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Tag: telehealth

A Guide to Heart-Healthy Exercise

Exercise has so many health benefits, but many people are not doing it. When you exercise, your heart rate increases, delivering oxygen and nutrients to your hard-working muscles. As you increase the intensity of your workout, your heart responds by increasing heart rate and contractility.

As you repeat your exercise sessions regularly, your heart gets stronger and more efficient, as do your respiratory muscles. You are able to swim, row, run, walk, or bike faster and further than you ever have in the past, with less effort.

But it takes time to get to this point, and many people find exercise uncomfortable and time-consuming. Choose physical activities that you enjoy and amp up the effort a little more as you do them. For example, instead of slowly walking around the block with your children or pets, pick up the pace or choose a route with hills. Investing in your heart health will pay off with better cardiovascular and respiratory function, improved oxygen and nutrient flow throughout the body, lower blood pressure, lower LDL (bad) cholesterol, and a reduced risk for heart disease.

What Is the Best Type of Exercise for Heart Health?

The best type of exercise for heart health is the one you will consistently do. According to the Physical Activity Guidelines for Americans, adults should aim to meet the following exercise goals each week:

  • A minimum of at least 150 minutes to 300 minutes of moderate-intensity exercise each week, or a minimum of 75 minutes to 150 minutes of vigorous-intensity exercise each week, or a combination of both
  • Two muscle-strengthening sessions each week that are of moderate or greater intensity and that exercise all major muscle groups

Moderate intensity: brisk walking (2.4-4.0 miles per hour), bicycling (5-9 miles per hour), active yoga, dancing, vacuuming, recreational swimming, gardening, and raking leaves.

Vigorous intensity: jogging, running, hiking, swimming laps, jumping rope, aerobics, bicycling (≥10 miles per hour), weightlifting, stair climbing, shoveling snow.

Instead of choosing one exercise, alternate between many different types of exercise so you don’t get bored. Any movement that increases your heart rate is an excellent choice for improving heart health.

A woman exercising

Examples of Exercises That Are Good for Heart Health

A wide range of exercises qualify as heart-healthy. Here is a list of some examples:

Aerobic exercises: improve cardiovascular fitness.

  • Walking
  • Jogging or running
  • Cycling
  • Swimming
  • Dancing
  • Aerobic classes
  • Jump rope
  • Hiking

Strength training: Increases muscle and heart strength.  

  • Weightlifting
  • Resistance band exercises
  • Bodyweight exercises
  • Strength Yoga
  • Pilates
  • CrossFit

Flexibility and stretching

  • Pilates
  • Yoga
  • Tai Chi

Household chores, yard work, and gardening can also provide an excellent physical workout!

How To Build Heart-Healthy Exercising Habits

One of the most challenging parts of exercise is getting started. Most people know that exercise is good for them, and a sedentary lifestyle increases their risk of heart disease, but they just find it hard to squeeze exercise time into their day. Before starting an exercise program or increasing exercise intensity, consult with a doctor if you have any medical conditions or health concerns that may limit your ability to exercise.

Here are some tips for making heart-healthy exercise a part of your regular routine:

  • Choose exercises that you are comfortable doing.
  • Start slow and keep the intensity low enough that you can keep a conversation going.
  • Alternate exercises so you do not get bored and to avoid overuse injuries.
  • Remove as many obstacles to exercise as possible. For example, lay out clothing ahead of time.
  • Set clear exercise goals and track your progress toward those goals.
  • Use podcasts and music to distract yourself while exercising.
  • Warm up and cool down before and after exercise to reduce your risk of injuries.
  • Stay hydrated during and after exercise.
  • Consume a nutritious diet to fuel your body for exercise.
  • Get plenty of high-quality sleep.
  • Use technology or wearable devices to monitor your progress.
  • Listen to your body when choosing exercise types and intensities.
A heart mold with healthy food in it.

Other Lifestyle Changes to Improve Your Heart Health

In addition to exercise, other lifestyle changes that can improve your heart health include:

  • Manage stress: Unmanaged or chronic stress affects your heart health by increasing heart rate and contractility, which puts added pressure on heart muscle. Use breathing techniques, meditation, or yoga to manage stress. Schedule time for relaxing and engaging in your favorite activities and hobbies.
  • Reduce LDL (bad) cholesterol: Good (HDL) cholesterol can reduce your risk of heart disease, but increased LDL cholesterol can increase your risk. Learn more about the difference between good and bad cholesterol.
  • Lose excess weight: There is a strong correlation between obesity and heart disease, as they share many of the same risk factors.
  • Check your blood pressure: High blood pressure rarely has symptoms, which makes it even more important to monitor your blood pressure regularly and identify hypertension early.
  • Quit smoking: The hundreds of chemicals in cigarette smoke increase your risk for heart and lung disease.
  • Consume a heart-healthy diet: Consume a diet rich in fruits and vegetables, whole grains, and lean proteins and low in saturated and trans fats, sodium, and added sugars.
  • Limit alcohol use: Excessive alcohol consumption increases your risk of heart disease.

It is much easier to make lifestyle changes now before you develop any heart disease. Some people wait for a serious heart event, like a cardiac arrest or a heart attack, before they start taking their heart health seriously.

When Medications May Be Necessary

Sometimes, lifestyle changes are not enough to prevent or treat heart disease. In this case, your doctor may prescribe medications. Commonly prescribed medications used to treat heart disease include:

  • ACE inhibitors (Angiotensin-Converting Enzyme Inhibitors): lower blood pressure and improve heart function
  • Antiarrhythmics: reduce the risk of arrhythmias
  • Antiplatelet agents: minimize blood clot risk
  • ARBs (Angiotensin II Receptor Blockers): dilate blood vessels and lower blood pressure
  • Beta-blockers: slow heart rate and reduce blood pressure
  • Calcium channel blockers: decrease the workload on the heart
  • Digitalis medications: reduce the risk of arrhythmias
  • Diuretics: remove excess water and salt from the body
  • Nitrates: Improve blood flow to the heart
  • Statins: lower cholesterol

Telemedicine platforms, such as TelegraMD, provide a convenient option for contacting a doctor, receiving an online medical diagnosis, and, if necessary, an online prescription. Telemedicine platforms have doctors on call that provide 24-hour access, and online doctor’s visits are very cost-effective, even if you do not have insurance.

When Surgical Intervention May Be Necessary

In some rare cases, surgical interventions may be necessary to treat heart disease. Examples of these surgical interventions include:

  • Aneurysm repair: Surgically support a weakened section of an artery
  • Angioplasty: minimally invasive procedure used to open blocked coronary arteries
  • Coronary artery bypass grafting: Used to bypass blocked coronary arteries
  • Defibrillators: Surgically implanted devices used to restore normal heart rhythms
  • Heart transplant: replace a severely damaged heart with a donor heart
  • Heart valve surgery: repair or replace damaged heart valves
  • Left ventricular assist device: an implantable device that assists the heart in pumping blood


While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

A Complete Guide to Hypertension

Hypertension, more commonly known as high blood pressure, is diagnosed when the pressure your bloodstream puts on the inner walls of your blood vessels is consistently higher than acceptable, healthy levels. This increased pressure causes damage to the inner blood vessel walls and can increase your risk of cardiovascular disease. Unfortunately, hypertension can cause damage while not causing symptoms.

Worldwide, hypertension contributes to an estimated 7.5 million premature deaths and 4.5 percent of the worldwide disease burden.1 It affects about 103 million U.S. adults and is second only to cigarette smoking as a preventable cause of death.2

Primary vs. Secondary Hypertension

Primary hypertension does not have a known and specific cause. It typically develops gradually over time and is influenced by a combination of genetic, environmental, and lifestyle factors. Primary hypertension accounts for about 90% of all cases.3

Blood moves from an area of high pressure to one of low pressure. Blood flow as a result of the force from heart contractions drives blood forward in arterial blood vessels.

Resistance to blood flow due to friction or narrowing in the blood vessel impedes its flow. Any disease process, medication, environmental, or lifestyle factor that affects cardiac output, blood vessel compliance, blood volume, blood viscosity or thickness, or blood vessel length or diameter can affect blood pressure.

Secondary hypertension has a known and specific cause. Underlying medical conditions that increase the risk of hypertension include kidney disease, hormonal disorders, and medication side effects.

Examples of causes of secondary hypertension include:

  • Excessive stress and sympathetic nervous system stimulation
  • Increased thyroid hormone
  • Increased calcium levels
  • Atherosclerosis
  • Heart failure
  • Liver cirrhosis
  • Glucocorticoids
  • Blood cell cancers
  • Stimulant medications
  • Sleep apnea
  • Chronic kidney disease
  • Pheochromocytoma
  • Coarctation of the aorta

Causes of Hypertension

Environmental and lifestyle factors, as well as genetic and other unmodifiable risk factors, can also increase your risk of hypertension. Examples of factors that may increase your risk of primary hypertension include:

Symptoms of Hypertension

Unfortunately, hypertension does not cause symptoms or have any warning signs. The only way to diagnose high blood pressure is to measure your blood pressure using a sphygmomanometer (blood pressure monitor).

Talk to your doctor about your risk of hypertension. Discuss how often you should have your blood pressure monitored, both in the medical office and at home.

Long-Term Complications of Hypertension

Long-term hypertension can damage blood vessels and increase your risk of several medical conditions, including:

  • Heart disease: increased blood pressure, especially when combined with increased cholesterol, can increase your risk for cardiac arrests and heart attacks.
  • Stroke: high blood pressure can damage blood vessels in the brain, contributing to a stroke.
  • Aneurysms: high blood pressure can weaken support in blood vessels, causing them to bulge. These aneurysms can rupture, causing severe internal bleeding.
  • Kidney damage: kidney filtering units filter waste and remove excess fluids from the blood. High blood pressure can harm these tiny clumps of capillaries.
  • Vision problems: damage to small vessels in the back of the eye can cause vision problems and, if untreated, blindness.
  • Cognitive decline: Untreated, long-term hypertension is associated with cognitive decline.
  • Peripheral artery disease: increased blood pressure can damage the lining of blood vessels, causing narrowing and blockages. This can cause leg pain and weakness and limit mobility.
  • Sexual dysfunction: blood vessel damage is associated with erectile dysfunction and can contribute to sexual dysfunction in men and women.
A close up of a blood pressure monitor

How Is Hypertension Diagnosed?

