Correspondence (reply): In Reply

The authors thank Dr Riehl for sharing his observations from the perspective of psychosomatic primary care. He sees an indication for immediate-release nifedipine as a “rescue medication” in order to enable patients with “cardiophobia” to break the vicious cycle of anxiety and rising blood pressure. We are not aware of any guideline recommendations for this problem, which is probably common in the primary care setting. In our article we advised against administration of immediate-release nifedipine in older patients (1). The desire to improve patients' self efficacy is understandable. We still have reservations against recommending self-administered treatment for older patients, particularly since in blood pressure spikes (not emergencies) immediate lowering of blood pressure is not required, but if medication is administered incorrectly there is a risk of hypotension and falls. We think it is important that in patients with (recurring) blood pressure spikes, adherence to their medication regimen should be checked and, if required, the patient's understanding of their illness should be discussed. This also offers a starting point for discussing the interplay of stressors (anxiety/fear) and rising blood pressure with the patient. We also think further differential diagnostic evaluation is essential, which should include psychological comorbidities (such as panic attacks). It would be highly desirable for guidelines for the treatment of hypertension to include the described problems and formulate therapeutic recommendations.