Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Jeremy Swartzberg

Jeremy Swartzberg, MD

Hospital Medicine

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Oakland Medical Center
Appt/Advice: 510-752-1190

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Overview

Hypertension means having higher than normal blood pressure. Blood pressure is the force of your blood on the walls of your blood vessels. This force, or pressure, helps blood to pump throughout your body. Everyone needs a certain amount of pressure to make this process possible. 

When the force of blood against your artery walls is too strong, you have hypertension. This causes your:

  • Heart to work too hard to send blood throughout your body.
  • Blood vessels to become increasingly damaged over time. 

By lowering your blood pressure, you can take some of this extra demand off your heart and blood vessels.

Causes and Risk Factors

Both lifestyle and genetic factors contribute to the development and severity of hypertension.

Lifestyle factors

Lifestyle causes of high blood pressure can include:

  • Eating too much salt
  • Being overweight
  • Drinking too much alcohol
  • Getting too little exercise

Preventing hypertension involves making good lifestyle choices and taking the proper medication if you need to.

Genetic factors

If members of your family have high blood pressure, you are at higher risk of developing hypertension and should have your blood pressure checked. 

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, African Americans are more likely to have high blood pressure and develop more complications from high blood pressure than 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). 

Even though high blood pressure generally does not have any symptoms, it still damages 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.

  • Optimal blood pressure: 119/79 or lower (stated as “119 over 79”)
  • Prehypertension: 120/80 to 139/89
  • Hypertension (high blood pressure): 140/90 or higher
What the numbers mean

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 optimal to prevent damage to blood vessels and major organs.

Treatment

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 gradually damage many important body organs, especially the brain, heart, and 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

For most people, an optimal or target blood pressure is 119/79 or lower, although this target goal may vary. Your doctor will tell you what your target blood pressure goal is. Be sure to ask if you’re not sure.

Home monitoring

Monitoring your blood pressure helps us keep it under control and adjust your treatment plan if needed. We take into account multiple readings done at home, during office visits, and in other settings.

Make sure you:

  • Keep a record of all readings.
  • Bring your blood pressure record to your office visits or email it to us between visits.

You can:

  • Buy an accurate device at the Health Education Center at any Kaiser Permanente Medical Center.
  • Schedule an appointment for a free blood pressure check with a medical assistant in your doctor’s office online or by phone.  

Keep in mind 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 may be experiencing.
  • It’s very important to continue your medications and healthy behaviors to maintain control of your blood pressure.
  • We can reduce the frequency of both home and office monitoring once your blood pressure is within your target range.

Medications

Medication lowers blood pressure and reduces your chances of having a heart attack or stroke or of developing heart and kidney disease. 

Recommendations about which medicines will work best for you are based on your individual needs and your response to treatment. 

Most patients:

  • Need more than one medication to control high blood pressure.
  • Report few, if any, side effects. Be sure to let us know about any side effects or if you are unable to take any prescribed medication.

There are several common medications for hypertension.

  • Thiazide diuretics lower blood pressure by relaxing the blood vessels. Hydrocholorothiazide (HCTZ) and chlorthalidone are examples of thiazide 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 and ARBs should not be taken by women who might become pregnant. These medications may increase the risk of birth defects.
  • Combination tablets such as lisinopril-hydrochlorothiazide that contain an ACE inhibitor and a diuretic reduce the number of pills you need. Other combinations of medications are also available.
  • 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.
  • Aldosterone blockers, such as spironolactone, block a hormone called aldosterone, making it easier for the body to get rid of excess salt.
  • 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. 

Most blood pressure medicines are taken on a long-term basis. If you think you need to stop taking your medication, check with your doctor first. Over time, changes can occur and you and your doctor may need to adjust your treatment. 

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.

Remembering to take your medication

Use these tips so you don’t forget:

  • Put medications in 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, at mealtime, or at the beginning of a TV show you watch every day.

Lifestyle Changes

Lifestyle changes can help control blood pressure. Even if lifestyle changes alone are not enough to bring your blood pressure to an optimal level, they can help: 

  • Your medicines work even better to lower your blood pressure.
  • Reduce the amount of medication you need.

Here are some of the things you can do:

  • Be active. Exercise may directly lower your blood pressure. It’s also a great way to cope with stress, and it helps you lose or maintain your weight. 
  • Stop smoking. If you smoke, quitting helps protect your heart, brain, and kidneys.
  • Maintain a healthy weight. Losing weight and keeping it off can help reduce your blood pressure. If you are overweight, losing 5 to 10 percent of your body weight may be the most effective way to lower your blood pressure. 
  • Eat a healthy diet. This includes less fat and more fruits, vegetables, whole grains, and beans.
  • Limit alcohol. Have no more than 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). Keep your intake to 2,300 mg per day (1 teaspoon).
  • Monitor your blood pressure at home. This helps us mange your blood pressure and adjust your treatment if needed.

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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