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.

Request a visit online 24/7 — we confirm your time by email or text.

New or uncontrolled high blood pressure is handled in a US$79 doctor visit. If you already take a blood pressure medicine and only need a refill, it is a US$49 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 visit can’t take place. 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.

If that isn’t enough, or if you have stage 2 blood pressure, diabetes or heart disease, medicines are added. The most used types are diuretics, ACE inhibitors, angiotensin II receptor blockers (ARBs) and calcium channel blockers. Many people need more than one. Never change your dose or stop a medicine on your own; if you have dizziness, cough or tiredness, tell the doctor: there is almost always another option.

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.

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