not try giving up coffee, alcohol, (cigarettes if you smoke) and salt for about a month before the test and see if that helps - also try some more excersise.

Best of luck

Maz

[QQ Tester]

Thanks for that Maz, you are right about it being difficult to suddenly become calm – I’ve tried and failed! I don’t drink coffee (never have), never smoked and I drink very little alcohol (couple of units a week). My diet is ok too but not perfect, the same can be said of my rather lethargic exercise program. The issue is not my actual BP, I think that’s ok – the problem is proving it. They say that high BP is not something that ‘sufferers’ feel, that being one of the reasons why its checked so often. With me I can notice the difference when at the doctors etc; I can feel the blood pumping harder – so I’m confident that it’s not a true reflection of my everyday BP.

Just been to see my GP this evening about my BP (high again!), she said a 24-hour test would require an out-patient appointment with the local cardio unit and that would take six months. I guess I’ll have to either really try hard to ‘chill out’ before seeing the nurse or go private for the test at significant cost (on top of my £411)!

One other thing, will I have to go through this every time I renew my medical certificate or do they make allowances for those of us with this silly reaction to the doctor?

Thanks - QQ

[Whirlybird]

I'm exactly the same way. Health is fine, eat all the right things, don't smoke, and whenever I see a doctor my bp is sky high. Somehow it was OK at Gatwick for my initial Class 1, but the next couple were really high, and my AME told me to get a 24 hour reading before the next one: "If you don't I'll ground you till you do" :eek: Luckily my own GP's surgery has the gizmo to do it, which saved extra cost and hassle. You do know when it's taking it, but you get so used to it, and so fed up with it, that you stop noticing. And my GP said if your bp is OK at night, they tend to assume it's OK.

As it was, mine was within the normal range all day and night, even though I had a stressful work day, losing my temper and getting worried a few times...made little difference to my bp - average overall was about 120/80. Of course next time I went to see my AME it came out sky high again. So now I'm official - White Coat Hypertension - it's down on the form.

That was about two years ago; he hasn't asked me to get another 24 hour reading yet, but I'm fully expecting to have to some day.

Weird thing is, I like my AME, and don't consciously feel tense around him. I guess it's something pretty deeprooted in my case.

Anyway, hope that helps. If you want to know any more about 24 hour readings etc, just ask.

[Flyin'Dutch']

White coat hypertension is well recognised.

Would be worthwhile to get a 24 hour ambulatory measurement. Shame your surgery can only do that by a referral to the cardiology clinic.

With a BP of 160/90 I suspect that the 24 hour measurement will be just fine (mind you that is suspect I can't give a guarantee!)

You may want to have a look around and see if there are any surgeries around which would be able to do it for your sooner than the cardio clinic.

HTH

FD

[Fox6]

I can tell you what works for me. Mine is high in the Dr's office as well. I usually try to work out or run (running is better) for approximately 30 minutes to an hour, an hour before the exam. There is a thing called post-exercise hypotension, that is caused by the release of serotonin and something else which is caused by the exercise. There have been studies that show one hour of exercise in the morning has the same effect as taking blood pressure medicine and the effect will last most of the day. You can look it up on the internet searching for post-exercise-hypotension. I would try this method and see if it works for you before actually going to the AME.

[QQ Tester]

Thanks for that tip Fox i'll give it a try tomorrow as I see the nurse for a BP check during the afternoon. I'll let you know how it goes.

Thanks - QQ

[Anti-ice]

My blood pressure has been borderline recently :(

Some very good books available at amazon to help....

A machine at home is reassuring, as my readings are often lower when at home/relaxed.....

Eating foods high in potassium (bananas/apricots are high..) are good too,as they counteract sodium in your body...

Avoid salt/sodium at all costs.... any processed / fresh packaged food is normally laden with it... check your labels where poss.
Any meal with over 0.5-0.8g+ of salt is considered 'high' .

ANY water retention 'spikes' a BP reading, so try & 'p' prior to your appointment..

Mines just starting to come down following these guidelines, give it a try.... relax at the surgery....& good luck:ok:

[FakePilot]

I had the same problem too, "borderline hypertension." A regular exercise program, 3 times 1 hr per week brought me back down to 80/130. Before that I was at 90/140, with spikes up to 100/160.

Also, regular exercise has the added benefits for me such as:

1. Elimination of aches and pains
2. Much more energy
3. Improved self-image and confidence.

Just my antedotal (sp?) observations. As always, follow the advice of your health care professional!

