Hypertension Care, Treatments And How To Save
This guide is focused on helping you understand your risk, get better outcomes, and find ways to secure more affordable care.
What Is Hypertension?
Hypertension, commonly referred to a high blood pressure, is a condition that can be caused by lifestyle choices (stress, diet) or an underlying physical condition like kidney disease. A normal blood pressure reading is 120/80. The American Heart Association defines Stage 1 Hypertension as a blood pressure reading of 130-129/80-89. Stage 2 Hypertension is a reading of 140/90 or higher. A Hyperintensive Crisis is defined as a blood pressure reading higher than 180/120.
Hypertension is a risk factor for heart disease, stroke, and many other health serious problems. If you have hypertension, your doctor will likely suggest lifestyle modifications and potentially medication to help you control your Stage 1 or Stage 2 Hypertension.
Most Common Types of Hypertension
Primary Hypertension: The most common; caused by lifestyle, age, diet, family history, etc.
Secondary Hypertension: Caused by other factors, such as renal artery stenosis, an adrenal tumor, etc.
Where to Start: Finding The Right Provider
Start With A Visit To Your General Practitioner
It’s always best to start with a visit to your general practitioner (GP). This is especially true of Hypertension, as your doctor will likely suggest lifestyle modifications or medication to control your high blood pressure. Trying to find a specialist on your own—in this case, a cardiologist or nephrologist—is possible, but it’s a process that usually feels like you’re playing Where’s Waldo. The sea of names, practices, and groups can be daunting.
On the whole, your GP or primary care physicians (PCP) are gatekeepers to the medical community. They’re the first to diagnose your condition and provide you with a broader perspective based on your personal medical history. The more they know about you, the more effective they’ll be at diagnosing your symptoms and recommending the right next course of action. They are the ones who make your referrals to specialists they know and trust.
Using Doctor Review Sites and Cost Estimator Sites To Find A Cardiologist or Nephrologist
There are many things to consider when it comes to finding the right specialist for your Hypertension treatment. If you’re just starting the process, the best way is to start with a recommendation from your GP.
If your Hypertension is severe or is causing other vascular or cardiac issues, your GP will refer you to a cardiologist or a nephrologist, depending on the manifestation of your symptoms.
If you’re comparing a few different specialists, review sites, transparency sites, and insurance cost estimator tools are a great way to understand where they stack up in regards to overall price and how successful they are at helping patients achieve positive outcomes.
The Top Doctor Review Sites For Or Cardiologists
- Medicare.gov Doctor Compare
- US News & World Report
- The Leap Frog Group (for hospitals)
Cost Estimator Tools For Hypertension
Your insurance company might also provide cost information as well as patient satisfaction information. These are the resources you have access to if you’re insured by a major insurance company. Note, you will need to log in to your account to access the tool.
If you aren't insured by a major carrier these tools also provide price transparency information:
Selecting The Right Specialist For You
Beyond cost and reviews, what are the other factors you should consider?
Start With This Checklist Of Questions
- Are they easy to access?
- What is the quality of their care?
- What do they charge?
- Are they in your network or out of it?
- Are they board certified?
- Do they have experience managing your condition(s)?
- How long have they been in business?
- Are they taking new patients?
- What is their hospital affiliation?
- Are there any red flags such as malpractice suits or sanctions?
- Are they vested in technology?
- Do they participate in electronic medical records and coordinate electronically with pharmacists, other specialists, hospitals, and you?
- Find a gastroenterologist with board certification
- Ask about clinical trials and recent research. You want to find a specialist who is knowledgeable in the field and who is well-connected to the medical community.
It’s also important to focus on how well you and your doctor get along. A good specialist is a good listener; they should not only be interested in helping your health, but also in helping you navigate the healthcare system in the best way possible.
Beyond that, there are a few specific things you should consider. It’s important to interview a few doctors first before you seal the deal.
Always Look For Practices With Support Programs
Managing hypertension is all about managing lifestyle. Both from what you eat to how you manage stress.
Many practices now have programs that help you better understand your treatment, help you track your progress and act as an advocate who coaches you on how to achieve the best possible outcome. They do this by getting you on board and keeping you on track with your treatment plan, which helps you get better, faster.
These services are offered at no extra cost to the patient and are usually referred to as a number of different names, that all do the same thing. When you’re researching Cardiologists and Nephrologists look for:
- Health navigators
- Care navigators
- Patient navigators
- Care managers
- Chronic disease management programs
The Doctor’s Communication Skills
Make sure your cardiologist or nephrologist is a good communicator who seeks your input, asks probing questions, and answers your call (or calls you back) when you need help or information. Ask yourself this: Does the specialist answer my questions and explain complex medical issues clearly, so I can understand them?
