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" 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]

white coat cure

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

[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.

[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.

[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

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