Good luck!

[Standard Noise]

Buy a good pressure cuff monitor (Omron or Boots) and test yourself once a fortnight, you may find that you will start to relax a little. I've had one for 4 years now, and despite quite a few AME's telling me how unreliable they are, I understand that the CAA now accept readings from these rather than just the traditional mercury monitors due to some European regulations involving the mercury.

Gatwick have hounded me for 10 years about my BP, I used to get a letter about a month after my renewal just to remind me they were watching. Funny thing though, my BP is lowering as I get older. I must be mellowing, despite being hounded by the BP Nazis.

As for eating, cutting out salt AND caffeine (tea, coca cola and coffee) is a grand idea. Apricots are all very well, but you can get a bit sick of them after a while. I have cut out the fry ups (it's hard to get a good Ulster fry in Somerset), and eat more chicken and veggies than I used to. Chasing after Lucifer every morning gives me all the exercise I need, who needs a gym!? Seems to be working.
:eek:

[mazzy1026]

A run in the morning is such a great thing and indeed does work as stated. I used to do this but after a while I got sick of getting up early hours, so I devoted my running time to late at night, around 9.30 - this way you are burning off excess carbs before you go to bed and wont be putting weight on as they say in your sleep. My running is getting so much easier only after a few tries and it really does help.

Best wishes

Maz

[Whirlybird]

Doing all these things is all well and good...and I mean that, it's good! I've been doing most of them for years. This may explain why my bp is LOW for my age...but it took a 24 hour reading to find that out!!!! When tested by any white coated person, it's usually just under the CAA's limit...and sometimes over. And that's if I relax, shut my eyes, and imagine I'm lying on a beach in the sun - my standard way of trying to feel relaxed. So they don't seem to deal with whatever deep-rooted fears I have...possibly of being pursued by bp nazis waving medication or grounding me. Or possibly due to having been an overweight kid (though a pretty fit one, actually) forever pursued by doctors telling me to exercise (I did, loads) and stop eating sweets (I didn't). That sort of thing leaves its mark, I suspect. I dunno, but I'll try that running stuff before my next medical anyway. Can I run for an hour? I used to be able to. Well, jog and walk anyway. :) :ok:

[QQ Tester]

Hello again,

I’m really pleased with all the responses to my question – thanks. I went along to see the nurse today for a BP check following an unsuccessful BP test with the doctor a couple of days ago. The result was still high (160/100). I tried Fox6’s method of having a run an hour or so before the appointment but it didn’t work for me. The nurse has given me an electronic BP meter to use at home. The above BP was recorded at the surgery about 20mins ago and now at home its 130/80 using the same machine! Quite a big difference considering they were taken so close together. It puts my mind at rest but won’t help with the CAA; they don’t accept such results as they are easy to cheat.

Anyway I’ll keep you all informed.

Thanks again - QQ

[Notso Fantastic]

Beware these little home BP machines. I had severe hypertension and my licence was pulled 4 years ago at 180/120. I don't have white coat syndrome, and I'm afraid I don't understand people who do- I don't know what there is to fear from the procedure itself. I have been on medication since and took 5 months to get my licence back. I never found much correlation between surgery readings and my home machine. I think these little home devices are only good for spotting a trend and not comparing individual readings from different machines as you did. It all depends on so many factors. In the surgery, you want to be upright leaning/half sitting on a desk or bed in there, not lying down.
It may be possible you do have hypertension!

[QQ Tester]

Thanks for your input Notso Fantastic.

I’ve been warned before about the results of these electronic gauges. There accuracy does depend on several factors – which include body position – I’ve noticed myself that there is a difference in reading depending on how I’m seated etc. The nurse who lent me the machine instructed me on exactly how I should use it and how I should sit. The point I was making in my last post regarded the difference in the given BP reading using the same machine; it was 160/100 with the nurse (when she was showing me how to use it) and 130/80 as soon as I for home using the same method. Not only was my BP lower but my heart rate had slowed too. My BP at Gatwick was 160/90 with the Doc’s Sphygmomanometer, at my GP’s it was 160/90 with her electronic monitor so there seems to be a reasonable correlation in my case. Also using the home monitor I have not once had an elevated BP as I did in the surgery, even after exercise.

