High Blood Pressure Treatment in Southlake, TX

We diagnose and treat high blood pressure using your readings from home, because a number taken in an exam room after you fought traffic on 114 is not the number damaging your arteries. Rachael Bowen, NP will teach you to measure properly, then adjust treatment every few weeks until you are genuinely at goal rather than approximately at goal.

Getting the diagnosis right

Unless your pressure is dangerously high, we do not start medication on one office reading.

We ask for two readings a day, morning and evening, for one to two weeks. That log tells us whether you actually have hypertension, how severe it is, and what time of day it is worst, which changes when you take your pills.

If you do not own a cuff we tell you which kind to buy: upper arm, validated, not a wrist device. Wrist cuffs are convenient and unreliable, and a cheap validated arm cuff beats an expensive wrist one every time.

The workup

New hypertension gets baseline labs: kidney function and electrolytes, a lipid panel, blood glucose or A1c, a urine test for protein, and a TSH. An EKG when it is warranted.

We are looking for two things: damage that has already happened, and causes worth finding.

Secondary causes get missed in a lot of practices. Sleep apnea, thyroid disease, primary aldosteronism, kidney artery narrowing, heavy alcohol use, NSAIDs, decongestants and some stimulants all raise blood pressure. Treating the cause beats adding a fourth drug, and primary aldosteronism in particular is far more common than the textbooks suggested and is genuinely curable in some cases.

We screen for sleep apnea in anyone with resistant hypertension, snoring, or early morning readings that will not come down.

Treatment and follow-up

We start one medication, usually recheck at four to six weeks using your home numbers, and adjust. Then again. Most people reach goal within two or three adjustments.

Which drug depends on you. ACE inhibitors and ARBs are first choice if you have diabetes or protein in your urine, because they protect the kidney beyond their pressure effect. Thiazide diuretics and calcium channel blockers are excellent first-line choices otherwise, and calcium channel blockers tend to work particularly well in Black patients.

Combination pills reduce the number of tablets you take, which matters more for actually taking them than anyone likes to admit. Half of blood pressure treatment failure is not the drug. It is the third bottle.

Once you are stable, visits move to every three to six months. For patients on remote patient monitoring, readings arrive continuously and we can act between visits.

Side effects worth naming

The dry cough from ACE inhibitors affects perhaps one in ten people and it is not something you have to live with. Tell us and we switch you to an ARB, which does not cause it.

Ankle swelling from amlodipine is common and dose-related. Diuretics can drop potassium and sodium, which is why we recheck labs after starting them. Lightheadedness on standing matters more with age, and we check sitting and standing pressures in older patients rather than assuming.

None of these are reasons to stop a medication on your own. All of them are reasons to call.

What controlling it protects

Blood pressure control is the single most effective thing most adults can do to prevent stroke, heart failure and kidney failure.

Our heart disease prevention page covers how it fits with the rest of your cardiovascular risk, and high cholesterol usually runs alongside it. If you also have chronic kidney disease, blood pressure control is the main lever for slowing progression.

Blood pressure is managed through our chronic condition management program. See our primary care Southlake practice overview.