The Practice’s EHR (Electronic Health Record) System
What’s an EHR? EHR stands for electronic health records. Back in 2009, the federal government passed a law called HITECH (the Health Information Technology for Economic and Clinical Health), which basically mandated that doctors start to use electronic health record systems.
About 80% of physicians now use a “certified EHR”. EHR’s allow doctors on the same system to easily and instantly share charts, notes and your medical history. Finding a specialist that’s on your hospital and GP’s EHR will make communication between doctors a whole lot easier.
Ask the specialist’s practice which EHR they use and then cross compare that to the doctors you’ve already established a relationship with. Here’s a list of the most popular EHRs:
Is it essential that your doctors are on the same EHR? No. But it will make your quality of life, and the doctor’s ability to communicate easier.
Alliances within the Medical Community
Cardiologists or nephrologists often need to communicate with your other healthcare providers, such as your primary care provider. Ask about their ties to other medical professionals and what hospitals they’re affiliated with. This is important because if your specialist uses the same electronic medical records (EMR) system as your primary care provider, that higher degree of coordination will save time and increase communication—both of which can lead to a better outcome for you!
A good cardiologist or nephrologist will be on top of all the latest research and developments in the space. They should also be well informed about clinical trials being done on meds, in case you’re eligible to participate in a study.
Whether They’re A Solo Practice or Multi-Physician Practice
A multi-physician practice will have better coverage or physician availability for patients if there is an urgent need. Though, if your disease is well maintained, this may not be as important of a consideration when choosing a doctor.
In addition, many specialists are outpatient providers, which means there are a few things you need to consider before choosing a practice to visit:
- Is it in network?
- Do they offer discounts?
What To Expect From A Visit With A Cardiologist
How to Prepare For An Effective Visit
Visiting your cardiologist with concerns about Hypertension can be scary. Here are some tips to improve your experience:
- Bring a list of your home blood pressure readings with you, including the time of day you took your blood pressure and how you were feeling. Vary the time of day you take the reading.
- Your doctor will need to see consistently high readings two weeks apart to recommend medication. Sometimes, patients get “white coat syndrome,” and their blood pressure runs higher in the doctor’s office. That’s why home readings are crucial.
- To take a home reading, use an arm cuff. Make sure you’re relaxed when you take the reading and haven’t been doing any strenuous exercise or activity immediately before. Keep the cuff level with your heart for the most accurate results.
How To Talk To Your Doctor
While most of us are used to relying on our doctor’s to guide the conversation, the only way to make sure you’re getting the best care is to speak up. Most doctors and practices are trained in the SBAR method. Use it to organize your thoughts.
- Situation: take ten seconds to explain your ailment
- Background: provide context with your medical health record
- Assessment: describe the specific problem/situation
- Recommendation: explain what you want to do about it and when
How Hypertension is Diagnosed and What to Expect
Every patient is unique, so every office visit will be, too. That said, there are building blocks of treating Hypertension that are standard. It’s important to understand this process and why each step is being taken. Remember that you have the power to gut check a particular test based on your level of symptoms.
- Your doctor will ask about family and health history
- You doctor should start with questions about your symptoms, health habits, and family history. If you have been keeping a record of your blood pressure readings, this is the time to share those!
- Every diagnosis then moves to a physical exam
- Hypertension most often will not cause visible physical symptoms. That’s why (when uncontrolled) it is often referred to as the “silent killer,” as many patients don’t know they have it. Instead, patients may experience “masked” symptoms, like shortness of breath, headaches, and changes in vision. Your doctor should conduct an extensive physical exam to make sure you don’t have any underlying issues that are contributing to your high blood pressure.
- Sometimes, your doctor will order tests
- Besides the obvious reading of your blood pressure in the office, the most common additional tests associated with Primary Hypertension are blood tests or other labs. Once you’re prescribed a medication or treatment plan, make sure you follow up with routine blood work and visits.
Questions to Ask Your Doctor Ask You Discuss The Diagnosis And Treatment Options
- What is the test for?
- How many times have you done this procedure?
- When will I get the results?
- Why do I need this treatment?
- Are there any alternatives?
- What are the possible complications?
- Which hospital is best for my needs?
- How do you spell the name of that drug?
- Are there any side effects?
