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Follow-Up Doctor Visits

Regular visits to your doctor are an important part of keeping your blood pressure under control. But how often is enough?

If you have stage 1 hypertension and are otherwise healthy, plan to see your physician once every month until you reach your blood pressure goal. However, if you have other health problems or stage 2 hypertension, you should visit your doctor more frequently—typically every two to four weeks.

At these visits, your doctor will measure blood pressure, ask about side effects, and discuss the progress you are making with lifestyle measures like diet, exercise and smoking cessation. Based on this information, the doctor may adjust your drug dosages, add another drug, switch a medication if side effects are troublesome and provide further advice on lifestyle changes.

Once your blood pressure has been lowered to your goal level or has stabilized, your doctor visits can usually be reduced to every three to six months, although people with other health conditions (such as diabetes or heart disease) may need to visit their doctor more often.

Your blood levels of sodium, potassium and creatinine should be measured at least once or twice a year to detect any adverse effects from your blood pressure medication and any deterioration in kidney function.

Only about a third of people with hypertension reach the blood pressure goal of less than 140/90 mm Hg. One reason is that some doctors do not treat hypertension aggressively enough. In other cases, people do not take their medication as prescribed or do not adopt the recommended lifestyle changes.

Being motivated to take your blood pressure medication is not always easy. Your hypertension may not be producing any symptoms, yet your doctor is asking you to make lifestyle changes and take medication that may be expensive or cause side effects. Nonetheless, taking your medication as recommended by your doctor is crucial to preventing blood pressure-related complications that could have a devastating effect on your health.

Publication Review By: Lawrence Appel, M.D., and Rafael H. Llinas, M.D.

Published: 16 Jul 2013

Last Modified: 16 Jul 2013

Complications caused by hypertension (high blood pressure), is one of the most common reasons for emergency room visits. Elevated blood pressure levels can cause substantial damage to our bodies and lead to conditions that can become life-threatening.

Knowing when to seek immediate emergency care can help you avoid delays in getting medical attention, and decrease your risk of developing severe complications caused by extremely high blood pressure.

According to the American Heart Association, when blood pressure levels increase severely and reach measurements of 180/110 or greater, you should seek immediate medical attention.

There are other warning signs coupled with high blood pressure that indicate you are having a hypertensive crisis and require emergency care. Signs and symptoms may include:

  • Severe chest pain
  • Nausea and vomiting
  • Severe headaches accompanied by blurred vision and confusion
  • Seizures
  • Unresponsiveness
  • Shortness of breath
  • Severe anxiety

The cause of a severe spike in your blood pressure and these symptoms could be the result of missing your blood pressure medications, a stroke, a heart attack, kidney failure or an artery rupture.

A hypertensive crisis can lead to complications or damages to your body such as fluid in the lungs, memory loss, vision damage, and damage to vital organs. This is why it is important that you go to your nearest hospital emergency room and receive the treatment needed to lower your blood pressure. Damage to your organs will be assessed and your doctors will immediately address complications.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

High blood pressure – what to ask your doctor

How can I change the way I live to lower my blood pressure?

  • What is a heart-healthy diet? Is it OK to ever eat something that is not heart healthy? What are some ways to eat healthy when I go to a restaurant?
  • Do I need to limit how much salt I use? Are there other spices that I can use to make my food taste good?
  • Is it OK to drink alcohol? How much is ok?
  • What can I do to stop smoking? Is it ok to be around other people who are smoking?

Should I check my blood pressure at home?

  • What type of equipment should I buy? Where can I learn how to use it?
  • How often do I need to check my blood pressure? Should I write it down and bring it to my next visit?
  • If I cannot check my own blood pressure, where else can I have it checked?
  • What should my blood pressure reading be? Should I rest before taking my blood pressure?
  • When should I call my provider?

What is my cholesterol? Do I need to take medicines for it?

What medicines am I taking to treat high blood pressure?

  • Do they have any side effects? What should I do if I miss a dose?
  • Is it ever safe to stop taking any of these medicines on my own?

How much activity can I do?

  • Do I need to have a stress test before I exercise?
  • Is it safe for me to exercise on my own?
  • Should I exercise inside or outside?
  • Which activities should I start with? Are there activities or exercises that are not safe for me?
  • How long and how hard can I exercise?
  • What are the warning signs that I should stop exercising?

High Blood Pressure: Should You Worry?

It’s a common condition, and it doesn’t have any symptoms: About one out of three U.S. adults has high blood pressure, or hypertension. And nearly one out of three American adults has prehypertension — blood pressure numbers that are higher than normal, but not yet in the high blood pressure range — which raises the risk of developing high blood pressure.

High blood pressure is a leading cause of heart attack, stroke, heart failure, and kidney disease, so it’s a serious condition that we all must be more conscious of as we age. African-Americans in particular should pay careful attention to blood pressure: In one year, the overall death rate from high blood pressure was 40 percent for African-American females and 52 percent for African-American males — more than for any other group.

When Does Blood Pressure Become High Blood Pressure?

According to guidelines followed by doctors, blood pressure is normal if it’s 120/80 or below. The range of 120/80 to 139/89, which was once classified as normal to high, is now considered to be prehypertensive.

