Hypertension specialist care
When blood pressure will not come down.
High blood pressure is common and usually straightforward. When it is not, because the numbers stay high on several medicines, swing between home and office, or come with side effects, it helps to see a doctor who has spent a career on it.
At a glance
Resistant hypertension
Pressure that stays high on three or more medicines.
Home and office mismatch
White-coat readings, or the reverse: normal in the office, high at home.
Looking for a cause
Kidney, hormone and medication causes that are easy to miss.
Simpler regimens
Fewer pills, better timing, and fewer side effects.
Why it gets complicated
The kidneys regulate salt and fluid, which is why blood pressure and kidney health are so closely linked, and why hypertension is part of Nephrology training. Some high blood pressure has a specific cause, such as narrowed kidney arteries, an adrenal gland that makes too much aldosterone, sleep apnea, or a medicine like an anti-inflammatory or a decongestant. Finding that cause can change the treatment completely.
How Dr. Shtern approaches it
It starts with good numbers. Office readings alone can mislead, so Dr. Shtern relies on accurate home readings and looks at the pattern rather than one visit. She reviews every medication and supplement, checks kidney function and electrolytes with labs drawn in the office, and looks for secondary causes when the history suggests one.
The goal is blood pressure that is controlled on a regimen you can live with. Because members can reach her directly, adjusting a dose does not have to wait for the next appointment.
Taking a good home reading
- Sit quietly for five minutes first, back supported, feet flat, arm resting at heart level.
- Use a validated upper-arm cuff in the right size. Wrist cuffs are less reliable.
- No caffeine, exercise or smoking in the 30 minutes before.
- Take two readings a minute apart, morning and evening, and write both down.
- Bring the log, or the cuff itself, to your visit.
FAQ
Blood pressure questions
What blood pressure is too high?
Current American guidelines define high blood pressure as 130/80 or higher on repeated readings. A reading of 180/120 or higher, especially with chest pain, shortness of breath, weakness or vision changes, needs emergency care: call 911.
What is resistant hypertension?
Blood pressure that stays above goal despite three medicines from different classes at good doses, usually including a diuretic. It often has a fixable cause, which is why it deserves a closer look.
Why is my pressure higher at the doctor’s office?
That is called white-coat hypertension, and it is common. Home readings or 24-hour monitoring show whether your pressure is high in everyday life, which is what matters for treatment.
Related care
Kidney care and Nephrology
A board-certified nephrologist who is also your internist: CKD, stones, electrolytes, creatinine that keeps creeping up.
Read morePreventive care and physicals
Executive annual physicals, screenings, and no day at a hospital.
Read moreNext step
Bring your blood pressure log. We will read it with you.
Every membership starts with a complimentary meet and greet. Sit down with Dr. Shtern, see the office, and ask whatever you like.