Hypertension is diagnosed by using a blood pressure cuff and monitoring. The blood pressure cuff is wrapped around the upper arm and inflated. It compresses the brachial artery in the arm until there is no blood flow through the vessel.

The cuff is gradually deflated, and blood flow resumes through the artery. As blood flow resumes, this number is read as the systolic blood pressure. As blood flow is fully restored and turbulence decreases in the vessel, blood flow sounds are no longer heard. This is diastolic blood pressure. Automatic blood pressure monitors read off blood pressure measurements without the need to listen for blood flow.

If your doctor needs more data to make a diagnosis, a 24-hour blood pressure test can provide multiple measurements throughout the day. This can be important because blood pressure fluctuates throughout the day and in response to environmental factors.

Understanding Blood Pressure Readings

The systolic blood pressure is the upper number in a blood pressure read-out. It is the point of maximum pressure in the artery. It occurs when the left ventricle is contracting. A normal systolic reading should be less than 120 mmHg.

The diastolic blood pressure is the lower number in the blood pressure read-out. It is recorded when the left ventricle is relaxing. A normal diastolic reading is less than 80 mmHg.

Blood pressure varies throughout the day. Taking more than one blood pressure measurement at different times of the day and in different situations is essential to accurately diagnosing hypertension.

Blood pressure categorySystolic blood pressure (mmHg)and/orDiastolic blood pressure (mmHg)
NormalLess than 120andLess than 80
Elevated120-129andLess than 80
Stage 1 hypertension130-139or80-89
Stage 2 hypertension140 or higheror90 or higher
Hypertension crisishigher than 180and/orhigher than 120

Common Comorbid Diseases

Comorbid diseases are one or more additional health conditions or diseases that cooccur with a primary medical condition. Comorbid conditions are common and can complicate diagnosis and treatment.

Common comorbid conditions linked to hypertension include:4

  • Obesity
  • Diabetes mellitus
  • Insulin resistance
  • Dyslipidemia
  • Cardiovascular disease
  • Chronic kidney disease
  • Coronary artery disease
  • Metabolic syndrome
  • Heart failure
  • Stroke

High Blood Pressure During Pregnancy

It is not uncommon for blood pressure to increase during pregnancy. Common physiologic changes that can increase blood pressure include:

  • Increased blood volume
  • Hormonal changes
  • Weight gain

In addition to these, chronic hypertension, gestational hypertension, and pre-eclampsia can cause increased blood pressure.

  • Chronic hypertension is hypertension diagnosed before pregnancy or in the first 20 weeks.
  • Gestational hypertension is more common in the second half of pregnancy. The contributing causes are not fully understood.
  • Pre-eclampsia is a serious medical condition that may occur in the second half of pregnancy. Pre-eclampsia requires immediate medical evaluation and treatment.

If you are pregnant, talk to your doctor about your blood pressure. Have regular checkups to monitor your blood pressure and identify any changes early. Unmanaged hypertension during pregnancy can cause complications for the mother and the baby.

Healthy food and a blood pressure cuff

Lifestyle Changes To Treat Hypertension

Lifestyle changes associated with better cardiovascular function that can help treat hypertension include:

  • Make heart-healthy exercise a priority
  • Attain a healthy weight
  • Decrease sodium intake
  • Increase potassium intake
  • Moderate alcohol consumption
  • Stop smoking
  • Manage stress

Medications To Treat Hypertension

If lifestyle modifications do not reduce your blood pressure to healthy levels, your doctor may add an antihypertensive medication to treat your high blood pressure. Medication classes used to treat hypertension include:

  • Diuretics: decrease blood volume by eliminating excess sodium and water and reduce blood vessel resistance
  • Calcium channel blockers: dilate blood vessels
  • Alpha-blockers: dilate blood vessels
  • Angiotensin-converting enzyme inhibitors: dilate blood vessels and decrease blood volume
  • Angiotensin II receptor blockers (ARBs): dilate blood vessels and reduce blood volume
  • Beta-blockers: decrease heart rate and contractility
  • Vasodilators: dilate blood vessels

If you are concerned about your blood pressure or have questions about hypertension, contact a doctor on the TelegraMD platform. Telemedicine provides a convenient and affordable option to receive a hypertension diagnosis and, if appropriate, antihypertension medications. These medications can be prescribed online and transmitted to your local pharmacy.

Surgical Options for Treating Hypertension

Surgical options are available to treat risk factors and causes of secondary hypertension. For example, bariatric surgery may be recommended if obesity is a comorbid disease with hypertension. Stents may be placed in narrowed blood vessels to improve blood flow and reduce blood pressure.

When You Should Check Your Blood Pressure at Home

Talk to your doctor to determine how frequently you should check your blood pressure at home. Blood pressure fluctuates throughout the day, so take readings at different times of the day. Record all your results and look for a pattern. The first time you take a blood pressure measurement, take it in both arms. After that, you can take a measurement using the same arm.

There are many options to measure your blood pressure, and new and upcoming wearable devices coming out all the time. Options include finger cuff monitors, wrist monitors, smartphone technology, blood pressure cuffs, and blood pressure kiosks in stores.


While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.


  1. World Health Organization. (2002). The World Health Report 2002: Risks to Health. Geneva: World Health Organization.
  2. Whelton, P.K., Carey, R.M., Aronow, W.S., Casey, D.E. Jr., Collins, K.J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner,  P., Ovbiagele,  B., Smith, S. C. Jr., Spencer,  C. C., Stafford, R. S., Taler,  S. J., Thomas, R. J., Williams, K.A. Sr., Williamson, J.D., & Wright,  J.T. Jr.(2018).  2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol.;71(19): e127-e248. DOI: 10.1016/j.jacc.2017.11.006. Epub 2017 Nov 13. Erratum in: J Am Coll Cardiol. 2018 May 15;71(19):2275-2279. PMID: 29146535.
  3. Oparil, S. Zaman, A., & Calhoun, D. (2003). Pathogenesis of Hypertension. Ann Intern Med. 139:761-776
  4. Noh J, Kim HC, Shin A, Yeom H, Jang SY, Lee JH, Kim C, Suh I. Prevalence of Comorbidity among People with Hypertension: The Korea National Health and Nutrition Examination Survey 2007-2013. Korean Circ J. 2016 Sep;46(5):672-680. doi: 10.4070/kcj.2016.46.5.672. Epub 2016 Sep 28. PMID: 27721859; PMCID: PMC5054180.

What Is the Difference Between Good and Bad Cholesterol?

Cholesterol has gotten a terrible reputation because of its contribution to cardiovascular disease. Cholesterol is a waxy substance essential for cell membrane formation and producing bile, vitamin D, and steroid hormones. About three-quarters of your body’s cholesterol is made in your liver, and the rest comes from your diet.

Excess cholesterol is deposited on the inner lining of your blood vessels, causing inflammation, damage, and atherosclerosis. When these plaques of waxy cholesterol and other fats rupture, blood clots can form on the damaged blood vessel lining, which can increase your risk for heart disease and strokes.

According to the Centers for Disease Control and Prevention, about 35% of U.S. adults have elevated cholesterol levels, with 10% having high cholesterol levels.1

What Is Good Cholesterol?

High-density lipoproteins (HDLs) are one of the two primary types of cholesterol. Increased HDL cholesterol levels benefit your health because HDL cholesterol travels through the bloodstream and picks up cholesterol left on the blood vessel walls. It transports this excess cholesterol back to the liver.

Because HDL cholesterol removes excess cholesterol from blood vessel walls, having high HDL cholesterol levels is good for your health.

Genetic factors, diet, smoking, increased body mass index, and physical inactivity can reduce HDL cholesterol.2,3,4


Consume unsaturated fats, vegetable oils, and nuts to boost your HDL cholesterol levels. A high-fiber, plant-based diet is an excellent choice.

A heart-healthy diet that increases HDL cholesterol includes:

  • Avocados
  • Oatmeal
  • Nuts
  • Olive oil
  • Fruits
  • Vegetables
  • Fatty fish
  • Soy

Health Impacts

Healthy HDL cholesterol levels protect your cardiovascular system by removing excess cholesterol from your bloodstream and blood vessels. This can reduce your risk of blood clots, heart disease, and strokes.

How To Boost Your Good Cholesterol

If your HDL cholesterol levels are too low, consider whether you can make improvements in any of the following lifestyle factors:

  • Consume a healthy diet: Choose foods low in saturated and trans fats; avoid processed foods and sugar.
  • Manage your weight: If you are overweight or have obesity, talk to your doctor about how to best manage your weight. Carrying excess abdominal weight is a risk factor for heart disease.
  • Exercise: Try to do at least 30 minutes of moderate-to-vigorous exercise daily. Choose fun activities and make them an important part of your daily routine.
  • Stop smoking: If you smoke or are exposed to second-hand smoke, this can lower your HDL levels. If you cannot quit smoking, talk to your doctor about a smoking cessation plan.
  • Limit alcohol consumption: Alcohol is high in calories, and it may lower HDL levels.

What Is Bad Cholesterol?

Low-density lipoprotein, often referred to as “bad cholesterol,” contributes to blood vessel disease. LDL cholesterol carries cholesterol from the liver to body cells, including the ones lining blood vessel walls. When cholesterol accumulates in these cells, it causes plaques. This is called atherosclerosis.

When plaques form on the lining of blood vessels, the vessel narrows. The plaque may rupture if inflamed, increasing the risk of a blood clot developing. If a blood clot forms and travels to the heart or the brain, it can cause a heart attack or a stroke.


Most LDL cholesterol is produced in the liver. Foods that can contribute to increased LDL cholesterol include saturated and trans fats and highly processed foods.

Avoid or minimize consumption of foods such as:

  • Red meat
  • Organ meats
  • Full-fat dairy products
  • Coconut and palm oil
  • Processed foods
  • Fried foods
  • Some margarines
  • Chips
  • Crackers
  • Baked goods
  • Hot dogs, sausages, and bacon
  • Coconut oil

Eggs and shellfish may increase LDL cholesterol in some people.