If your blood pressure falls somewhere in the prehypertensive range, it may quickly develop into high blood pressure, or 140/90 or above. Most doctors now recommend lifestyle changes to lower blood pressure for anyone with a reading above 120/80. If you have added risk factors such as being overweight or having high blood sugar or cholesterol, the concern is even greater. Even though you may not have any symptoms, high blood pressure increases your risk for cardiovascular disease. Since cardiovascular disease is the cause of death for one out of every three Americans, any evidence of high blood pressure is cause for concern.

How Can You Lower Your High Blood Pressure?

High blood pressure is a treatable condition. Most doctors recommend starting with these lifestyle changes to lower blood pressure:

  • Stop smoking
  • Lose weight
  • Limit alcohol and caffeine
  • Exercise
  • Eat a healthy, low-sodium diet
  • Reduce your stress levels

When lifestyle changes are not enough, your doctor may prescribe one or more antihypertensive medications. You may need to take blood pressure medication for the rest of your life to keep your condition under control. Remember: Stopping medication on your own can increase your risk of cardiovascular disease.

How Do You Handle Resistant High Blood Pressure?

What happens if you’ve made lifestyle changes and you’re taking medication, but your blood pressure is still out of control? Doctors call this resistant hypertension. Resistant hypertension occurs in about 20 to 30 percent of people with high blood pressure. Some common causes include:

  • Uncontrolled risk factors. Poor control of risk factors such as obesity and diabetes can contribute to resistant hypertension.
  • Not taking medications as directed. Failure to take medication on schedule or stopping medication without a doctor’s approval can cause blood pressure to go up.
  • Alcohol and salt intake. Many people with resistant high blood pressure are not controlling their intake of salt and alcohol.
  • Effects of other drugs. Over-the-counter pain relievers, decongestants, and some herbal compounds can interfere with blood pressure control.
  • Other health conditions. Medical conditions such as sleep apnea and diseases of the adrenal glands or kidneys can cause resistant high blood pressure.

If you are having trouble controlling your blood pressure, work with your doctor to find out how you can better manage risk factors. Your doctor may want to perform additional tests to make sure there are no other medical conditions contributing to your high blood pressure.

Do I Really Need Regular Blood Pressure Checkups?

To prevent cardiovascular disease and other possible effects of high blood pressure, it is important to have your blood pressure checked regularly. Blood pressure that was once considered to be high-normal is now cause for concern. If you work with your doctor to find the right combination of lifestyle changes and medication, you will probably be able to control your high blood pressure over time.

A hypertensive (high blood pressure or HBP) crisis is when blood pressure rises quickly and severely with readings of 180/120 or greater.

The consequences of uncontrolled blood pressure in this range can be severe and include:

  • Stroke
  • Loss of consciousness
  • Memory loss
  • Heart attack
  • Damage to the eyes and kidneys
  • Loss of kidney function
  • Aortic dissection
  • Angina (unstable chest pain)
  • Pulmonary edema (fluid backup in the lungs)
  • Eclampsia

An elevated reading may or may not be accompanied by one or more of the following symptoms:

  • Severe headache
  • Shortness of breath
  • Nosebleeds
  • Severe anxiety

Know the two types of high blood pressure crisis to watch for

There are two types of hypertensive crises—both require immediate attention as early evaluation of organ function is critical to determine an appropriate course of action.

Hypertensive Urgency

If your blood pressure is 180/120 or greater, wait about five minutes and try again. If the second reading is just as high and you are not experiencing any other associated symptoms of target organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision, or difficulty speaking, this would be considered a hypertensive urgency. Your healthcare provider may just have you adjust or add medications, but rarely requires hospitalization.

Hypertensive Emergency

If your blood pressure reading is 180/120 or greater and you are experiencing any other associated symptoms of target organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision, or difficulty speaking then this would be considered a hypertensive emergency. Do not wait to see if your pressure comes down on its own, Call 911.

Be prepared

If you have been diagnosed with high blood pressure, track your blood pressure and medications. If possible during an emergency, having these logs with you can provide valuable information to the medical team providing treatment.

Blood pressure numbers

Which is more important, the bottom or the top number?

We have discovered that systolic blood pressure (the top number or highest blood pressure when the heart is squeezing and pushing the blood round the body) is more important than diastolic blood pressure (the bottom number or lowest blood pressure between heart beats) because it gives the best idea of your risk of having a stroke or heart attack.

We know, for example, that having a blood pressure of 160/80mmHg is more “risky” than having a blood pressure of 150/90mmHg. Having a raised systolic blood pressure but normal or low diastolic blood pressure is called Isolated Systolic Hypertension (ISH) and carries an increased risk of developing heart attacks or strokes and should be treated.

However, there are some circumstances where diastolic blood pressure may be more important than systolic. For example, some studies suggest that, in people aged younger than 40 years, diastolic blood pressure is a better way of assessing risk. However, younger people are less likely to have a stroke or heart attack, so information on their risk of future problems is limited. It could be that diastolic blood pressure becomes more important when it is very high. There is some evidence to suggest that, for example, a blood pressure of 180/120mmHg gives a greater risk of stroke or heart attack than 180/100mmHg.

The only way to resolve this issue is to obtain data from thousands of patients collected on a systematic basis. The statistical tests to investigate the relative importance of systolic and diastolic blood pressure are immensely complicated. However, current evidence strongly suggests that, over the age of 40, it is systolic pressure that is most important.

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