Understanding hypertension
Blood pressure is the force your blood exerts on artery walls, and when it runs high for years the heart and vessels quietly remodel to cope. Because there is usually nothing to feel, treatment decisions rest entirely on measurement — which is exactly where much hypertension care goes wrong.
Office readings can run high in people whose pressure is fine at home ("white-coat" hypertension) and, less famously, can look normal in people whose pressure runs high everywhere else ("masked" hypertension). Before committing anyone to years of medication, Dr. Marsh insists on confirming the diagnosis with out-of-office numbers — a 24-hour monitor or a structured week of home readings.
What you might notice
Reasons patients are referred to us for blood pressure:
- Office readings that keep coming back high
- Blood pressure that stays up despite two or more medications
- Big swings between home and office readings
- High readings at a young age, or during/after pregnancy
- A new home cuff and no idea what to make of the numbers
How we evaluate it
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24-hour ambulatory monitoring
A wearable cuff that samples your pressure through a normal day and night — the reference standard for confirming hypertension.
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Structured home-monitoring plan
The right cuff, the right technique, and a simple one-week protocol that produces numbers worth acting on.
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ECG and echocardiogram
To check whether years of pressure have started to affect the heart's muscle and function.
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Lab work
Kidney function, electrolytes, and screening for the handful of treatable conditions that secretly drive resistant hypertension.
Every test above is described — prep included — on the diagnostics & testing page.
How we manage it
Treatment is built in the order that evidence supports: confirm the diagnosis, look for secondary causes when the pattern suggests one, then combine lifestyle foundations — sodium awareness, activity, sleep, alcohol moderation — with medication chosen around your life, not just your numbers.
Follow-up is where blood pressure care succeeds or fails. Expect an explicit home-reading routine, medication adjustments made from real data rather than single office snapshots, and a written target you and your primary-care physician both hold a copy of.