I have been having episodes where my heart feels like it's racing.  I took my blood pressure two weeks ago and it was 168/100.  When I went to my drs office, it went up to 180/100.
I was on one enalapril maleate 20mg, so the dr doubled it.
My blood pressure has been lower and stable.
Since then, I have had a couple more episodes where I feel like my heart is racing and my blood pressure is elevated.
I'm working wth my gynecologist to balance out my estrogen and seeing an endocrinologist for my thyroid next week.
My dr gave me a prescription for xanax to take if I need it till I see those drs.
Meanwhile, I am really scared of having more episodes and if something could be wrong with my heart.
It's like a switch turning the episodes on and off.
When they happen, I feel like running to the er but so far I haven't.
Any advice?

This is a common complaint and naturally, arises to a great extent because of vigilance to one's physiology as though it needs to be monitored for signs of trouble.

Whenever we see blood pressure readings with such a spread between the systolic and diastolic side, more particularly where the systolic is somewhat elevated, it is most commonly produced by white-coat hypertension or in other words, apprehension that something is wrong or going wrong with your otherwise normal health status.

Heart rate can be elevated for many reasons and it's important to understand that heart rate in general is an extremely dynamic process, the absence of which would actually represent a problem and not the other way around. Just as a reminder, accurate assessment of self-monitoring blood pressure is essential. For accurate readings, it's important to be seated quietly for an average of 20 minutes before attempting to obtain readings and the arm to which the cuff is applied should be resting at a point equal or above the heart. Monitors which use wrist or finger cuffs tend to be a little less accurate than arm cuffs and depending upon cuff application, detection of the korotkoff sounds can be biased, ie the cuff being applied too loosely or too tightly.

Doubling anti-hypertensive therapy is a common response in the presence of direct and uncontrolled hypertensive episodes, but it is often necessary to follow up this action with regular notation of blood pressure in such patients 2 times per day and at the same time and conditions. In other words, it was likely that when your heart was racing, you took your pressure during or directly following an episode of sinus tachycardia. The results of such readings are really not that meaningful at all, but merely episodic. Understand that blood pressure under certain conditions can easily attain such levels and do not necessarily constitute hypertension in the context of a disorder.

I also have little doubt that the reading frightened you and that your fears or apprehension of the doctor's subsequent findings played a significant role in your blood pressure while in the clinical setting. It will also produce both a physical and emotionally calming effect if your doctor increases your dosage, with the assurance that you'll be doing better.

It would be my belief that what you are likely experiencing is stress hypertension and given time, changes in your stress levels and worries will produce a corresponding change in blood pressure. The pattern you describe would be inconsistent with primary hypertension as a disease.

The bottom line, however, is to remain closely in your physician's care and under their explicit direction regarding healthcare matters. While the forum here exists to provide medical information, it should never be construed to supplant the advice and care of anyone's primary care physician or specialist.

You'll be just fine. I see nothing here that would warrant concern.

Best regards and Good Health

Anxiety is a not a clinical disorder, but rather a state of mind. Although the American Psychological Association classifies it under the DSM as a disorder, there is a good deal of separation between what this group portends and the physician community stands with in certain instances.

While there are obviously medications to treat the effects of anxiety, its underlying nature is more rooted in habitual patterns of thought based upon those aspects of daily life which have not yet arrived. Despite the overt inability to influence that which has not yet occurred, persons demonstrating anxiety feel compelled to engage in mental rehearsal and prediction of the broad range of possible conclusions of a nature steeped in the irrational beliefs.

There is nothing wrong with your heart. Only you believe this to be the case and you must pause to question precisely what basis you are relying upon to make take such a firm and entrenched position. You must question whether your fears are accurate and warranted or whether they are derived on the basis of irrational and unverifiable perceptions.

I see absolutely nothing of your concerns that would warrant concern or even remotely suggest that an underlying organic cause for the events you perceive to be symptoms.

You're going to be just fine. Take a deep breath and relax.

Best regards,

Rutheford Rane, MD (ret.)