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Experience:  Versatile Emergency Physician, 20 years experience as a Physician.
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does fluctuating blodd pressure cause mood swings

Customer Question

does fluctuating blodd pressure cause mood swings
Submitted: 3 years ago.
Category: Medical
Expert:  Dr Su S replied 3 years ago.
Greetings,

What are your symptoms? How is your blood pressure?


Regards
Customer: replied 3 years ago.
my blood pressure fluctuates 144/95 but can drop as low as 90/55, my blood pressure can be stable at 125/72, while on 5mg 2x daily.I can be completely relaxed ,but then can become agitated and teary for no apparent reason and note bp is high,can also haveslow cognitin and fatigue and note bp very low, this can all happen during a day.
Expert:  Dr Su S replied 3 years ago.
Thank you for the input.

I think you need an adjustment of dose & timing of your blood pressure medicine. You may need change of medicine too. You need to inform your doctor about the fluctuation of blood pressure. Blood pressure may be slightly elevated in anxiety, stress or emotional stress but such wide variation is unusual.

Any query, please feel free to ask.
It will be my privilege to assist you.
Regards.
Customer: replied 3 years ago.
Hi
It's my wife who is making the enquiry. Her specific question is whether it is possible for sudden escalation in blood pressure can be the cause for(NOT THE RESPONSE TO) feelings of agitation and ill-at-ease. My wife is a School Principal and in almost any domain, handles any stress with great ease, confidence and efficiency. She is highly practical and extremely pragmatic about her various maladies. As she mentioned, she has Sjogren;s Syndrome, with the typical "sicca" symptoms and episodic arthralgia, but is reasonably well-controlled by the Hydroxychloroquine. Her diabetes is on basis of PCOS and is treated with Metformin 1000mg B.D.
Her hypertension was diagnosed several years ago, when she first experienced this unexplained episodic "agitation". Intial mild elevated BP was attributed to "white coat phenomenon". She didn't appreciate that physician's perception(particularly because he was almost young enough to be her grandson). Subsequently, a 24hr. BP monitor showed her BP to fluctuate throughout the day, and rises DID seem to generate the same "ill-at-ease" sensation. Investigations excluded all the other serious potential etiologies for H/T and Lisinopril seemed to be effective, with dose gently titrated against the daily BP measurements(range 20mg B.D. thru to 2.5mgB.D. more recently). Over this period, my wife has made a great effort at weight reduction, down from 80KG one year ago, down now to 68Kg.

The question is then, do you believe that BP escalation can trigger the agitation(rather than or alternate to the standard vice-versa belief). AND, would you believe that perhaps EIGHT HOURLY dosing with Lisinopril might be better at stabilising BP. I should add, My wife DOES NOT take NSAIDs for her arthralgia(as she develops gastritis), so these can be excluded as a confounding influence on the BP.
Regards
Dr. John M. Feller (Consultant Paediatrician at Sydney Children's Hospital)
P.S. It may seem odd that a Physician's wife would seek advice via the web, but sadly, none of my Nephrology or Adult Physician colleagues(and any of my wife's treating clinicians) can contribute much to this discussion.
Expert:  Dr Su S replied 3 years ago.
Sorry I am opting out.
Expert:  The Physician replied 3 years ago.

Greetings

 

Firstly I would like to start with the issue of the fluctuating BP. As you know and might have noted even on continuous monitors, there is a constant fluctuation of BP in every individual as a result of physiological mechanisms responding to the environmental factors as well as changes to the internal milieu (electrolytes, hormones, respiration etc).

From the renal RAS system, to the CNS cardiac centers, and the peripheral mechanisms like the carotid 'sensor' all are working in a delicately coordinated way in maintaining a control of the BP, NOT at a steady state but within a range of threshold.

So the difference between a hypertensive individual and a non hypertensive is NOT lack of fluctuating BP, but a failure of one or more of these mechanisms and hence failure of maintaining the equilibrium, allowing the BP to go up unchecked (Le Chattalier's principle of equilibrium)

Lisinopril an ACE inhibitor works at the RAS system, but as you rightly mentioned other factors might be at play, the adrenergic (emotional ) mechanisms (anxiety, stress, anger, joy, excitement, fright, fight,) all could still influence the balance.

Could it be based on this understanding, Doc that your wife's situation might be vice versa (meaning could it be that it is 'subconscious' anxiety/ agitation etc that is influencing the fluctuation rather than the fluctuation causing the agitation)

Logically, increased blood pressure is a RESPONSE of the physiological changes in the homeostasis brought about by both internal and environmental factors, and might in itself influence other physiological endpoints like heart rate, renal function etc (over long term also anatomical changes like atherosclerosis). Doc, we know this as a basic understanding of physiology.

It is difficult to argue it would initiate any changes in the psyche, except if it does that by affecting the anatomy, like in ischaemia leading to anatomical changes in neuronal pathways, it produces other symptoms, that are easily recognized like memory impairment etc.( MRI might be indicated to investigate this)

Lisinopril has a long half life (12 hrs accumulated), it will be unwise to give it 8 hourly. If 2.5 mg is not keeping the BP within a 'desirable range', then it could be increased to 5 mg or changed to Angiotensin Receptor blocker (ARBs) like Irbesartan or more a Direct Renin activity inhibitor like Aliskeren, ( They have more benefits in PCOS, and both classes are more renoprotective as well as cardioprotective than ACE inhibitors, in addition to antihypertensive properties)

 

 

 

The Physician, Doctor
Category: Medical
Satisfied Customers: 945
Experience: Versatile Emergency Physician, 20 years experience as a Physician.
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Expert:  The Physician replied 3 years ago.

Thanks Doc,

 

The issue of using Le chattalier as an analogy was in reference to a broader thinking regarding 'factors' in homeostasis, NOT in specific biological / pathophysiological models.

 

Thanks anyway, for allowing me express my opinion.

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