High cholesterol foods

Health Impacts

Increased LDL cholesterol increases your risk of heart disease. Metabolic disease, obesity, type 2 diabetes, high blood pressure, and high cholesterol share similar risk factors and can all increase your risk for cardiovascular disease.

There is a strong correlation between obesity and heart disease because obesity is typically associated with insulin resistance, high blood pressure, and high cholesterol. Carrying excess weight can also put a strain on the heart.

In this complete guide to hypertension, you may note that high blood pressure, like high cholesterol, is a silent disease that affects blood vessels and can increase your risk of heart disease, including cardiac arrests and heart attacks.

Tips for Lowering Bad Cholesterol

Tips for lowering bad cholesterol are similar to the ones for raising HDL cholesterol. Choose a heart-healthy diet and make physical activity part of your daily life. Choose one of the many new and upcoming wearable devices that can help you track your weight, calorie consumption, and exercise.

Even a five-pound weight loss can significantly affect your cardiovascular health. Walking throughout the day is one of the easiest heart-healthy exercises you can choose. Start slow. Increase your pace and walking incline as you gain confidence and fitness. Of course, before starting any exercise program, talk to your doctor to verify whether you have any exercise restrictions.

Lipid panel blood tests

Understanding Cholesterol Levels

Cholesterol levels are measured when you send a blood sample to your lab. Your blood sample is evaluated, and the results are reported as part of a lipoprotein panel.

If you are age 19 or younger:

  • Have your cholesterol checked between the ages of 9 and 11
  • Have your cholesterol rechecked every 5 years

If you are age 20 or older:


  • Under age 45: have cholesterol checked every 5 years
  • Between 45 and 65: have your cholesterol checked every 1 to 2 years


  • Under age 55: have your cholesterol checked every 5 years
  • Age 55 to 65: have your cholesterol checked every 1 to 2 years

Total Cholesterol

Total cholesterol is HDL level + LDL level + 20% triglyceride level.

  • Desirable total cholesterol: Less than 200 mg/dL
  • Borderline high total cholesterol: 200–239 mg /dL
  • High total cholesterol: 240 mg/dL and above

Optimal triglyceride levels are <150 mg/dL

Your total cholesterol level is one measurement your doctor can use to predict your heart disease and stroke risk. If your risk is elevated, your doctor may recommend lifestyle changes to decrease your cholesterol levels and medications if it remains high.

HDL (good cholesterol)

Optimal HDL cholesterol levels vary by sex:

  • Men: Optimal ≥ 40 mg/dL; Low ≤ 40 mg/dL
  • Women: Optimal ≥ 50 mg/dL; Low ≤ 50 mg/dL

Losing excess weight, increasing physical activity and exercise, reducing consumption of refined carbohydrates and saturated fats, stopping smoking, and ensuring your blood sugar is within normal limits can help increase your HDL cholesterol levels.

LDL Cholesterol

According to Medline Plus, LDL cholesterol levels are considered:

  • Optimal: less than 100 mg/ dL
  • Near or above optimal: 100-129 mg/dL
  • Borderline high: 130-159 mg/dL
  • High: 160-189 mg/dL
  • Very high: 190 mg/dL and above
A patient consulting with a doctor

When To Seek Treatment

If you have had your cholesterol levels checked and they are not optimal, reach out to a doctor on the TelegraMD platform to discuss your risk for heart disease, get an online diagnosis, and, if appropriate, receive an online prescription to lower your cholesterol and reduce your risk of heart disease.

Over the last few decades, the link between cholesterol and heart disease has been questioned. Many researchers believe that the relationship between cholesterol and heart disease is not as direct as it may seem.

Telehealth is a perfect option for busy people who want to stay on top of their health. It is easy to schedule an appointment to receive expert advice, and most likely, the consultation will cost less than an in-person visit.


While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider.  You should always consult a practicing professional who can diagnose your specific case.  The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice. 


1. Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Beaton, A. Z., Boehme, A. K., Buxton, A. E., Commodore-Mensah, Y., Elkind, M. S. V., Evenson, K. R., Eze-Nliam, C., Fugar, S., Generoso, G., Heard, D. G., Hiremath, S., Ho, J. E., … on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2023). Heart disease and stroke statistics—2023 update: A report from the American Heart Association. Circulation, 147(8).

2. Stadler JT, Marsche G. Obesity-related changes in high-density lipoprotein metabolism and function. Int J Mol Sci. 2020 Dec;21(23):8985. doi:10.3390/ijms21238985

3. Ruiz-Ramie JJ, Barber JL, Sarzynski MA. Effects of exercise on HDL functionality. Curr Opin Lipidol. 2019 Feb;30(1):16-23. doi:10.1097/MOL.0000000000000568

4. He BM, Zhao SP, Pen ZY. Effects of cigarette smoking on HDL quantity and function: implications for atherosclerosis. J Cell Biochem. 2013 Nov;114(11):2431-6. doi:10.1002/jcb.24581

What is Paxlovid Rebound?

According to the Centers for Disease Control and Prevention, Paxlovid is recommended to treat mild-to-moderate COVID-19 in its initial stages of the disease when people are at elevated risk that their disease may progress in severity. Paxlovid treatment helps reduce the risk of disease progression, hospitalization, and death.

Whether or not you have been vaccinated, for some people who take Paxlovid, COVID-19 symptoms seem to diminish and then return. Symptom rebound typically occurs between 2 and 8 days after symptoms appear to improve. Sometimes, people do not report a return of symptoms but test positive for COVID-19. This rebound in symptoms also occurs in people who do not take Paxlovid, and it is not considered to be a side effect linked to Paxlovid.

If you have a recurrence of your symptoms and test positive again, whether or not you took Paxlovid, follow the CDC guidelines for isolation. You should restart isolation for a full five days after the positive test result (the next day). End isolation after five days if you are fever-free (without taking fever-reducing medications) and your symptoms are improving. Following this, you should wear a mask for a total of 10 days, starting from the time your symptoms started.

What Is Paxlovid?

Paxlovid (nirmatrelvir tablets; ritonavir tablets) is a prescription oral antiviral drug used to treat mild-to-moderate COVID-19 infections in people at increased risk for more severe disease. The U.S. Food and Drug Administration issued an Emergency Use Authorization (EUA) to Pfizer to manufacture Paxlovid to treat adults and children over the age of 12 who meet the prescribing guidelines.

Paxlovid is not authorized to be used:

  • To treat patients requiring hospitalization for severe or critical cases of COVID-19
  • For pre- or post-exposure prophylaxis to prevent a COVID-19 infection
  • To be used for longer than five days

Paxlovid clinical trials were conducted, and 2,113 participants were randomized to receive either Paxlovid or placebo, one dose (300 mg nirmatrelvir and 100 mg of ritonavir) by mouth every 12 hours for five days. Anyone with a history of COVID-19 infections or who was vaccinated against COVID-19 was excluded from the trial, as were people taking medications that may adversely interact with Paxlovid.

Clinical trial data supported Paxlovid’s efficacy. It reduced the proportion of adults who were hospitalized or died by 86% when compared to placebo. Patients in the study were treated within five days of symptom onset, and they did not receive monoclonal antibody treatment.

On May 25, 2023, the U.S. Food and Drug Administration approved Paxlovid for treating mild-to-moderate COVID-19 in adults who are at high risk for progressing to severe disease.

COVID-19 coronovirus

Signs of Paxlovid Rebound

Symptoms associated with a Paxlovid rebound would be the same as with an initial COVID-19 infection. The symptoms are typically described as mild to moderate in severity:

  • Cough
  • Fatigue
  • Headache

Whether you believe you have a new-onset COVID-19 infection or a rebound infection, take a COVID-19 test. If your at-home COVID-19 test is positive following a negative one, follow the CDC isolation guidelines. Contact a doctor on the TelegraMD platform to receive access to a doctor 24 hours a day. They can discuss your COVID-19 test results and symptoms and determine whether a prescription antiviral medication is an appropriate treatment.

How Common Is Paxlovid Rebound?

According to data from the two Phase 2/3 Paxlovid clinical trials, Paxlovid rebound occurs in 1% to 3% of patients.

According to a preprint article published in medRxiv that examined the rates and relative risks of COVID-19 rebound in 92 million patients treated with Paxlovid or Molnupiravir between January and June 2022, researchers found rebound rates were as follows:


  • 7-day COVID-19 rebound rate: 3.53%
    • with symptoms: 2.31%
    • hospitalized: 0.44%
  • 30-day COVID-19 rebound rates: 5.4%
    • with symptoms: 5.87%
    • hospitalized: 0.77%


  • 7-day COVID-19 rebound rate: 5.86%
    • with symptoms: 3.75%
    • hospitalized: 0.84%
  • 30-day COVID-19 rebound rates: 8.59%
    • with symptoms: 8.21%
    • hospitalized: 1.39%

Results from the EPIC-HR, EPIC-SR 2021 (pre-Omicron), and EPIC-SR 2022 (Omicron) study data that Pfizer shared with the FDA showed that rebound rates after taking Paxlovid ranged from 10.4% to 15.8%. Rebound rates in the placebo group ranged from 13.6% to 14.1%, leading researchers to theorize that the viruses that cause COVID-19 cause a waxing-waning symptom course.

How Long Does Paxlovid Rebound Last?

In one study, after 28 days, 68% of participants reported their symptoms had resolved. Of these, 44% reported at least one symptom came back. For the most part, these symptoms were described as mild. None of the participants who had symptom relapse reported severe symptoms, had a hospitalization, or were treated with Paxlovid.

Is Paxlovid Rebound Worse Than the Original Symptoms?

No, most sources report that the symptoms related to Paxlovid rebound are mild to moderate. Symptoms may feel more severe because they are unexpected.

Side Effects of Paxlovid

Based on the results of two Paxlovid clinical trials, the most common side effects were:

  • Dysgeusia: a change in taste
  • Diarrhea: runny, frequent bowel movements

Other side effects that were reported after Paxlovid was granted EUA include:

  • High blood pressure
  • Stomach (abdominal) pain
  • Nausea
  • Vomiting
  • Fatigue
  • Headache
  • Severe skin rashes
  • Hypersensitivity reactions
  • Anaphylaxis

Other Antiviral Treatments for COVID-19

Other antiviral treatment options are available to treat COVID-19, including:

  • Remdesivir: This antiviral medication is an FDA-approved alternative to Paxlovid. It requires intravenous (IV) infusion for three days.
  • Tocilizumab: This medication is approved to treat hospitalized adults with COVID-19 who receive systemic steroids and require supplemental oxygen.
  • Baricitinib: This medication is approved to treat hospitalized adults with COVID-19 who receive systemic steroids and require supplemental oxygen.

