My Doctor Online The Permanente Medical Group

Causes and Risk Factors

Both genetic and environmental factors contribute to the development and severity of hypertension. Environmental causes of high blood pressure can include eating too much salt, being overweight, drinking too much alcohol, and not getting enough exercise. Preventing hypertension involves making good lifestyle choices and taking the proper medication if you need to.

Factors that are not related to your lifestyle are also linked with high blood pressure. If members of your family have high blood pressure, you are at higher risk of developing hypertension and should have your blood pressure checked. Older people have higher blood pressure, as blood pressure tends to increase with age. More men than women have hypertension, although in people over 60, both sexes have the condition equally. Also, high blood pressure is more likely to be severe in African Americans than in other ethnic or racial groups.

Symptoms

Most people do not have symptoms from hypertension; however, a small percentage of people may develop headaches when their blood pressure is higher than normal (elevated). High blood pressure generally does not create any symptoms while it is damaging your body, so it is important to check your blood pressure regularly when you have hypertension. The damage that high blood pressure causes happens gradually over a period of time. The less time that your blood pressure is elevated, the lower the chance that it will seriously damage important organs, like the brain, heart, and kidneys.

Diagnosis

Hypertension is diagnosed by taking your blood pressure.

• Normal blood pressure: 119/79 or lower (stated as “119 over 79”)
• Pre-hypertension: 120/80 to 139/89
• High blood pressure (hypertension): 140/90 or higher

The top number of your blood pressure measurement is the systolic pressure. This is the force of blood against your arteries when your heart is sending blood to your body.

The lower number is the diastolic pressure. This is the force of blood against your arteries while your heart relaxes between beats. Both numbers are important and need to be normalized to prevent damage to blood vessels and major organs.

Why Treatment Is Important

With treatment to control your blood pressure, you can avoid many of the effects of high blood pressure. Without this treatment, high blood pressure will cause gradual damage to many important body organs, especially the brain, the heart, and the kidneys.

When high blood pressure is not treated and controlled, you have a higher risk of:

• Strokes 
• Heart attacks
• Heart failure
• Kidney failure

Treatment Goals

Our goal is to lower your blood pressure to 139/89 or less. 

Know your target blood pressure:

• Ask about your target blood pressure.
• Consider buying a blood pressure monitor. Take your blood pressure at home and keep a record of all readings. You can buy an accurate device at the Health Education Center at any Kaiser Permanente Medical Center. 
• Bring your blood pressure record to your visit or e-mail it to us between office visits.
• You can also get your blood pressure checked in our Medical Center in Health Education or by volunteers.

Medication

Medication lowers blood pressure and lessens your chances of having a heart attack or stroke or of developing heart and kidney disease. There are many medications to choose from. It is very common to need more than one medication to control high blood pressure. Most patients report few, if any, side effects. Recommendations about which medicines and what doses will work best for you are based on your individual needs and your response to treatment. Be sure to tell us about any side effects or if you are unable to take any medication prescribed.

• Diuretics work in the kidneys by helping your body get rid of extra water and sodium (salt). Having extra fluid can contribute to high blood pressure. Hydrochlorothiazide (HCTZ) and chlorthalidone are examples of diuretics.
• ACE inhibitors/ARBs work by causing the blood vessels to relax and widen. This increases the supply of blood and oxygen to the organs (heart, brain, and kidneys) and helps the heart beat more easily. This medicine can be especially helpful for people who have other conditions that affect blood vessels (such as diabetes, kidney problems, heart disease, or heart failure) or for people who have had a stroke. Lisinopril is an example of an ACE inhibitor. ACE inhibitors should not be taken by women who are trying to get pregnant or are at risk for pregnancy because they can cause birth defects.
• Combination tablets such as prinzide that contain an ACE inhibitor and a diuretic reduce the number of pills you need. Other combinations of medications are also available.
• Beta blockers relax the heart muscle and slow down the heart rate. This lessens the work of the heart and allows it to pump blood more easily. Atenolol is an example of a beta blocker. 
• Calcium channel blockers relax the muscles around your arteries, making it easier for your heart to pump blood. Amlodipine is an example of a calcium channel blocker.

