Should I keep pursuing some avenue of treatment for high blood pressure?

I am a 42-year-old woman in excellent physical condition (I run ~3 half-marathon races per year), but slightly overweight (BMI – 29). I have what I consider to be an elevated blood pressure for five years (average 145 / 95) however my primary care physician doesn’t think it needs to be treated as long as we keep an eye on it. For the past 8 – 10 months I have been getting pain in the left side of my chest. My physician ordered an echocardiogram and my aortic root measured 42 mm. My physician says that’s normal and says I need to let the chest pain go, chalk it up to anxiety. I have been doing reading, and think that my long-term elevated blood pressure may have caused my aorta to be enlarged, which could be what is causing this chest pain that won’t go away. My question is do I let all of this go, or should I keep pursuing some avenue of treatment for high blood pressure? I’m not even sure what that avenue would be, as my primary care physician has refused either referral or treatment. Should I be concerned?

Submitted by Sarah from Hamilton, Ontario on 09/05/2014

by Atasu K. Nayak, MD

Your blood pressure is high. Our recommendation would be for you to see a cardiologist for management of this hypertension. Ideal blood pressure should be 120-130/80-85 mm Hg. Please discuss this with your cardiologist. You will likely be advised to monitor and record your blood pressure in the morning after you get up. If you were my patient, I would have to determine if you needed MRA/CTA of the thoracic aorta for actual diameter of the aortic root and ascending aorta. Please discuss with your cardiologist. If the root is dilated, a beta blocker may help control blood pressure and further dilation of your aorta. Thanks.