If you have mild-to-moderate COVID-19 symptoms and are unsure whether you qualify for antiviral therapies, contact a doctor on the TelegraMD platform to receive an online diagnosis. They can help you with COVID-19 screening and testing and, if appropriate, transmit an online prescription to your local pharmacy to treat your COVID-19 symptoms. You will probably find it more cost-effective to consult a doctor online than other on-demand options, especially if you do not have insurance.  

Viral particles and a person graphic with his hand up

Why Prevention Is Still Important

Vaccination is the most effective way to prevent COVID-19. Ask your doctor or healthcare provider whether you are a suitable candidate for the booster vaccine.

COVID-19, influenza, and respiratory syncytial virus are all respiratory viruses that spread through close contact with the respiratory secretions from a person infected with the virus. All three classes of viruses have vaccines that reduce the risk of severe disease. Everyone’s immune system is different. We will all respond to vaccination slightly differently, and we will all respond to COVID-19 infection slightly differently as well. Talk to your doctor to better understand your risk versus benefits ratio for vaccination and if you have COVID-19, for treatment.

Considerations for Healthcare Businesses

COVID-19 and other pathogens are constantly evolving. New medications and treatment options come on the market all the time, challenging businesses such as online pharmacies and labs to continually review the most recent clinical trial and prescribing information so they can advise patients on such topics as COVID-19 rebound.


While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

Short- and Long-Term Health Effects of a Sedentary Lifestyle

Your body was made to move! Today’s lifestyle makes it hard to keep your body moving throughout the day. Many people sit all day at work and then go home to use technology or watch television. But a sedentary lifestyle can contribute to health problems such as type 2 diabetes, obesity, high blood pressure, and premature mortality.

According to a study published in JAMA:1

  • About 1 in 4 adults sit for over 8 hours daily.
  • About 4 in 10 adults are physically inactive.
  • About 1 in 10 adults sits for over 8 hours daily and is physically inactive the rest of the day.

According to data collected by the Centers for Disease Control and Prevention, more than 25% of adults are physically inactive. Exercising or engaging in physical activity for a few hours and then sitting meets the criteria for exercise. However, according to researchers, it is still not healthy. Prolonged periods of sitting are associated with an increase in all-cause mortality. Sitting for less than 30 minutes at a time decreases your risk of an early death.2

What Is a Sedentary Lifestyle?

Several organizations have defined a sedentary lifestyle or sedentary behavior. According to the Sedentary Behavior Research Network, some of these definitions include:3

  • A class of behaviors characterized by low energy expenditure.
  • Sedentary behaviors such as TV watching, computer use, or sitting typically fall in the energy-expenditure range of 1.0 to 1.5 METs (multiples of the basal metabolic rate).
  • Behaviors that do not increase energy expenditure substantially.
  • Non-upright behaviors.
  • Any time spent sitting or lying.

Putting these together: A sedentary lifestyle is defined by an increased amount of sitting, lying, or reclining that has very low energy expenditure, which is typically defined as 1.0 to 1.5 METs.

Characteristics of a Sedentary Lifestyle

Your day can be divided into three parts:

  • Sleep: During the 6 to 10 hours you sleep each night, you are either sitting, reclining, or lying down. This portion of your day is appropriately sedentary.
  • Physical Activity: During this part of your day, you are in motion and can be engaged in light, moderate, or vigorous physical activity. Increasing your time moving will improve your overall health and reduce your risk for chronic disease. Light exercise is better than sedentary behavior, moderate activity is better than light, and vigorous activity can be even better depending on your fitness level.
  • Sedentary Behavior: Any time spent lying, reclining, or sitting throughout your day.
A doctor explaining heart disease to a patient

Why Do Sedentary Lifestyles Negatively Affect Health?

When your body doesn’t move, you:

  • Burn fewer calories and can more easily gain weight.
  • Increase your risk for blood clots in your legs.
  • May lose bone density and mass more quickly.
  • Lose muscle mass and endurance.
  • Lose cardiovascular fitness.
  • May experience anxiety and depression.
  • May find it harder to get quality sleep.
  • Have increased fatigue.

In one study over 12 years that enrolled 17,000 Canadian adults, it was found that adults who spent most of their time sitting were 50% more likely to die than those who sat the least. The researchers controlled for age, smoking, and physical activity levels.4

Possible Short-Term Health Effects

Lack of exercise and physical movement throughout the day increases your risk for:

  • Weight gain
  • Poor exercise endurance
  • Low mood
  • Constipation
  • Decreased energy
  • Back pain

These short-term effects of sedentary behavior can be reversed by incorporating physical activity into your day.

Possible Long-Term Health Effects

When a sedentary lifestyle becomes a habit, you increase your risk for:5,6

  • Obesity: Your body burns calories daily as you fidget and move around. However, most obesity risk comes from diet. Research is inconclusive on how much a sedentary lifestyle affects your weight.7
  • Mortality: Seven systematic reviews indicate that sedentary behavior is associated with increased all-cause and cardiovascular mortality, independent of physical activity and body mass index.
  • Heart disease: In one study, researchers found that sitting just two hours a day was associated with a 5% increase in cardiovascular disease.5 Having obesity is another risk factor for heart disease. Physical activity can help you manage your weight and improve your cardiovascular health. Learn more facts and common myths about heart disease.
  • High blood pressure: Sedentary behaviors may increase your risk of hypertension.6 Physical activity improves cardiovascular health and lowers blood pressure. High blood pressure does not have symptoms. Learn how to protect your cardiovascular health in this hypertension guide.
  • Osteoporosis: Osteoporosis is decreased bone density and mass. Adolescents and young adults build their lifetime supply of bone. Pounding exercises like walking and running increase bone density as bone responds to stress.
  • Falls: When the stabilizing muscles in your core become weak from sitting too much, it increases your risk of falls.
  • Blood clots: If you have a genetic predisposition for blood clots, sitting for long periods can increase your risk.
  • High cholesterol: Sedentary behavior increases LDL (bad cholesterol) and triglycerides. Physical activity increases HDL or good cholesterol. Read more about the differences between good and bad cholesterol.
  • Certain cancers: Sedentary behavior may increase your risk for colorectal, breast, endometrial, ovarian, and prostate cancers.6 However, the results are inconclusive and may be influenced by time spent in physical activity and body mass index.
  • Type 2 diabetes: Research suggests that sitting for 2 hours per day is associated with a 20% increase in risk for type 2 diabetes.
  • Depression and anxiety: Some studies show an association between sedentary behavior and depressed mood.8,9 However, more evidence supports how physical activity boosts mood and reduces stress. Stress can also have a significant effect on heart health.

While many studies on the health effects are inconclusive, the studies that demonstrate the benefits of physical activity for overall health are not. It is challenging to design studies that measure the health effects of sedentary behavior and exclude possible confounding variables. However, there is a growing body of evidence that sedentary behavior is a risk factor for multiple adverse health outcomes in adults, regardless of whether they exercise.10

A person using an exercise tracker.

How To Change Your Sedentary Lifestyle

Research suggests that even people who meet the recommended physical activity guidelines are still at risk if they sit for the rest of the day. It will take a conscious effort to develop new habits that involve moving your body regularly throughout the day.

At Home

Try to incorporate some of these heart-healthy exercises and physical activity into your daily schedule:

  • Pace while you talk on the phone.
  • Save TV watching for when you are using a treadmill or other exercise equipment or if you sit, get up, and walk during each commercial.
  • Set a timer when you sit down.
  • Listen to recorded books so you can walk while you listen.
  • Space out your chores so they include more walking.
  • Play with your pets.

At Work

Increase your physical activity at work by trying to incorporate some of the following behaviors into your day:

  • Park further from the building.
  • Take the stairs instead of the elevator.
  • Set reminders on your phone or watch to get up and move every 30 minutes.
  • Go for a walk on your breaks.
  • Use restrooms on a different floor.
  • Pace in your office when you are on the phone.
  • Invest in a standing desk or a walking pad.
  • Organize walking meetings.
  • Stand while riding the bus.
  • Walk to work.
  • Make it a habit to get up and do quick exercises periodically throughout the day.

When To Seek Help From Health Professionals

If you are concerned about your risk for chronic disease, cannot exercise, or are excessively fatigued, make an appointment with a Telegra MD doctor to discuss your symptoms and health history. TelegraMD doctors are available 24 hours a day, so you can get help when you need it. They can provide an online diagnosis and develop an individualized treatment plan. However, if you have shortness of breath, chest pain, or any other signs of a medical emergency, see a local doctor for urgent care.


While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.


1. Ussery EN, Fulton JE, Galuska DA, Katzmarzyk PT, Carlson SA. Joint Prevalence of Sitting Time and Leisure-Time Physical Activity Among US Adults, 2015-2016. JAMA. 2018;320(19):2036–2038. doi:10.1001/jama.2018.17797

2. Diaz KM, Howard VJ, Hutto B, et al. Patterns of Sedentary Behavior and Mortality in U.S. Middle-Aged and Older Adults: A National Cohort Study. Ann Intern Med.2017;167:465-475. [Epub 12 September 2017]. doi:10.7326/M17-0212

3. Tremblay, M.S., Aubert, S., Barnes, J.D. et al. Sedentary Behavior Research Network (SBRN) – Terminology Consensus Project process and outcome. Int J Behav Nutr Phys Act 14, 75 (2017).

4. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009 May;41(5):998-1005. doi: 10.1249/MSS.0b013e3181930355. PMID: 19346988.

5. de Rezende LF, Rodrigues Lopes M, Rey-López JP, Matsudo VK, Luiz Odo C. Sedentary behavior and health outcomes: an overview of systematic reviews. PLoS One. 2014 Aug 21;9(8):e105620. doi: 10.1371/journal.pone.0105620. PMID: 25144686; PMCID: PMC4140795.