Most people who take blood pressure medicines need to take them indefinitely. As the body changes with age or with the development of other conditions or risk factors, more medications may need to be added. Taking these drugs lowers blood pressure and lessens the chances of having a heart attack or stroke or of developing heart disease. We will customize your specific treatment to match your individual lifestyle and needs.

Hypertension medications and pregnancy

Some hypertension medications should not be taken by women who are trying to get pregnant or are at risk for pregnancy because they can cause birth defects. If you have hypertension and want to get pregnant, please talk to us. It is best to have your blood pressure under good control before trying to get pregnant. Hypertension can complicate your pregnancy and increase health risks for you and your baby. If you are a woman of childbearing age (15 to 49) and are not planning to get pregnant, use an effective form of birth control. You must be using a highly reliable birth control method if you are taking certain medications for hypertension.

Tips for remembering to take your medication: 

• Use a pillbox that has 7 sections, one for each day of the week.
• Establish a daily routine for taking your medications, such as at bedtime, mealtime, or at the beginning of a TV show that you watch every day.

Lifestyle changes and your medicine's effectiveness

Making healthy changes can help your medicines work even better to lower your blood pressure. If you are overweight, focusing on losing 5 to 10 percent of your body weight may be the most effective way to lower your blood pressure naturally and reduce the amount of medication necessary to control your blood pressure.

Lifestyle Changes

• Get more exercise.
• Maintain a healthy weight.
• Stop smoking (does not lower blood pressure but protects your heart, brain, and kidneys).
• Eat more fruits, vegetables, grains, and beans and less fat.
• Limit alcohol.
• Limit salt.
• Know your target blood pressure.

Lifestyle modifications may help normalize blood pressure. Even if lifestyle modifications alone are not enough to bring your blood pressure to normal, making healthy lifestyle changes can help reduce the amount of medication you need.

Get more active. Exercise may directly lower your blood pressure. It's also a great way to cope with stress, and it helps you lose weight. 

Maintain a healthy weight. Losing weight and keeping it off can help reduce your blood pressure. People who are successful at losing weight:

• Become more physically active.
• Develop healthy eating habits.
• Adopt healthy behaviors and stick with them over time.

Stop smoking. Becoming a nonsmoker may be the most important step you can take for your health.

Eat more fruits, vegetables, grains, and beans and less fat.

Limit alcohol to 1 drink per day if you are a woman and no more than 2 drinks per day if you are a man.

Limit salt (sodium) to 2400 mg per day.

Home blood pressure monitoring can be useful to ensure more continuous control of your blood pressure by enabling you to track it. Reporting what your blood pressure is outside of the office allows adjustments to be made to your medications, taking into account your blood pressure readings at multiple times, in multiple settings. Keep in mind, though, that your blood pressure varies throughout the day and is not the same number each time it is measured. For example, it may go up depending on the level of pain or stress you are experiencing.

Once your blood pressure is at target, we can reduce the frequency of both home and office monitoring. However, it is very important to continue your medications and healthy lifestyle behaviors to maintain control of your blood pressure.

Your Care with Me

If your blood pressure is above 180/100 and:

• You have chest pain, dizziness, severe headache, shortness of breath, or symptoms of stroke such as numbness, visual changes, weakness, or slurred speech, call 911 or go to the Emergency Department.
• You do not have any other symptoms, call the Appointment and Advice line.

We make it easy to have your blood pressure checked. We take your blood pressure at every visit in most departments. If your blood pressure is high, my Medical Assistant (MA) can assist you with follow-up with your personal physician. You can also get your blood pressure checked in the Health Education Department or by volunteers at most of our medical facilities. Home blood pressure monitors are also for sale in the Pharmacy or Health Education Center.

Classes about hypertension management and other related topics are available through our Health Education Department.

Contacting Me

You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

How We Coordinate Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

Convenient Resources for You

As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.