Q. I am a 26-year-old male, and I'm worried as my blood pressure has been inconsistent this year.

A few months ago, my blood pressure reading was within the normal range of 120/80, but it shot up suddenly to a hypertensive 160/90. Recently, it has been toggling between 140/80 and 140/70 for two weeks.

I have a mild heart condition, mitral valve prolapse, that may affect blood pressure readings. I have seen cardiologists and many general practitioners, but they did not send me for further tests.

I am terribly upset. I have no family history of high blood pressure. My BMI and cholestrol levels are normal, and I don't suffer from hyperthyroidism. My potassium and sodium levels are also normal.

I'm also getting some form of depression now after all these episodes.

What is wrong with me?

A. It seems that this young man is of anxious disposition. This will affect the BP readings.

When stressed either physically or mentally, the BP will rise. It does not mean he has hypertension. It is simply a physiological response.

The BP level which he mentioned is not overtly high although a systolic of 140mmHg is at the threshold of systolic hypertension. Not everyone who has hypertension need to be investigated for secondary hypertension.

Conditions such as those he mentioned may have other clinical features which would alert the doctors whom he has seen to carry out tests as required. As he has already mentioned, the electrolytes (sodium and potassium levels) are normal. So that makes endocrinological causes unlikely. One further test which may be considered would be a 24 hr Ambulatory BP monitoring. This would give a profile of his BP over 24 hr period.

Conversely, he can continue to monitor his own BP at home. I would suggest he takes 2 readings 5 minuts apart. This should be done when he is in a comfortable position and totally unstressed. If the BP is consistently elevated, he should return to a doctor whom he feels comfortable with and whom he can trust for further treatment.

This question was answered by Dr Tan Chong Hiok, Consultant of Department of Cardiology, Changi General Hospital.