6. Park JH, Moon JH, Kim HJ, Kong MH, Oh YH. Sedentary Lifestyle: Overview of Updated Evidence of Potential Health Risks. Korean J Fam Med. 2020 Nov;41(6):365-373. doi: 10.4082/kjfm.20.0165. Epub 2020 Nov 19. PMID: 33242381; PMCID: PMC7700832.

7. McGuire, K. A., & Ross, R. (2011). Sedentary behavior is not associated with cardiometabolic risk in adults with abdominal obesity. PloS One, 6(6), e20503.

8. Sanchez-Villegas, A., Ara, I., Guillén-Grima, F., Bes-Rastrollo, M., Varo-Cenarruzabeitia, J. J., & Martínez-González, M. A. (2008). Physical activity, sedentary index, and mental disorders in the SUN cohort study. Medicine and Science in Sports and Exercise, 40(5), 827–834.

9. Zhai L, Zhang Y, Zhang D. Sedentary behaviour and the risk of depression: a meta-analysis. British Journal of Sports Medicine 2015;49:705-709.

10. Thorp, A. A., Owen, N., Neuhaus, M., & Dunstan, D. W. (2011). Sedentary behaviors and subsequent health outcomes in adults. American Journal of Preventive Medicine41(2), 207–215.

A Guide to Mold Allergies

Mold (fungal) allergies can cause congestion, headaches, coughing, wheezing, itchy, watery eyes, and skin rashes. Molds are common in indoor and outdoor environments, where they thrive in high humidity and moisture. However, not all mold spores cause allergy symptoms.1 The American College of Occupational and Environmental Medicine estimates that about 10% of people have a mold allergy, with about 5% having symptoms, and that 10% to 30% of the population may be sensitive to mold allergens. Depending on your geographic location, outdoor mold allergies may peak in the fall or be year-round.

Symptoms of a Mold Allergy

Mold allergies can develop at any age. The symptoms associated with mold allergies are similar to those of other allergies. They can develop immediately or be delayed. Common mold allergy symptoms include:

  • Nasal congestion
  • Runny nose
  • Headache
  • Sneezing
  • Sore throat
  • Watery eyes
  • Dry cough
  • Shortness of breath
  • Wheezing
  • Hives
  • Nausea
  • fatigue

Mold seems to cause more respiratory symptoms than other allergens, increasing the risk for severe allergies and asthma in susceptible people.

How To Prevent Mold Allergy Symptoms

According to the Environmental Protection Agency, getting rid of all molds and mold spores in your home is impossible. However, the following steps can help reduce mold spores:

  • Reduce indoor humidity to 30% to 60%.
  • Vent bathrooms, dryers, and other moisture-generating sources to the outside.
  • Use dehumidifiers and air conditioning to reduce humidity.
  • Increase ventilation throughout your home and use HEPA filters.
  • Use exhaust fans when cooking.
  • Wipe counters and other hard surfaces with water and detergent, and dry thoroughly.
  • Leave wet shoes and clothing in a mudroom.
  • Ensure your home has adequate insulation to prevent condensation.
  • Avoid carpeting in areas of the home that are prone to collecting moisture, such as bathrooms.
  • Remediate any mold safely.

When prevention is not enough to control your symptoms, antihistamines, decongestants, corticosteroids, and asthma medications may be needed to control your symptoms. Contact a doctor on the TelegraMD platform to receive a diagnosis, a personalized treatment plan, and, if appropriate, an online prescription transmitted to your local pharmacy.  

A child getting allergy testing

How To Treat Mold Allergy Symptoms

The first step in treating mold allergies is to reduce your exposure. While molds are ubiquitous, reducing moisture and humidity in your home can help relieve symptoms.

The next step is to take allergy medications to control your symptoms:

  • Antihistamines reduce itching, watery eyes, sore throat, and post-nasal drip.
  • Decongestants reduce nasal congestion and headaches.
  • Steroid nasal sprays reduce nasal congestion.
  • Nasal saline rinses remove allergens from the nose and sinuses.

If environmental remediation and medications are not enough to control your symptoms and your symptoms worsen or persist, you may want to consider immunotherapy. After having allergy testing, your doctor can prepare an allergy serum that will be used to help your immune system become less sensitive to mold allergens.

You will receive escalating doses of the allergy serum. You will notice decreased symptom severity as your immune system becomes less sensitive to your allergen.

Places Where Mold May Be Present

Mold is typically present in moist, dark areas, inside and outside the home, where there is organic matter, such as wood, for them to grow on. Look for mold in these locations:

  • Poorly vented bathrooms, look around showers and sinks
  • Wet basements in corners and any exposed wood or insulation
  • Poorly vented laundry rooms
  • Around windows
  • In kitchens, under the sinks, refrigerators, and dishwashers
  • Attics with poor ventilation and roof leaks can accumulate moisture
  • Crawlspaces that accumulate moisture
  • Air ducts that are not properly maintained
  • Wet carpeting
  • Along damaged roofs or clogged gutters
  • Along exterior wall cracks
  • Leaf piles or garden waste
  • Wooden decks and fences
  • Outdoor furniture

Remove moisture sources, caulk, and check for gaps in walls and cabinets. Clean up spills promptly, improve house ventilation, check the integrity of your windows, roof and gutters, clean appliances that use water, check for condensation, use dehumidifiers, and remove plants to reduce mold in your home.

Mold remediation

Types of Mold Allergies

Types of molds causing allergies and human diseases include:2,3,4

  • Alternaria: An outdoor mold found in soil, plants, and decaying vegetation.
  • Cladosporium: found on plants, soils, and HVAC systems.
  • Aspergillus: found on decaying leaves and compost piles
  • Penicillium: found in damp homes.
  • Mucor: found in soil, plant surfaces, and decaying leaves.

All mold species have the potential to cause sensitization and allergies, but compared to other environmental allergens, the allergenic potential of each mold species is low.4

Mold Allergies vs. Seasonal Allergies

Mold allergens are common anywhere there is moisture, inside and outside the home. Like other indoor allergens, such as dust mites and pet dander, mold allergies can cause symptoms year-round.

Seasonal allergies are caused by outdoor allergens that peak at certain times of the year. Seasonal allergies, like mold allergies, are common. Both seasonal allergies and mold allergies cause similar symptoms. It may be easier to diagnose seasonal allergies than mold allergies based on the time of year in which you have symptoms. Treatment for seasonal and mold allergies is the same and includes reducing exposure, using medications, and considering allergy testing. Unlike seasonal allergens, mold is more likely to cause asthma and allergy symptoms.

Colds and pink eye have symptoms that overlap with allergies, so it is essential to get an accurate diagnosis before starting treatment.

Are Mold Allergies Genetic?

Both environmental factors and genetic predisposition can influence your risk of developing mold allergies. Specific genetic markers have been linked to mold allergies. However, more research is needed to determine whether specific gene variants cause allergies. Your risk of developing allergies increases if one or both of your parents has allergies.

Who Is Most at Risk of a Mold Allergy?

At the highest risk for mold allergies are people:4

  • Who work or live in warm, moist climates
  • With asthma or allergies
  • Who with immunosuppression
  • With respiratory diseases such as cystic fibrosis
  • At the extremes of age
  • Who work in construction, agricultural fields or gardening, mold remediation, library archives, breweries or wineries, paper processing, feed production, ventilation/air conditioning maintenance

Can You Develop a Mold Allergy?

Yes, it is possible to develop a mold or other type of allergy later in life. Changes in your environment, immune response, or overall health can increase your sensitivity to allergens.

Can You Outgrow a Mold Allergy?

It is possible to outgrow a mold allergy, but it is uncommon.

When To Consult a Doctor

If you are unsure whether allergies are causing your symptoms or you have more severe allergies or asthma symptoms, consult with an online doctor on the TelegraMD platform. Doctors are on call 24 hours a day to provide an online diagnosis, prescribe appropriate treatment, and provide an individualized treatment plan to combat your allergy symptoms.


While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.


1. Borchers, A.T., Chang, C. & Eric Gershwin, M. Mold and Human Health: a Reality Check. Clinic Rev Allerg Immunol 52, 305–322 (2017).

2. Portnoy JM, Jara D. Mold allergy revisited. Ann Allergy Asthma Immunol. 2015 Feb;114(2):83-9. doi: 10.1016/j.anai.2014.10.004. PMID: 25624128.

3. Singh, M., & Hays, A. (2016). Indoor and outdoor allergies. Primary Care, 43(3), 451–463.

4. Hurraß J, Heinzow B, Aurbach U, Bergmann KC, Bufe A, Buzina W, Cornely OA, Engelhart S, Fischer G, Gabrio T, Heinz W, Herr CEW, Kleine-Tebbe J, Klimek L, Köberle M, Lichtnecker H, Lob-Corzilius T, Merget R, Mülleneisen N, Nowak D, Rabe U, Raulf M, Seidl HP, Steiß JO, Szewszyk R, Thomas P, Valtanen K, Wiesmüller GA. Medical diagnostics for indoor mold exposure. Int J Hyg Environ Health. 2017 Apr;220(2 Pt B):305-328. doi: 10.1016/j.ijheh.2016.11.012. Epub 2016 Dec 5. PMID: 27986496.

What To Do About Dry Eyes During Allergy Season

Dry, itchy, and irritated eyes are common allergy symptoms, but they have other causes as well. When your eyes don’t make enough tears or your tears dry too quickly due to a lack of lipids in the fluid, it can cause fatigue, stinging sensations, redness, blurred vision, and light sensitivity.

The lacrimal gland, which is above the eye, produces tears. Tears coat the surface of the eye, protecting it and keeping it moist. Excess tears drain into the lacrimal duct in the lower corner of your eye.

Dry eye syndrome affects between 16 and 24 million people in the United States.1,2 Older age, having an autoimmune condition, female sex, a lack of vitamin A, decreased blinking, and wearing contact lenses can increase your risk of dry eyes.3

Can Allergies Cause Dry Eyes?

Allergic conjunctivitis causes redness, itching, and dryness due to a sensitivity to allergens in the air. Eye allergies develop when your immune system becomes sensitized and overreacts to harmless substances in the air. These allergens trigger mast cells in your immune system to produce histamine and other chemicals.

Seasonal or perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, contact allergic conjunctivitis, and giant papillary conjunctivitis are the most common types of eye allergies.

