Ask the doctor
Q. When I am under great stress, my blood pressure sometimes shoots up to 200/120 for a short time but then quickly goes down to 120/80 or lower and stays there. One doctor told me that spikes like these are normal and not to worry about them. Another told me this isn't normal or healthy. Who is right?
A. Blood pressure normally goes up and down 20 or 30 points during the day. Surges up to 200/120 due to stress are impressive, and out of the ordinary. How harmful they are is a bit unsettled.
A fair amount of research has looked at whether blood pressure "reactivity" to psychological stress indicates an increased risk of cardiovascular problems. I would summarize the available data like this: Maybe... but not much. Some studies suggest that every 10-point jump in blood pressure due to psychological stress carries an increased risk of future problems, but most data suggest that this risk is small, and trivial compared with your baseline blood pressure.
That said, the fact that your blood pressure rises to this level means that the arteries in your brain and elsewhere are subjected to fairly high blood pressures, even if briefly. You might want to look into breathing exercises or other stress management techniques to help smooth out these surges.
— Thomas Lee, M.D.
Editor in Chief, Harvard Heart Letter