Your point on not understanding the ‘fear’ of the doctor is one I share. I have no conscious fear of visiting the doctors at all; it makes no sense to me. I can feel my heart racing and from that I can guess that my BP level will be high – and it always is! Totally irrational but there you go.

Thanks - QQ

[Whirlybird]

I too don't UNDERSTAND White Coat Hypertension, despite the fact I've been fairly conclusively proved to have it...see my previous posts. Though actually, now I think about it, I do perceive a lot to fear from the procedure - it might prove that's there's something seriously wrong and I might get grounded. And I find that a pretty scary prospect. But I suspect my fear of white coated professionals stems from early childhood experiences. Do I understand that? No. Is it possible? Maybe. Do any of us really understand the workings of the body and how they intereact with the mind, past experiences, etc? I know I don't. And it's not something that can be rationalised away. believe me, I've tried, and trying to rationalise away my White Coat Hypertension usually makes my BP go even higher - probably the stress of trying not to think about what I can't help thinking about!!!!

[Nearly Man]

QQ

Hmm, my pressure gets up when I go to the docs, so I know how you feel.
I did read in one of the journals a while back that having your BP taken at the docs is one of the worst places and a lot of the time gives wrong indications .. mostle due to the stress of it all.

Lose the weight with cardio. I found that was the best thing for me .. and sadly, lay off the lagers a bit :sad:

Hope you nail that BP soon

[QQ Tester]

Thanks Nearly Man,

I don’t drink too much booze and my weight is within the ‘normal’ range for my height so I guess any high BP readings must be one of two things….

1. A genuine problem which requires further investigation (as I already lead a healthy-ish lifestyle it ort not to be due to any of the usual suspects e.g. smoking).
or,
2. The reading is false due to stress / anxiety.

Currently I only have evidence that it’s the latter due the stark differences in the home and surgery readings. I hope this is the case obviously but you never know, that’s why I’m doing everything my doctor asks of me to prove my health.

Looking back at my posts I’ve failed to mention my age; I’m only 24 and I don’t have a history of BP problems (not even in my family).

Thanks - QQ

[Notso Fantastic]

I'm still not sure from what you said in your earlier post about the reading you took at home after the surgery one. Was it using a home device showing a lower reading? The actual reading of those things is irrelevant, the only function of them I believe is to monitor long term trends measured on the same device.
I have no history in my family of high BP. Parents, children, all low BP. Me- it went through the roof.
I have witnessed white coat syndrome. My brother in law, an ex Naval Officer, in A&E following a suspected heart attack, was hooked up to a periodical BP machine. Whenever it came on, he put on a disgraceful spectacle of squirming and moaning- even in A&E I was shouting at him. The nursing staff were quite disgusted with him. He was a bit better when I made him focus on the wall, but I was appalled.
It's something you have to resolve somehow if you want the licence. When your eye test is done, you will fail if your eyesight is not good enough. Does the tension of that make the test harder? So what is it with BP? Absolutely painless!

[QQ Tester]

Hello again NotSo Fantastic,

I understand your point and to a certain degree agree; the problem I have is simple though. When I’m being physically examined, be it for hearing, sight or BP I feel a little stressed. I guess this could be likened to the nerves associated with receiving exam results; in other words if the outcome is important so I worry a bit. It is well understood that when under pressure or anxious BP will show to be elevated. This seems to be the case for me.

To help convince me that my BP is broadly normal and not always elevated my GP has lent me an electric BP monitor for a week. I’m recording my BP twice a day at random. So far the ‘trend’ has been encouraging; not one of my results has shown anything like the level recorded with the same machine in the surgery. An average of the seven recordings taken so far indicates a BP of 125/75 with a heart rate of about 80BPM (rate was 120 at the surgery) which is quite normal.

To talk trends again; for over five years my BP has shown this pattern of being elevated at the doctors. This is the second time I have had to convince a GP that my BP is ok – which I believe it is. Last time, like this, I borrowed a home monitor for a week; it showed my BP to be within the normal range.

Another point which helps my argument is that my sister (a registered nurse) took my BP at home using a Sphygmomanometer several times recently and found it to be fine. I guess familiarity is something that helps me stay calm.

White coat syndrome, like most medical conditions, affects different people differently. My reaction is not as extreme as the one you witnessed for instance but still causes the same net result. The testing process is painless as you state and I don’t mind it at all, it’s the situation and the fear of failure which causes unease.