- Will this medicine interact with medicines that I’m already taking?
- What is my diagnosis?
- What are my treatment options?
- What are the benefits of each option? What are the side effects?
- Will I need a test? What is the test for? What will the results tell me?
- What will the medicine you are prescribing do?
- How do I take it? Are there any side effects?
- Why do I need surgery? Are there other ways to treat my condition? How often do you perform this surgery?
- Do I need to change my daily routine?
How to Save On Diagnostic Testing
If you have health insurance, make sure you are staying in network. As a general rule of thumb, if you need imaging for any reason (likely associated with Secondary Hypertension), a freestanding lab will be less expensive than getting having the test done at a hospital.
While the most common way to test for hypertension is with a standard blood pressure cuff, there are other procedures that are used to test for damage to the heart or blood vessels.
Electrocardiogram And Echocardiography Costs
Common Prescription Treatments for Hypertension and How Much They Cost
Your doctor will discuss your modifiable risk factors either before prescribing medication or in tandem with prescribing medication. These recommendations may include trying to lose weight, controlling your diet (many will recommend the Mediterranean diet), stopping smoking, and reducing stress.
Prescriptions are commonly used to treat Primary Hypertension. Here are a few basic types and how much they cost:
Common Drug Classes
Angiotensin Receptor Blockers (ARBS)
Calcium Channel Blockers
Angiotensin-converting Enzyme (ACE) Inhibitors
- Combination Pills (of the above)
Note that if you are a diuretic, that can cause electrolyte abnormalities. Your doctor should monitor that. ACE Inhibitors and ARBs are metastasized by the kidneys, so your doctor will monitor your kidney function at least twice a year while you’re taking these medications. That’s another reason it’s very important to follow up with your doctor for routine blood work when you take these or any kind of medications.
Questions To Ask Your Doctor About Your Medication
- Do I need medication, or are there other ways I can control my Hypertension?
- If I do need medication, what kind?
- What side effects can I expect?
- When is the best time of day to take the medication? And how often?
- How long do I need to remain on this medication if my Hypertension improves?
- What alarm symptoms should I watch out for as I start this treatment?
Average Drug Costs
Here is a sampling of some of the generic and name brand drugs in the categories above. In no way is this a full list of all the available drugs used to treat Hypertension, but it will give you an idea of what you may encounter price-wise. Always talk to your doctor about the benefits and side effects—including the cost—of medications they prescribe.
Saving On Prescription Drugs
Whether your health insurance covers prescription medication or you have to pay out of pocket, drug cards are one of the most effective way to save on Rx. See our how drug cards on our How to Savepage.
Drug cards aren't the only way you can save on prescriptions, though. There are tons of insider tricks you can follow, starting with asking your doctor the right questions. See our guide to the questions you should be asking to save money on your prescriptions.
Regular Tests To Avoid Complications
You should get into practice of regularly measuring and logging your blood pressure at home. Your doctor might also recommend additional routine tests, like a blood test, a cholesterol test and an electrocardiogram.
The reason for the testing is that hypertension can lead to and put you at risk of other, more serious diseases. Aneurysm's, coronary artery disease, heart failure, stroke and dementia are all risks if hypertension isn't managed and treated seriously.
Lifestyle Changes That Will Improve Your Health
Changing Your Lifestyle to Help Cope with Symptoms and Increase Your Health
Sometimes the easiest way to lower the cost of healthcare is simply not to get sick. Besides the unmodifiable risk factors associated with Secondary Hypertension, the good news is that many of the risk factors for Primary Hypertension fall under the modifiable category.
The American Heart Association recommends the following five specific steps for lifestyle changes to reduce Hypertension:
- Keep your BMI between 18.5 and 24.9
- Reduce your intake of saturated and total fat, and increase your intake of fruit, vegetables, and low-fat dairy
- Keep your sodium intake to under 1,500 mg per day
- Participate in aerobic exercise for at least 90-150 minutes per week (and/or do three sessions of isometric resistance exercises per week)
- Drink less alcohol (Men: two per day; women: one per day)
Living With A Chronic Condition
Living with a chronic condition can be incredibly difficult. Being diagnosed with Hypertension can be stressful and scary, but the good news is that having the diagnosis means you can begin to make changes that will positively affect your life.
When it comes to receiving care and being able to afford the cost of care, you have many more options than you think.
We continually update this guide with the latest tools, resources and savings tips. If you have a story to share about your treatment or how you’ve Uncovered better healthcare, join our community and share it!