SILVA PSYCHIATRIC CARE
  • MEET DR. SILVA
  • NEW PATIENTS
    • COST OF TREATMENT
    • Patient Reviews
    • REQUEST AN APPOINTMENT
    • ADULT ADD/ADHD?
    • Frequency of Visits
    • Frequently Asked Questions
  • THE CONCIERGE MODEL
    • WHAT IT IS
    • Concierge Reviews
  • TELEMEDICINE
    • WHAT IT IS
    • HOW IT WORKS
    • PATIENT REVIEWS
  • TREATMENT PHILOSOPHY
    • INFORMATION FOR PATIENTS & THEIR FAMILIES
    • ARCHIVES
  • CONTACT
  • ABOUT
    • PAYMENTS
    • REFILL POLICY
    • CANCEL/NO-SHOW
    • PRIVACY
    • FORMS
    • RECOMMENDED

HYPERTENSION

"THE SILENT KILLER"
Picture

According to the Centers for Disease Control, "about 9 out of 10 Americans will develop high blood pressure during their lifetime."
"Measuring your blood pressure is the only way to know you have high blood pressure."



THE IMPORTANCE OF
​WELLNESS CHECKS



BLOOD-PRESSURE LOG
COMPLIANCE INSTRUCTIONS
(all SPC Patients receiving
​psychostimulant therapy)



VIEW RECOMMENDED
HOME BLOOD PRESSURE
MONITORS HERE
​
DR. SILVA'S PICK:


HOW TO
​PROPERLY MEASURE
​YOUR BLOOD PRESSURE


All SPC patients taking stimulant medications for the treatment of ADD/ADHD, Binge Eating Disorder, and other conditions requiring such medications (for example, Adderall, Vyvanse, Ritalin, Concerta, etc.) are required to monitor their blood pressures and to submit a blood pressure log in order to initiate, continue, or resume treatment with those medications, regardless of their past medical histories. 

One of the few disadvantages of the telemedicine model is that I am unable to measure patients' vital signs at evaluation, or when they return to clinic for their follow-up appointments.  However, the standard of care demands that I monitor for, and rule out, medication-induced hypertension, or elevated blood pressure, which is fairly common.  Patients who already take medication for hypertension are not exempt from this requirement because, even assuming that their pressure is well-controlled on their current regimen of anti-hypertensive agents (many patients require more than one to achieve adequate control), I have to ensure that a patient's blood pressure continues to be well-controlled after prescribing a stimulant.  What I usually find is that most patients do not even own a home blood pressure machine, are not routinely checking their blood pressures, and are not well-controlled, even at baseline, without a stimulant.  Many others are normotensive at baseline (i.e., they do not have high blood pressure), but a single dose of their stimulant medication raises their pressure to an unacceptably high level that would result in significant morbidity and mortality if left untreated for a significant length of time (usually measured in years, but for some patients with significant pre-existing comorbidity, acutely elevated blood pressure could lead to heart attacks, strokes, intracranial bleeds and other potentially lethal cardiovascular accidents over the course of much shorter timespans).  Treatment cannot proceed without adequate control of blood pressure.

Patients most at risk for stimulant-induced hypertension would be those with pre-existing hypertension, well-controlled or otherwise, middle-aged and older persons, including those who were not hypertensive in youth, patients who are overweight or obese and/or type II diabetics, smokers, persons who drink alcohol, individuals who do not regularly engage in cardiovascular exercise, certain individuals whose diets regularly exceed the maximum daily requirement of sodium (leading to fluid retention) and individuals who are prone to fluid retention and swelling/bloating due to other medical conditions, as well as individuals with clinically-significant anxiety, chronic or undue stress--especially poorly-managed stress--individuals who struggle with anger management ("Type A" personalities), and  patients with a host of other common disease states, such as hypercholesterolemia, emphysema, obstructive sleep apnea, and cirrhosis of the liver, to name just a few.  Even pregnancy can be a risk factor, and while less common, adolescents and young children can develop high blood pressure, too.


Learn more about medication-induced hypertension:
Picture


RETURN TO ARCHIVES

See Dr. Silva's profile on Healthgrades.

Picture

SERVICES

  • Comprehensive Psychiatric Evaluations
  • Psychotropic Medication Management
  • Brief Counseling Sessions
  • Competency/Guardianship determinations
  • Pre-Surgical Clearances (elective bariatric and plastic surgery procedures)
  • Court-Mandated Evaluations
  • DOT Clearances
  • + other fitness-for-duty and focused psychiatric evaluations
  • Emotional Support Animal Documentation
  • + other medical endorsements

ABOUT SPC

  • Dr. Silva, M.D.
  • CV
  • Cost
  • Patient Reviews
  • Payment Policy
  • No-Show Policy
  • Refill Requests
  • Refill Policy
  • Privacy

Suicide Prevention Hotline

SUPPORT

  • Contact Me
  • Set Up/How To
  • Telemed App
  • ZOOM Download
  • GoodRx/$4.00 Meds
  • Medical Record Copies
  • Medication Prior Authorizations
  • Patient Portal
  • FORMS
  • FAQ

RESOURCES

  • Dr. Silva's Blog (2009)
  • S. Stahl, Prescriber's Handbook (7th Ed.)
  • American Psychiatric Association (APA)
  • Alcoholics Anonymous
  • Centers For Disease Control
  • La Hacienda Treatment Center
  • NAMI (National Alliance on Mental Illness)
  • Narcotics Anonymous
  • Physician's Desk Reference
  • MEET DR. SILVA
  • NEW PATIENTS
    • COST OF TREATMENT
    • Patient Reviews
    • REQUEST AN APPOINTMENT
    • ADULT ADD/ADHD?
    • Frequency of Visits
    • Frequently Asked Questions
  • THE CONCIERGE MODEL
    • WHAT IT IS
    • Concierge Reviews
  • TELEMEDICINE
    • WHAT IT IS
    • HOW IT WORKS
    • PATIENT REVIEWS
  • TREATMENT PHILOSOPHY
    • INFORMATION FOR PATIENTS & THEIR FAMILIES
    • ARCHIVES
  • CONTACT
  • ABOUT
    • PAYMENTS
    • REFILL POLICY
    • CANCEL/NO-SHOW
    • PRIVACY
    • FORMS
    • RECOMMENDED