Thanks – QQ

[Notso Fantastic]

QQ- thanks for the explanation. I would suggest that if the situation of a surgery causes distress, then hack it to death until you are so bored with it it causes no further stress. Explain to the receptionists and then go sit in the Doc's waiting room looking at the buzzer and the numbers. Do it on days off, do it for hours until you stop reacting. When you feel more at ease, make appintments with the Doc for anything, get there 2 hours early, and wait....... Keep walking into his surgery until he threatens you with the sack if you come once more with Athlete's foot/headache/backache/rash/constipation/urine a funny colour. Then tell him why!
This is a monster you have to exterminate. Get your sister to come around before/after her shift (and do your BP). Get a professional lady to come around in a nurses uniform and chuck you around a bit. Get your wife/girlfriend to dress up and walk in on you. You have this funny association with white coats/surgeries. Aviation requires you to prove your BP is OK. Only you can reprogram your mind that white coats/surgeries do not equal terror, but complete boredom!

[QQ Tester]

Hi NotSo Fantastic,

I enjoyed your reply very much and believe your method to be sound. In a way I am already doing something similar except with regard to the recording process. I’ve had used the BP machine so many time since borrowing it that the whole affair is far less of a ‘big deal’ than even on Wednesday when started the week long monitoring. I’m almost confident that on Thursday when I return the machine I will be able to demonstrate a normal BP to the nurse – fingers crossed.

On the subject of proving my BP to the aviation industry; I believe that it is perfectly acceptable for an AME to grant a medical certificate based on a GP’s report. Providing I can prove to my GP that my BP is ok then it’s a done deal. The CAA require the GP’s report to be based around either a 24-hour BP test or three distinct visits to the surgery with normal readings recorded.

Which beings us full circle I guess. I hope that with familiarity my BP will reduce at the surgery. My BP was high at Gatwick and on my visit to see the GP but both of these were plunges into the unknown (I have just signed up to this GP), even my second visit to the local surgery had an aspect of unfamiliarity with it as it with the nurse and not the doc.

I don’t enjoy all this messing about and I wish that I had ‘produced’ a nice healthy BP at Gatwick but that’s life! Lets hope it can all be resolved fairly soon.

Thanks – QQ

[Notso Fantastic]

Well good luck! It's up to you to put the effort into making Doctor Surgeries so utterly boring and tedious that your BP goes the other way. As long as you convince your own mind that there is no pain involved and the sooner you get it out of the way the sooner you will be down the pub, you will then join the rest of the human race in finding Doctor Receptionists not figures of fear, but boring twats!

[islipj]

The 24 hour blood pressure check is much more useful than the home monitors which are often inaccurate and lead to a great deal of anxiety.
It is important to establish whetjher you have hypertension as then you can take steps to lower the pressure-firstly without using drugs and if this fails you can take medication which in almost all cases will lower it.One rarely finds a treatable cause for this problem.
If you ignore raised blood pressure it will catch up with you in the coming years.

[gingernut]

.......and above all qq, remember, you are not ill, were just trying to prevent you getting ill.

Ambulatory (24hr) bp is quite useful, although clinicians are sometimes alittle unsure as to what to do with the results.

The process involves wearing a little machine, on your belt, and a bp cuff for 24 hrs. It records your bp against time every 15 mins, the results can then be downloaded to a graph/spreadsheet.

From the studies I've seen, white coat syndrome can be defined when the readings "spike" at certain instances, usually walking into the quacks office, and interestingly, coitus.

There's some really useful advice re. lifestyle on this thread. It does seem a bit of a faff having to attend a cardio clinic for monitoring (havn't they got better things to do ?) Perhaps you coukld persuade your local friendly practice nurse/gp to contact the drugs company reps, as I know that some of the manufactures will provide the equipmwent.

For god's sake, don't tell them I told you so !

[Frank Furillo]

QQ
Sorry to hear you have High Bp.
I am hypertensive and on a small dose water tablet for it, I only just found out before my inital class one last year, 180/110 (but i had been proded etc just before), so the CAA asked for the monitoring or three readings on succesive days, I opted for the latter and i obtained my class one. I am on medication but thats life.
Are you sure your BP just anxiety? (Sorry to say that, I hope it does not make it worse)
I hope so but even if you have to take medication for it, it's not the end the CAA are there to help.

[QQ Tester]

Hello Ginger and Frank,

I’m amazed at how many good responses have been posted regarding my question – thanks everyone!