Unlike other causes of conjunctivitis, allergic conjunctivitis is not contagious. It typically has a seasonal pattern, depending on what you are allergic to. Many people with allergic conjunctivitis have other allergy symptoms, such as a runny nose, facial itchiness, and a dry cough.

Seasonal allergens that may be causing your dry eye symptoms include:

  • Mold spores
  • Pollen from grasses, trees, and weeds
  • Dust mites
  • Pet dander

Cigarette smoke, perfume, cleaning chemicals, diesel exhaust, and other irritants can worsen your dry eye symptoms.

Other Causes of Dry Eyes

While allergies commonly cause dry eyes, there are other potential causes. These conditions are commonly misdiagnosed as pink eye because they can cause redness, irritation, and tearing.

Common causes of dry eye include:

  • Foreign bodies in the eye
  • Exposure to pollution
  • Medication use, especially antihistamines, antidepressants, and blood pressure medications
  • Health conditions such as autoimmune disorders
  • Laser eye surgery
  • Smoky or dry environments
  • Prolonged computer use
  • Wearing contact lenses
  • Decreased blinking
  • Vitamin A deficiency

To determine whether your dry eyes are due to allergic conjunctivitis or another condition, make an online appointment to talk with a telemedicine doctor and receive an online diagnosis. After receiving your diagnosis, your doctor will provide an individualized care plan to relieve your dry eye symptoms.  

Close-up of a pink eye

Symptoms of Allergic Conjunctivitis

Symptoms of allergic conjunctivitis can vary but commonly include:

  • Blurry vision
  • Burning
  • Feeling like there is dirt or grit in your eyes
  • Itchiness
  • Light sensitivity
  • Redness
  • Stinging
  • Swollen eyelids
  • Watery eyes

How To Treat Dry Eyes from Allergies

Dry eyes from allergies or other causes can affect your physical and psychological health and reduce your quality of life. Treating dry eyes from allergies can improve your vision and reduce your symptoms.4

Try To Limit Exposure to Allergens

Limit your exposure to inside and outside allergens by taking the following steps to allergy-proof your home:

  • Add HEPA filters to vacuums and furnaces to reduce allergens.
  • Avoid exposure to foods, chemicals, perfumes, tobacco, and air pollution.
  • Avoid using window fans that can draw outdoor allergens into the home.
  • Control pet allergens with frequent bathing, brushing, and grooming.
  • Dustproof your home by removing unnecessary carpet, drapes, bedding, and upholstered furniture.
  • Encase mattresses and pillows in a zipped plastic, dust-mite-proof encasing.
  • Keep your hands away from your face and eyes.
  • Leave your shoes and coats in a mudroom to avoid tracking allergens throughout your home.
  • Stay indoors with your windows closed during high-allergen times. Many weather apps report common allergens and their levels in your area.
  • Wash bedding weekly in hot water.
  • Wash your hands after petting or touching animals.
  • Wear glasses or sunglasses, especially outside, to limit contact with wind-blown eye allergens.
A family and pet with allergy symptoms

Use Eye Drops

Prescription and over-the-counter eye drops can reduce irritation, remove allergens, and cleanse an irritated eye. Some prescription eye drops can prevent eye allergy symptoms. Talk to a doctor on the TelegraMD platform about your dry eye symptoms. If appropriate, your doctor can transmit an online prescription to your local pharmacy.

Take Oral Antihistamines

Oral antihistamines reduce histamine, a chemical that causes redness, swelling, tearing, and itchiness. Oral histamines are commonly used to treat allergies but they can worsen dry eye symptoms.

Practice Good Eye Hygiene

According to the Centers for Disease Control and Prevention, approximately 99% of contact users surveyed report not following at least one of the recommended contact lens hygiene behaviors and, therefore, increasing their risk of pink eye.5

When wearing contact lenses, practice these steps to reduce irritation and allergen accumulation on your contacts:

  • Add fresh disinfecting solution to your case before storing your contacts overnight.
  • Add fresh solution each day.
  • Do not top off your disinfecting solution in your contact cases.
  • Keep your contact case clean and dry between uses.
  • Replace your storage case every three to six months.
  • Wash your hands before putting contacts in your eyes or removing them.

Allergens can become trapped between your eyes and contacts, increasing your risk of eye irritation and dryness.

Consider Allergy Shots

If your allergy symptoms are severe and eye drops, allergy medications, and environmental changes do not improve your symptoms, consider allergy shots.

Your doctor may suggest allergy shots after allergy testing to determine which allergens your immune system is sensitive to. This involves injecting a gradually increasing dose of an allergen as your immune system adjusts to it.

Allergy shots can be highly effective at reducing your allergy and asthma symptoms. Typically, allergy shots are given weekly until you reach a maintenance dose. After that, your injection schedule may be spaced out more.

Allergy shots require time and commitment to receive the injection and wait in the office for the required 15 to 20 minutes in case of a reaction. Allergy shots can be expensive, especially if you do not have insurance coverage.

However, if you commit to taking allergy shots, you may see a significant improvement in your symptoms. Talk to your TelegraMD doctor to learn more about allergy shots and whether you would be a suitable candidate for them.

A woman talking to a telehealth doctor

When To See a Doctor

Dry eye causes can vary, so getting an accurate diagnosis and discussing your treatment options is important. Whether you have decreased tear production due to a health issue or as a result of aging, poor tear quality, or tears that evaporate too quickly, an online doctor can help diagnose and treat your condition. Telehealth is a cost-effective way to see a doctor about your dry eye and other allergy symptoms.

Warning signs and symptoms that suggest that something other than allergies may be contributing to your symptoms include:6

  • Bloody nose
  • Difficulty or inability to smell
  • Fever
  • Severe headache
  • Nasal blockage in one nostril
  • Nasal discharge from one nostril
  • Blurred vision
  • Eye pain
  • Blisters or vesicles around the eye

Make an online appointment to get a prescription online if over-the-counter allergy medications are not helping your symptoms or you are concerned that something other than allergies is causing your dry eyes.


While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.


  1. Reza D, Bradley JL, Guerin A, et al. Estimated prevalence and incidence of dry eye disease based on coding analysis of a large, all-age United States healthcare system. American Journal of Ophthalmology. 2019;202:47-54. doi:10.1016/j.ajo.2019.01.026
  2. Farrand KF, Fridman M, Stillman IÖ, Schaumberg DA. Prevalence of diagnosed dry eye disease in the United States among adults aged 18 years and older. American Journal of Ophthalmology. 2017;182:90-98. doi:10.1016/j.ajo.2017.06.033
  1. National Eye Institute. Dry Eye. (n.d.). NIH.Gov. Retrieved September 13, 2023, from
  2. Guo OD LW, Akpek E. The negative effects of dry eye disease on quality of life and visual function. Turk J Med Sci. 2020 Nov 3;50(SI-2):1611-1615. doi: 10.3906/sag-2002-143. PMID: 32283910; PMCID: PMC7672346.
  3. Cope JR, Collier SA, Nethercut H, Jones JM, Yates K, Yoder JS. Risk Behaviors for contact lens–related eye infections among adults and adolescents — United States, 2016. MMWR Morb Mortal Wkly Rep. 2017;66(32):841-5.
  4. Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK, Williams H; ISAAC Phase Three Study Group. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006 Aug 26;368(9537):733-43. doi: 10.1016/S0140-6736(06)69283-0. Erratum in: Lancet. 2007 Sep 29;370(9593):1128. PMID: 16935684.

How Smoking and Vaping Can Affect Mental Health

Almost 70% of the 28.3 million U.S. adults who smoke say they want to quit.1 Smoking poses significant health risks. Cigarette smoking causes over 480,000 deaths in the United States annually, making it the leading preventable cause of death worldwide.2

Vaping and smoking are two alternative methods to deliver nicotine. Concerns about the health risks of smoking have led many people to choose vaping as an alternative. About 1 in every 20 Americans (10.8 million) uses vaping devices, and one in three uses them daily.3 According to the 2022 Gallup poll, 8% of U.S. adults regularly or occasionally vape. One in every four high school students uses vaping products. 

Nicotine is a compound that is rapidly delivered to the brain. It is a highly addictive substance that alters brain chemistry, prompting researchers to look into its potential effects on mental health.

Does Nicotine Cause Anxiety?

Generalized anxiety disorder is characterized by a persistent feeling of worry and anxiety.4 This chronic mental health condition affects all aspects of life, leading many to seek relief by smoking or vaping. Compared to the general population, smoking rates are higher in people with anxiety disorders, and anxiety disorders are more common in people dependent on nicotine.5

Research has shown inconsistent results when exploring the relationship between nicotine use and anxiety. Some studies show that nicotine can ease anxiety, though the effect may be temporary.6 Other studies indicate that, ultimately, nicotine use increases anxiety.7

A study of 2,500 adults and teens found that those who smoke or vape reported more anxiety (60%), depression, and suicidal thoughts than those who did not (40%).  

A person smoking

Can Nicotine Help With Anxiety?

People living with depression or anxiety have a much higher rate of smoking than the general population, leading some researchers to theorize that people who smoke use nicotine to relieve their mental health symptoms,7 but does nicotine use really help with anxiety?

No, nicotine use does not help treat anxiety. Nicotine withdrawal causes uncomfortable symptoms, including anxiety, irritability, and depression. People who stop smoking may mistakenly believe that nicotine is easing their anxiety, but in reality, it relieves symptoms from quitting smoking.7

A sad woman with a cigarette

The Relationship Between Nicotine and Mental Health

Addiction, stress, anxiety, depression, and schizophrenia are mental health conditions linked to nicotine use. Researchers continue to investigate the complex relationships between mental health conditions and nicotine’s effects on the brain.

Compared with the general population, people with schizophrenia, depression, and other mental health conditions are three times more likely to smoke. They also smoke more intensely, drawing more nicotine out with each breath, and are more nicotine-dependent. 8  

The high prevalence of smoking in people with mental health conditions may be because nicotine temporarily reduces symptoms such as poor concentration, low mood, and stress. Ultimately, smoking cessation is linked to reduced depression, anxiety, and stress, as well as better mood and quality of life.9,10


Nicotine is a highly addictive substance that changes brain chemistry and leads to cravings and withdrawal symptoms with decreased use. Changes in brain chemistry from nicotine exposure cause tolerance or a need to use higher and higher nicotine doses to get the same effect.

