High blood pressure: control and treatment online in Puerto Rico

Blood pressure is the force of blood against the walls of your arteries. It is written as two numbers: the top (systolic) and the bottom (diastolic), for example 120/80 mm Hg.

Most people with high blood pressure feel nothing. That is why many don’t know they have it, and over the years it can damage the heart, kidneys, eyes and brain without warning. The only way to know is to measure it. According to MedlinePlus, repeated nosebleeds can be a sign of another condition, such as high blood pressure: see nosebleed. These categories apply to adults who are not taking blood pressure medicine and are not ill:

• Normal: under 120 and under 80.
• Elevated: 120 to 129 and under 80.
• Stage 1 high blood pressure: 130 to 139, or 80 to 89.
• Stage 2 high blood pressure: 140 or higher, or 90 or higher.
• Hypertensive crisis: higher than 180, or higher than 120. Get medical care right away.

Video doctor visits 24/7 — book online and choose your time right away.

New or uncontrolled high blood pressure is handled in a doctor visit. If you already take a blood pressure medicine and only need a refill, it is a follow-up visit: see prescription refills. If a follow-up turns out to need a full visit, the doctor explains why and, with your consent, you pay the difference.

The same price for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the clinic can’t see you. A doctor’s note is included. We do not bill insurance; the lab and the pharmacy charge separately. See all prices. The service is run by The Health Initiative, a nonprofit.

High blood pressure usually causes no symptoms. But extremely high blood pressure (malignant hypertension) is an emergency and can cause:

• Severe headache
• Nausea and vomiting
• Confusion
• Vision changes
• Nosebleeds

Treatment usually starts with lifestyle changes: a heart-healthy diet with less salt (under 1,500 mg of sodium a day), at least 150 minutes of exercise a week, a healthy weight, limiting alcohol and quitting smoking. According to the CDC, smoking damages blood vessels and raises the risk of heart disease and stroke; if you want to quit smoking, the doctor helps you with a plan. Losing even some weight helps lower blood pressure; if it has been hard, see how we help with medically supervised weight loss.

If that isn’t enough, or if you have stage 2 blood pressure, diabetes or heart disease, a blood pressure medicine is added. There are several types, such as diuretics and angiotensin II receptor blockers (ARBs); the most common are explained below, under “Common blood pressure medicines.” Many people need more than one. Never change your dose, switch pills or stop a medicine on your own; if you have dizziness, cough, tiredness or erection problems, tell the doctor: there is almost always another option.

Losartan, according to MedlinePlus, is an ARB: it blocks substances that tighten blood vessels so blood flows more smoothly. It is used to treat high blood pressure, to lower the risk of stroke in some people with high blood pressure, and to treat kidney disease in people with type 2 diabetes and high blood pressure. You keep taking it even when you feel well.

Pregnancy: ACE inhibitors and ARBs, such as lisinopril and losartan, are not taken during pregnancy because they can seriously harm the baby. MedlinePlus lists it as an important warning, and the FDA label for lisinopril carries its strongest, boxed warning: drugs that act on the renin-angiotensin system can injure and kill the developing baby, and they are stopped as soon as pregnancy is detected. If you are pregnant, planning a pregnancy or become pregnant while taking one, call the doctor right away to change your treatment.

The doctor gives you a lab order when you start or change a medicine, to check your kidneys and electrolytes, and to look for other conditions that raise your risk, such as diabetes and high cholesterol.

There are several groups of blood pressure pills, and the doctor decides whether a medicine is right for you based on your readings, age, kidneys and other conditions. These are the most common, with one example of each:

• ARBs (angiotensin II receptor blockers): for example, losartan.
• Calcium channel blockers: for example, amlodipine, which relaxes blood vessels so the heart doesn’t have to pump as hard.
• ACE inhibitors: for example, lisinopril.
• Beta blockers: for example, metoprolol, which is also used for angina and after a heart attack. Another is propranolol, which is also used to prevent migraine and for tremor.

Lisinopril and other ACE inhibitors: according to MedlinePlus, lisinopril can cause a cough. If you have a cough that won’t go away, tell the doctor instead of stopping the pill. Rarely they cause swelling of the face, lips, tongue or throat (angioedema), which the FDA label says can be fatal: if your lips or tongue swell, or you have trouble breathing or swallowing, call 911.

Metoprolol and other beta blockers: don’t stop them suddenly. The FDA label warns that stopping abruptly can worsen angina and, in some cases, cause a heart attack; when one has to be stopped, the dose is lowered gradually under medical guidance.

Amlodipine: according to MedlinePlus, it can cause swelling of the hands, feet, ankles or lower legs; if it is severe or doesn’t go away, tell the doctor. See also swollen legs.

If you already take one of these medicines and are running low, a prescription refill is a follow-up visit. Book an evaluation; the doctor decides whether a treatment is right for you.

Home readings can be a better measure of your real blood pressure than office readings. Use a digital upper-arm monitor with a cuff that fits you and follow these CDC steps:

• Don’t eat or drink anything for 30 minutes before.
• Empty your bladder.
• Sit with your back supported for at least 5 minutes first.
• Keep both feet flat on the floor, legs uncrossed.
• Rest your arm on a table at chest height.
• Put the cuff on bare skin, not over clothing.
• Don’t talk during the reading.
• Take at least two readings 1 or 2 minutes apart, at the same time every day, and write them down.

According to the CDC, Puerto Rico had the highest rate of diagnosed diabetes among adults of any U.S. state or territory in 2021: 14.4%, and diabetes raises the risk of high blood pressure. During hurricane season, plan ahead so you don’t run out of your pills: read medications and hurricanes.

In children and teens, blood pressure is not compared with adult numbers but with norms for age, height and sex. The doctor evaluates your child by video with you on camera, reviews readings taken with a correctly sized cuff and, if needed, gives you a lab order for a lab near you.

We see children of all ages. Patients under 21 need a parent or legal guardian on camera with ID.

For your safety, call 911 or go to the emergency room if your blood pressure is above 180/120 with symptoms, or if you have any of these signs. See when to go to the ER.

• Blood pressure above 180/120
• Chest pain or pressure
• Shortness of breath
• Weakness, numbness or drooping on one side of the body
• Trouble speaking, confusion or sudden vision changes
• A sudden, very severe headache
• Swelling of the lips, tongue, face or throat, or trouble breathing or swallowing