High Blood Pressure Consult Online

High Blood Pressure (Hypertension) - Overview

High blood pressure, or hypertension, is characterized by a high force of blood in vessels known as arteries in the body, resulting in an elevated risk for a number of other health conditions. Through Push Health, people with high blood pressure or in need of hypertension prescription medication can get a prescription for high blood pressure medications from a medical provider when appropriate to do so.

What Causes High Blood Pressure?

What causes high blood pressure, also known as hypertension? Risk factors for hypertension include advanced age, ethnicity, tobacco use, alcohol intake and sex. Family history and stress can sometimes lead to high blood pressure as can a high sodium diet. Certain types of medications can also cause one's blood pressure to go up. Some episodes of blood pressure have no identifiable reason at all. These cases of high blood pressure are sometimes referred to as essential hypertension, primary hypertension or idiopathic hypertension.

Blood Pressure Classification

Blood pressure is measured in millimeters of mercury (mmHg) and expressed as two numbers: systolic pressure (the pressure when the heart beats) over diastolic pressure (the pressure when the heart rests between beats). According to the American College of Cardiology (ACC) and American Heart Association (AHA) guidelines:

Category	Systolic	Diastolic
Normal	< 120 mmHg, and	< 80 mmHg
Elevated	120-129 mmHg, and	< 80 mmHg
High - Stage 1	130-139 mmHg, or	80-89 mmHg
High - Stage 2	≥ 140 mmHg, or	≥ 90 mmHg or higher
Hypertensive Emergency	Higher than 180 mmHg	Higher than 120 mmHg

A hypertensive emergency, consisting of blood pressure above 180/120 mmHg requires immediate emergency medical care and is not appropriate for telehealth management, particularly in the setting of symptoms such as shortness of breath, chest pain or neurological changes. Patients experiencing these symptoms should call 911 or go to the nearest emergency room immediately.

High Blood Pressure - Signs / Symptoms

High blood pressure (hypertension) symptoms can vary from person to person. Many people with hypertension are asymptomatic, meaning they have no symptoms at all. Severe cases of high blood pressure (sometimes referred to malignant hypertension) can cause major symptoms such as an altered mental state, chest pain, shortness of breath, nervous system disorders and even death. People can sometimes also have moderate symptoms from high blood pressure, including visual changes, fatigue, palpitations, and changes in their urine. High blood pressure can also cause damage to organs and systems over time even in the absence symptoms, making it important to stay on top of abnormal blood pressure readings.

High Blood Pressure Medications - Online

One cannot simply buy high blood pressure medications online as medications for hypertension require a prescription from a licensed medical provider in the United States. For this reason, OTC blood pressure medications are not available, either. Push Health can connect people who might be in need of a hypertension prescription medication with medical providers who can prescribe high blood pressure prescription medications when appropriate to do so.

High Blood Pressure - Medication Classes

High blood pressure medications exist to help people with hypertension get their blood pressure to a more acceptable level. Medications for hypertension are designed with different purposes in mind. Some high blood pressure medications cause the blood vessels to relax while other blood pressure medications cause fluid to be excreted from the body, lowering the pressure in the blood vessels. There are several classes of prescription medications used to treat high blood pressure. The most commonly prescribed classes are described below:

ACE Inhibitors

ACE (angiotensin-converting enzyme) inhibitors block the production of angiotensin II - a hormone that constricts blood vessels and raises blood pressure. By blocking this pathway, ACE inhibitors allow blood vessels to relax and reduce the workload on the heart. Lisinopril is the most commonly prescribed ACE inhibitor and one of the most dispensed medications in the United States. Other ACE inhibitors include benazepril, captopril, enalapril, fosinopril, quinapril, and ramipril. ACE inhibitors are particularly beneficial for patients with hypertension who also have diabetes, heart failure, or chronic kidney disease. The most common side effect is a persistent dry cough.

