Blood Pressure: The High's, The Low's and Everything in Between

Thursday, March 22, 2018
David Abrams

While 120/80 mmHg is the standard benchmark for good health in adults, factors including age, gender and other existing conditions all contribute to varying blood pressure numbers. In recent articles from various organizations including the American Heart Association and the American College of Cardiology there is a widespread promotion of new and at times somewhat conflicting blood pressure guidelines.  With all this new information, it is of no surprise that patients with high blood pressure can be overwhelmed. In my practice, I am able to take the time to customize a blood pressure range that takes into account the individual variations and preferences of my patients using home blood pressure monitoring.


Everybody has different medical conditions, different choice of medications and different sensitivity to medications. Blood pressure fluctuations are extremely common and not all spikes and dips prompt concerns. The changes in blood pressure reflect the body's ability to adapt and can be a part of a normal daily physiology-- even laughing, talking, walking can cause noticeable increases. However, distinguishing between the normal from the abnormal is crucial. Setting a target blood pressure range based on one's medical history, current medications and overall health goals is achievable. To recognize and acknowledge this conclusion is the key to not only reach healthy blood pressure but also maintain an overall healthy lifestyle.  


Thanks to advances in electronic communication my patients keep me up to date with secure email, text messages, even old fashioned fax transmissions of their blood pressure readings and perhaps any symptoms they are having. That is Telemedicine.

Telemedicine is getting noticed

Tuesday, October 06, 2015
David Abrams

An article recently appeared on discussing my favorite topic: Telemedicine. In it, the American College of Physicians, known as the ACP, acknowledged that telemedicine can “increase access to care and patient satisfaction while delivering care that is more efficient and less costly than in-person encounters.”

The ACP went on to say that telemedicine might be a threat to regular office-based visits, from a bottom-line standpoint. They think that direct-to-patient telemedicine should only be used once in a while as an alternative to visiting a physician, rather than as a replacement for. I don’t agree with that, and it’s not simply because I’m a practitioner of telemedicine. I think it’s the way of the future. I believe that it makes seeing a doctor easier for most people because to see a doctor simply means looking into a computer screen and camera. There’s no travel involved; no hassle in getting there. You’re already where you need to be.

Even with their reticence, the ACP “supports the ongoing commitment of federal funds to support the broadband infrastructure needed to support telehealth activities.”

There were just two comments to the article, one from a man named Roger Downey who said this: “For those wondering what the important distinction is, telemedicine involves a remote physician seeing a patient via realtime videoconference at a location recognized for reimbursement as an "originating site" by Medicare, Medicaid and/or state law. Typically, there is a patient "presenter" with the patient following the doctor's instructions to perform an exam with integrated medical devices such as a stethoscope, otoscope, exam camera for closeups of the throat, eyes, and skin, ultrasound probe, EKG, spirometer and vital signs monitor. The images, audio and data are shared live with the physician, but at the end of the patient session they can be preserved in the patient's electronic medical record for continuity of care.”

Here’s what I said in response: “There are individual docs such as myself who practice telemedicine from other than an "originating site" with their own patients who see this as an extraordinary benefit for access. Importantly, the patients also benefit from more and faster attention to acute illness and closer monitoring of chronic illness. And, in my case I will when necessary even send a trained assistant to their home with those same devices you mention. I do appreciate the ACP for their cautious approach while the experience of the D2C telehealth companies is assessed.”

I feel confident that telemedicine will make the practice of health care and the opportunity for quality care available for all, and that it will ultimately benefit the patient by providing easier access to a primary care physician.