Withdrawal symptoms can cause insomnia, mood changes, cravings, anxiety, restlessness, and depression. 

Stress and Anxiety

Changes in brain chemistry from nicotine exposure are associated with a depressed mood, agitation, and anxiety shortly after smoking. A person who smokes has fluctuations in their psychological state as they go through repeated withdrawal cycles throughout the day. This can worsen mental health. However, according to researchers, a causal relationship between smoking and mental health conditions cannot be supported. In a review of 29 studies, researchers found that quitting smoking and vaping was associated with a decrease in anxiety and stress symptoms.10


In one study, over half of the 108 participants who were moderately or heavily dependent on nicotine reported moderate-to-severe depression, and 44% reported moderate-to-severe anxiety, as well. Interestingly, the degree of nicotine addiction was inversely related to the severity of anxiety and depression. This illustrates the complex relationship between mental health conditions and nicotine use.11

In a review of 29 studies, the improvement researchers saw in mood disorders when people stopped smoking was similar to using antidepressant treatments.10


A strong link between schizophrenia and smoking exists. Some reports suggest that cigarette smoking increases the risk of schizophrenia. However, more research is needed.

Theories on the association between schizophrenia and smoking include:12

  • Self-medication theory: Smoking increases dopamine levels and may improve symptoms.
  • Causal: Smoking may play a role in developing schizophrenia.
  • Genetic: There may be a shared genetic predisposition for both schizophrenia and smoking.

People with schizophrenia inhale more deeply, have higher nicotine exposure, consume more cigarettes, and have higher levels of nicotine dependence than smokers who do not live with schizophrenia. People living with schizophrenia have a shorter lifespan (by 28 years) than people who do not, and the health effects of cigarette smoking contribute to this.12

Varenicline and other smoking cessation medications can be effective for smoking cessation and can increase the odds of quitting by a factor of 4 to 5 times in people with schizophrenia. Without medication, the smoking cessation success rate is very low.13 More research is needed to develop effective smoking cessation programs for people with mental health conditions.12

A therapist talking to a client

How Quitting Can Benefit Mental Health

Nicotine increases dopamine levels in the brain and changes the metabolism of other brain chemicals. When people quit smoking, they are more likely to experience irritability, anxiety, depression, and memory and concentration problems.

To successfully quit smoking, it is essential to prepare yourself mentally and physically for your first smoke-free day. After quitting smoking, you will experience many long-term mental and physical health benefits. Smoking has a significant impact on heart health, and reducing stress also improves heart health.

What About Depression After Quitting Smoking?

Not only are people who smoke more likely to experience depression than those who do not, but low mood is more common when trying to quit smoking due to nicotine withdrawal.

People who experience depression after quitting smoking are more likely to relapse. However, the first two to three days after quitting smoking will be the worst. According to timelines for quitting smoking, nicotine cravings, irritability, sleep problems, anxiety, and restlessness peak within three to seven days after stopping smoking and using nicotine replacement therapies can make these symptoms much more manageable. The symptoms are expected to resolve within a month.

If you can successfully quit smoking, researchers have found that depressive symptoms significantly improve.14

How To Get Help With Addiction or Mental Health

Nicotine is very addictive, maybe even more so than cocaine and heroin.15 Its addictive quality makes it difficult for people to stop smoking. Behavior, psychological, and medical support can make it easier to successfully quit. Smoking cessation help is available, even online, through the TelegraMD platform.

Talk With a Therapist

Smoking cessation and withdrawal from nicotine can temporarily increase anxiety, stress, and depression. Talk to a good online therapist to develop a plan for managing your addiction and other mental health symptoms. An analysis of over 52 clinical studies and nearly 20,000 patients found that using a combination of behavioral therapy and medication compared to minimal support alone led to more effective smoking cessation success.16

Consult With a Doctor

Online doctors can provide an individualized smoking cessation program and prescribe nicotine replacement therapy as an online prescription and transmit it to your local pharmacy. These prescription and over-the-counter medications ease withdrawal symptoms. The TelegraMD platform provides 24-hour doctor care access so you can get help whenever you need it.


While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.


1. Cornelius ME, Loretan CG, Jamal A, et al. Tobacco Product Use Among Adults — United States, 2021. MMWR Morb Mortal Wkly Rep 2023;72:475–483.

2. Rigotti NA. Strategies to Help a Smoker Who Is Struggling to Quit. JAMA. 2012;308(15):1573–1580. doi:10.1001/jama.2012.13043

3. Mohammadhassan Mirbolouk, Paniz Charkhchi, Sina Kianoush, et al. Prevalence and Distribution of E-Cigarette Use Among U.S. Adults: Behavioral Risk Factor Surveillance System, 2016. Ann Intern Med.2018;169:429-438. [Epub 28 August 2018]. doi:10.7326/M17-3440

4. National Institute of Mental Health. Generalized anxiety disorder: When worry gets out of control. Updated 2022. Accessed September 11, 2023.

5. Kutlu MG, Parikh V, Gould TJ. Nicotine addiction and psychiatric disordersInt Rev Neurobiol. 2015;124:171-208. doi:10.1016/bs.irn.2015.08.004

6. Xiao X, Shang X, Zhai B, Zhang H, Zhang T. Nicotine alleviates chronic stress-induced anxiety and depressive-like behavior and hippocampal neuropathology via regulating autophagy signaling. Neurochemistry International. 2018;114:58-70. doi:10.1016/j.neuint.2018.01.004

7. Fluharty M, Taylor AE, Grabski M, Munafò MR. The association of cigarette smoking with depression and anxiety: a systematic review. NICTOB. 2017;19(1):3-13. doi:10.1093/ntr/ntw140

8. Gilbody S, Peckham E, Bailey D, Arundel C, Heron P, Crosland S, Fairhurst C, Hewitt C, Li J, Parrott S, Bradshaw T, Horspool M, Hughes E, Hughes T, Ker S, Leahy M, McCloud T, Osborn D, Reilly J, Steare T, Ballantyne E, Bidwell P, Bonner S, Brennan D, Callen T, Carey A, Colbeck C, Coton D, Donaldson E, Evans K, Herlihy H, Khan W, Nyathi L, Nyamadzawo E, Oldknow H, Phiri P, Rathod S, Rea J, Romain-Hooper CB, Smith K, Stribling A, Vickers C. Smoking cessation for people with severe mental illness (SCIMITAR+): a pragmatic randomised controlled trial. Lancet Psychiatry. 2019 May;6(5):379-390. doi: 10.1016/S2215-0366(19)30047-1. Epub 2019 Apr 8. PMID: 30975539; PMCID: PMC6546931.

9. National Institute on Drug Abuse. Do people with mental illness and substance use disorders use tobacco more often? February 24, 2023. Accessed September 11, 2023. Retrieved from

10. Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P et al. Change in mental health after smoking cessation: systematic review and meta-analysis BMJ 2014; 348 :g1151 doi:10.1136/bmj.g1151

11. Papazisis A, Koreli A, Misouridou E. Heavy Smoking is Associated with Low Depression and Stress: a Smokers’ Paradox in Cardiovascular Disease? Mater Sociomed. 2019 Dec;31(4):268-272. doi: 10.5455/msm.2019.31.268-272. PMID: 32082091; PMCID: PMC7007605.

12. Ding JB, Hu K. Cigarette Smoking and Schizophrenia: Etiology, Clinical, Pharmacological, and Treatment Implications. Schizophr Res Treatment. 2021 Dec 13;2021:7698030. doi: 10.1155/2021/7698030. PMID: 34938579; PMCID: PMC8687814.

13. Cather C, Pachas GN, Cieslak KM, Evins AE. Achieving Smoking Cessation in Individuals with Schizophrenia: Special Considerations. CNS Drugs. 2017 Jun;31(6):471-481. doi: 10.1007/s40263-017-0438-8. PMID: 28550660; PMCID: PMC5646360.

14. Stepankova L, Kralikova E, Zvolska K, et al. Depression and Smoking Cessation: Evidence from a Smoking Cessation Clinic with 1-Year Follow-Up, Annals of Behavioral Medicine, Volume 51, Issue 3, June 2017, Pages 454–463,

15. Brunette P, Harris S et al. UCSF Medical Center Fontana Tobacco Treatment Center Stop Smoking Workbook. Accessed July 6, 2023. extension://oemmndcbldboiebfnladdacbdfmadadm/

16. Stead LF, Koilpillai P, Fanshawe TR, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev. 2016 Mar 24;3(3):CD008286. doi: 10.1002/14651858.CD008286.pub3. PMID: 27009521; PMCID: PMC10042551.

Tips for Managing High Blood Pressure

High blood pressure, or hypertension, is diagnosed when blood pressure exceeds healthy limits. When you have high blood pressure, your blood exerts more force on the inner lining of blood vessels. Over time, excessive force and friction damage the inner lining of blood vessels. This increases your chances of developing cardiovascular diseases, such as stroke, heart attacks, kidney disease, vision loss, and sexual dysfunction.

The following statistics about high blood pressure epidemiology are concerning:1,2,3,4

  • Worldwide, about 1.28 billion adults have high blood pressure, including 122.4 million adults in the U.S.
  • In 2021, hypertension caused or contributed to 691,095 deaths in the U.S.
  • Just under half (46%) of people with high blood pressure do not know they have this condition.
  • Less than half of adults with high blood pressure are being treated, and only one in every five adults with hypertension has it under control.
  • High blood pressure is a leading cause of premature death worldwide.
  • The prevalence of high blood pressure is rising due to an aging population and increased exposure to detrimental lifestyle factors.

As these statistics show, the first step to improving your heart health is to learn whether you have high blood pressure. TelegraMD doctors are available 24 hours a day to evaluate your medical history and blood pressure readings and provide an individualized plan for lowering your blood pressure to healthy levels.

High blood pressure is managed by modifying lifestyle factors that increase your risk and taking medications. Whether or not you have high blood pressure, consider changing any lifestyle factors that increase your risk.

What Causes High Blood Pressure?