ARBs (Angiotensin Receptor Blockers)

ARBs block the receptor that angiotensin II acts on, producing similar blood pressure reduction to ACE inhibitors but without causing the dry cough. Losartan (Cozaar) is the most commonly prescribed ARB and is a standard alternative for patients who develop a cough or an ACE inhibitor. Other ARBs include azilsartan, candesartan, irbesartan, olmesartan, telmisartan, and valsartan.

Beta Blockers

Beta blockers reduce blood pressure by slowing the heart rate and reducing the force of cardiac contractions, thereby lowering cardiac output. They are particularly useful in patients with hypertension who also have angina, heart failure, prior heart attack, or atrial fibrillation. Metoprolol (Lopressor, Toprol) is one of the most commonly prescribed beta blockers. Other beta blockers used for hypertension include atenolol, bisoprolol, carvedilol, labetalol, nebivolol, and propranolol. Beta blockers should generally not be stopped abruptly.

Calcium Channel Blockers (CCBs)

Calcium channel blockers prevent calcium from entering heart muscle and blood vessel wall cells, causing blood vessels to relax and widen. Amlodipine (Norvasc) is the most widely prescribed CCB and is used both as monotherapy and in combination with ACE inhibitors or ARBs. Other CCBs include diltiazem, felodipine and verapamil. Leg swelling sometimes occurs as a side effect of some CCB medications.

Thiazide Diuretics

Thiazide diuretics lower blood pressure by causing the kidneys to excrete more sodium and water, reducing blood volume and vascular pressure. Hydrochlorothiazide (Microzide) is the most commonly prescribed diuretic for hypertension and is often used in combination products with ACE inhibitors or ARBs. Chlorthalidone is considered by some guidelines to have a slight clinical advantage over HCTZ due to its longer duration of action. Indapamide is another thiazide-like diuretic used for hypertension.

Other Medications

Additional blood pressure medication classes include alpha-1 blockers (doxazosin), central alpha-2 agonists (clonidine, methyldopa), direct renin inhibitors (aliskiren), direct vasodilators (hydralazine, minoxidil), and aldosterone antagonists (spironolactone). These agents are typically used when first-line options are insufficient or contraindicated, or as add-on therapy in resistant hypertension.

High Blood Pressure - Medication List

Examples of medications that might be used to manage high blood pressure are as follows:

All hypertension medications should be used under the guidance of a licensed medical provider to make sure that they are being used appropriately.

How To Lower High Blood Pressure

In addition to taking medications for hypertension under the guidance of a medical provider, what are other ways to lower high blood pressure? A number of lifestyle changes can be helpful in lowering high blood pressure and reducing future health risks. Some recommended lifestyle changes to improve hypertension include, but are not limited to, losing weight, decreasing sodium intake, getting regular exercise, reducing alcohol intake, and meditating daily.

High Blood Pressure Medications - Side Effects

Medications used for hypertension can cause side effects. Mild side effects of high blood pressure medications include stomach upset, dizziness, weakness, nausea, vomiting and headache. As one might expect, all medications that are used for high blood pressure can cause low blood pressure if used in too large of a dose. All blood pressure medications can also result in a hypersensitivity or allergic reaction when used and should be avoided when this occurs. Questions and concerns about high blood pressure medications should be directed to one's medical provider and pharmacist prior to use.

How to Get a Blood Pressure Prescription with Push Health

• Complete a brief health intake. Answer a few questions about your blood pressure readings, current medications, medical history, and any relevant conditions - including kidney disease, diabetes, or prior reactions to blood pressure medications.
• Connect with a licensed medical provider. A provider will review your information and evaluate which blood pressure medication is most appropriate for your situation. Same-day consultations are available.
• Receive your prescription electronically. If a blood pressure medication is appropriate, your provider will send a prescription to a pharmacy of your choice - no office visit required.
• Pick up your medication same day. Most generic blood pressure medications are extremely affordable, typically costing under $15 for a 30-day supply at most retail pharmacies. No health insurance or subscription is required.

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