Ginger and Frank you both raise some valid points which I must consider in depth. If I am I indeed hypertensive for real and being ‘fooled’ by what look like normal readings from the electric monitor – how will I know as the GP is only going on these results to make her decision? All I can do is take the advice of the GP (which won’t help with the CAA as the electric monitor records won’t wash with them). So it’s down to either performing for the nurse three times or paying for a 24-hour test (I’m not even sure the nurse will agree to three ‘unnecessary’ visits). Anyway it’s unlikely that I will calm down enough to be able to ‘prove’ my BP without a 24-hour test.

So what do I do. Well I maybe able to play a joker at this point and return home for a few days. How will this help I hear you mutter. I’ll explain, after four+ years of moving around with uni etc I’ve ended up living in the south (Wilts to be exact). Before this I lived at ‘home’, up north. My plan is to go back up north for a few days where I know the doctors, nurses and surgery very well and get my three BP readings taken up there (my mother’s the practice manger you see so its easy to arrange such things, she might even be able to arrange a short notice 24-hour test if need be!).

So there you have it, I’m either hypertensive but just for the doc’s or hypertensive all the time but not for the little electric machine! Either way I’ll have a hard time convincing myself, the doctor and the CAA. I just hope the truth will out sooner rather that later.

Thanks again – QQ

P.S – my results from the electric BP monitor so far:

Day Time BP Rate Activity
Thursday 07:30 109/72 70 Before b’fast
20:05 130/78 74 Watching TV
Friday 12:25 134/79 78 After Lunch
20:47 119/81 109 After exercise
Saturday 09:03 118/74 77 Before b’fast
16:05 122/67 74 Resting on sofa
Sunday 10:40 125/81 90 During house work
23:33 111/71 87 After bath
Monday 11:49 132/84 81 Before lunch
21:15 110/75 100 After exercise
Tuesday 08:00 130/75 80 After b’fast
21:46 122/70 94 5mins after exercise

[Notso Fantastic]

Your mother's the practice manager! Why didn't you say? You'd better get organising some 'conditioning' for yourself- sitting in that waiting room until you get bored out of your mind- don't read, just watch the buzzer until you don't react when it goes off! Do it day after day. Get her to organise quick BP readings out of the medics. Nobody is going to wave a magic wand so you stop reacting like you do. You're going to have to put hours of 'your' own time in to sort out 'your' problem.

[QQ Tester]

Hello again everyone,

I returned the BP machine to the nurse yesterday. She was pleased with my results and stated that no further action was required. She also took my BP whilst I was there, with an electric monitor, which turned out to be 159/89. High again! I was disappointed that I couldn't hold it together after demonstrating all week to myself that my BP is ok (average = 123/75 82BPM).

My next move is to return home and get my BP measured in familiar surroundings. If I can manage three 'normal' readings on three different days I'll be fine for the CAA.

Regards, QQ

[canuck76]

One of my guys had the same problem, and he started drinking blackhip tea or some such nonsense. No more coffee or proper tea - just this herbal stuff. Maybe it was called blackthorn tea - can't remember and he is up the line for a few days. A health food store would know the stuff. Load of mumbo-jumbo if you ask me. Funny thing is that it reduced his BP by 20.

[razzele]

My dad is a doctor he took my blood pressure recently. We were surpised to see that it was high 140/80 ish...

he tried a larger armband as my arms are quite chunky from the gym and pizzas and the next reading was 120/70.


you do sound very nervous heartbeat 120 at rest in the surgery!!! thats like me jogging!!


He says that the size and fitment of the arm Cuff is critical for an accurate reading.

hope that helps

[Re-Heat]

Ref the 3 readings, or 24 hour BP monitor: at the last Class 2, the BP was a bit high. The reasons for this turned out to be an issue other than white coat hypertension - now sorted -, however the AME discussed with me future Class 1 issue and what it might mean.

He said that he could get me on a 24 hour monitor prior to the Class 1 initial, which I could then arrive with at Gatwick if the BP reading did turn out to be high - 6 months to get an NHS one sounds excessive, perhaps due to the area you are in, but I would suggest, if you are going to go for the 24 hour one, to go via the AME rather than local GP (or ideally get a GP who is an AME!).

The monitors, it is fair to say, are not most accurate, however some such as the Braun are nowadays more accurate that NotSo suggests - perhaps times have changed, but of course for the ideal reading the surgery equipment is best. Perhaps take the electronic one along for a reading at the same time as the GP takes one to judge how good it is?!