Question
I get high blood pressure whenever I see a BP cuff! I am a diagnosed hypertensive, on Norvasc with good results, but I have the yearly dilemma of my DOT physical! Last time it took a long discussion between my Cardiologist and the examining MD to get the card signed. Fortunately I have been worked up out the wazoo (cardiolyte stress, echo, CXR, EKGs, IVP, doppler, etc) and also a 48 hour ambulatory BP which showed good control with medication.
What do I do the day that I can't calm down enough to pass the DOT physical (drop 2 NTGs and see you on the floor?)
Answer
I can only speak for my clinic and how my staff handles any hyperstensive person who comes in for a physical. If it is their first visit to our facility, we begin the exam with a vision test, then move to the vital signs. (B/P, Temp, Pulse, Respirations)
If the driver is above the 160/90 limit on the initial B/P, we ask if they have been diagnosed with high blood pressure in the past. If the answer is yes, we ask when they last took their medication. If they have just taken it, we proceed with the rest of the physical. Once everything else is completed we ask them to sit quietly in the reception area and relax for about 1/2 hour. We then recheck the pressure. If it is coming down but still not acceptable, we wait longer. If they are not at an acceptable limit by the third try, we ask them to come back the next day if possible. If they can not return, then we can not qualify them at that time.
Whenever we see a B/P that is initially high but is moving toward normal with each reading, this is a good indicator that 'White coat Syndrome' is playing some part in the high reading. We know that many people experience this and we will try to get the patient past the anxiety. Sometimes we can, sometimes we can't but we never fail someone for one high B/P reading.
My suggestion for your next exam is:
1. Make sure you have been very compliant with your meds and have been taking them at a regular time each day.
2. Try to get your exam done first thing in the morning when you are the most rested and least stressed.
3. Avoid caffeine, nicotine and other stimulants until after the exam.
4. Try to mentally calm yourself a few minutes before and while your pressure is being taken. Visualize a calming scene, a pleasant experience, etc.
5. Empty your bladder before they take your blood pressure. (Make sure you provide any required urine specimens first.)
Let me know how you do next time around.
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Keeping you safe, healthy, and on the road.
Nurse Red
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Answer
Very interesting problem.
Vasodilation/constriction and heartrate are both conditionable responses. I would suggest another tack. There is good statistical evidence 10-15 percent of high blood pressure syndromes can be solved by simple administration of calcium supplements. I wonder if this was tried before you were prescribed medications?
You are very medically knowledgeable, and I am sure you know carotid massage can temporarily lower blood pressure. The method was used by stage magicians for years performing hypnosis. Also in hospital emergency rooms until the hazards became known. It can be self administered. Plaque can be dislodged by this technique, travel and cause oclusion of a blood vessel in the brain, so there is some hazard.
Answer
Just took my physical; 118/76, go figure?!