Blood pressure is a measurement of the pressure exerted by circulating blood on the walls of arteries, similar to the pressure exerted by water on the walls of a hose. Systolic pressure is measured when the lower chambers of the heart contract and push blood into the circulation. Diastolic pressure is the number recorded when the heart relaxes.

Factors that can cause high blood pressure (hypertension) include:

  • Blood volume/cardiac output: Excess blood volume from fluid retention (chronic kidney disease, heart failure, liver disease) or increased salt in your diet can raise blood pressure. Excess sympathetic nervous system stimulation, increased thyroid hormone, and high calcium levels can also increase blood pressure.
  • Compliance: When blood vessels are stiff and non-compliant due to microscopic damage or fat and cholesterol deposits, it can increase blood pressure. Blood vessel compliance decreases with age and cholesterol deposition.
  • Viscosity: Thicker blood from increased red blood cells or blood proteins can increase blood pressure.
  • Vessel length: The longer a blood vessel, the higher its resistance and the blood pressure needed to overcome this resistance. Carrying extra body fat (obesity) increases total capillary length. Obesity is a strong risk factor for heart disease.  
  • Resistance: Narrowing the lumen of a blood vessel increases its resistance, and high blood pressure is needed to overcome this resistance. Smoking, stress, and some medications (stimulants) may narrow blood vessels.

Having a genetic predisposition to high blood pressure can also increase your risk, as can medical conditions that are associated with high blood pressure, such as:

  • Sleep apnea
  • Chronic kidney disease
  • Pheochromocytomas
  • Adrenal gland tumors
  • Thyroid disease
  • Coarctation of the aorta
high blood pressure, cuff and risk factors

Ways To Reduce High Blood Pressure

Lifestyle factors contribute to high blood pressure. Mitigating these factors can reduce your blood pressure and your risk for chronic health conditions associated with high blood pressure. In addition to maximizing the benefits of healthy lifestyle choices, consult with an online doctor to get answers to your questions right away.

1. Get Regular Exercise

Regular exercise can reduce stress, improve mental health and cardiovascular function, and help you shed some extra pounds. Physical activity strengthens the heart, making it more efficient when pumping blood.

Research suggests that physical activity decreases systolic blood pressure by about 11 mm Hg and diastolic blood pressure by 8 mm Hg in about three-quarters of people with high blood pressure. Researchers also noted that:5

  • Exercise reduces blood pressure more in women than in men.
  • Middle-aged adults benefit more from exercise to reduce blood pressure than younger or older adults.
  • Low- to moderate- levels of exercise yield as much or even more benefit than high-intensity exercise.
  • Prolonged exercise improves blood pressure more than shorter episodes.
  • Decreases in blood pressure remain for up to 24 hours after exercising.

The American College of Sports Medicine (ACSM)6 and the U.S. Department of Health and Human Services Physical Activity Guidelines7 jointly recommend:

  • Aim for at least 150 to 300 minutes of moderate-intensity aerobic physical activity, 75 to 150 minutes of vigorous physical activity, or an equivalent combination of moderate- and vigorous-intensity activity throughout the week.
  • Do muscle-strengthening exercises that target every major muscle group at least twice a week.

Choosing a sedentary lifestyle has many potential health effects, including an increased risk for metabolic syndrome, high blood pressure, and obesity. Any physical activity that you incorporate into your daily schedule will pay off in health benefits. The best exercises are ones you enjoy and will continue doing.

Examples of heart-healthy exercises include:

  • Aerobic exercises: walking, jogging, cycling, rowing, swimming, and dancing to improve cardiovascular fitness.
  • Strength training: push-ups, squats, and planks to increase muscle mass.
  • High-intensity interval training to improve cardiovascular fitness and burn calories.
  • Yoga or Pilates to improve flexibility and posture.

2. Cut Back on Sugary and Salty Foods

When researchers compared 14 different macronutrient diets, they found all diets resulted in modest weight loss and improved blood pressure over six months, but at 12 months, weight reduction decreased, and blood pressure improvements largely disappeared. Reviewers pointed out that very low-carbohydrate diets were not included in the study.8

Long-term follow-up data from the Framingham Heart Study revealed that compared to normal-weight adult men and women, the relative risks for developing high blood pressure were 1.48 and 1.70 for overweight men and women and 2.23 and 2.63 for men and women with obesity, respectively.9 Losing weight to a healthy body mass index can reverse this risk.10

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure found that weight reduction by 22 pounds resulted in a 5 to 20 mm Hg reduction in systolic blood pressure.11

Sodium can increase water retention and blood volume, leading to high blood pressure. Reduce sodium intake to less than 2,400 mg sodium per day. Optimally, decrease it even further to 1,500 mg per day. Restricting sodium is expected to decrease systolic blood pressure by 2 to 8 mm Hg.11 Most sodium in the typical American diet comes from consuming processed foods, not from adding salt to foods at the table.

Increasing potassium in your diet can lower your blood pressure. A low potassium-to-sodium ratio is associated with increased blood pressure. The DASH diet recommends a daily intake of 4.7 g of potassium.12

A person using an exercise tracker.

3. Eat More Heart-Healthy Foods

Consuming a diet rich in fruits and vegetables and low-fat dairy products with reduced saturated and total fat, such as the DASH (Dietary Approaches to Stop Hypertension) diet, can reduce blood pressure by 8 to 14 mm Hg.11  Heart-healthy foods are rich in antioxidants and healthy sources of fat and low in saturated fat and sodium.

The DASH diet emphasizes eating:

  • Fruits
  • Vegetables
  • Whole grains
  • Fish
  • Poultry
  • Beans
  • Nuts and seeds
  • Vegetable oils

Besides lowering blood pressure, a heart-healthy diet can lower low-density lipoprotein (LDL) bad cholesterol and increase high-density lipoprotein (HDL) cholesterol.

Foods rich in omega-3 fatty acids

4. Reduce Smoking and Alcohol Consumption

Chemicals in cigarette smoke constrict blood vessels, increasing resistance and, therefore, blood pressure. These chemicals damage the inner lining of blood vessels and can negatively impact heart health. Increased risk of cardiovascular disease from smoking is not life long. After one year of smoking cessation, the risk of coronary heart disease is cut in half and continues to decline. After 15 years of abstinence, coronary heart disease risk is comparable between smokers and nonsmokers.13

Long-term or excessive alcohol consumption can damage the liver and affect the heart. For every 10 grams of alcohol consumed, blood pressure increases by about 1 mm Hg. After 2 to 4 weeks of abstinence, the effect of alcohol on blood pressure declines to baseline. The relationship between alcohol consumption and blood pressure is the same regardless of the type of alcohol consumed.14

Drinking alcohol in moderation, which is less than or equal to two drinks per day for men and one drink per day for women, can reduce your systolic blood pressure by 2 to 4 mm Hg.11

5. Manage Stress to Reduce Blood Pressure

Unmanaged stress stimulates the sympathetic nervous system (“fight or flight”), which releases hormones that narrow blood vessels and increase resistance and, therefore, blood pressure. Stress can have a significant impact on heart health. Unmanaged stress does not directly cause high blood pressure but can increase risk.15

Many people find that some of the following activities can help them manage stress:

  • Meditation
  • Being in nature
  • Exercising
  • Playing with a pet
  • Taking a nap
  • Yoga or Pilates
  • Hobbies

6. Take the Right Medication or Supplements

Lifestyle changes are the first-line treatment for managing blood pressure. Blood pressure medications are frequently needed if lifestyle changes alone don’t reduce blood pressure to a healthy level.

Some potentially heart-healthy supplements that may improve heart health and blood pressure include:

  • Omega-3 fatty acids
  • Magnesium
  • Fiber
  • Folate
  • Coenzyme Q-10
  • Vitamin E

Before taking supplements to improve your heart health or blood pressure, schedule a medical consultation to discuss your best treatment options.

A person taking another person's blood pressure

What Kind of Doctor Manages High Blood Pressure?

Typically, a primary care doctor manages blood pressure. This could be a pediatrician to manage high blood pressure in children, a family medicine or internal medicine doctor for adults, and an obstetrician-gynecologist for pregnant people.

Schedule an online appointment with a TelegraMD doctor to discuss your concerns about your blood pressure and potential risk for heart disease. They will review your medical history and develop an individualized treatment plan incorporating heart-healthy lifestyle recommendations and prescription medications (if needed).

How To Monitor Your Blood Pressure

Blood pressure fluctuates from minute to minute, so it is important to monitor your blood pressure using a wearable device that tracks blood pressure or by taking your blood pressure at home.

When taking your blood pressure:10

  • Avoid caffeine, alcohol, tobacco use, or exercise within 30 minutes of taking your blood pressure.
  • Sit upright with your back against the back of the chair and your feet flat on the floor.
  • Avoid tight-fitting clothing.
  • Wrap the blood pressure cuff around your upper arm, not over clothing.
  • Place your arm on the table with your palm up so the cuff is even with your heart.
  • Push start on the machine and sit quietly until your blood pressure is measured.
  • Recheck your blood pressure on the other arm.

Tracking your blood pressure and making lifestyle changes that are linked to better heart health and lower blood pressure can pay off with a longer, healthier life.


While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.


1. World Health Organization. (2023). Hypertension. Retrieved September 8, 2023, from

2. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020 Apr;16(4):223-237. doi: 10.1038/s41581-019-0244-2. Epub 2020 Feb 5. PMID: 32024986; PMCID: PMC7998524.

3. National Center for Health Statistics. Multiple Cause of Death 2018–2021 on CDC WONDER Database. Accessed September 8, 2023.

4. Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Beaton, A. Z., Boehme, A. K., Buxton, A. E., Commodore-Mensah, Y., Elkind, M. S. V., Evenson, K. R., Eze-Nliam, C., Fugar, S., Generoso, G., Heard, D. G., Hiremath, S., Ho, J. E., … on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2023). Heart disease and stroke statistics—2023 update: A report from the American Heart Association. Circulation147(8).

5. Hagberg JM, Park JJ, Brown MD. The role of exercise training in the treatment of hypertension: an update. Sports Med. Sep 2000;30(3):193-206. doi:10.2165/00007256-200030030-00004

6. American College of Sports Medicine. Trending Topic | Physical Activity Guidelines. Accessed September 8, 2023.

7. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Accessed September 8, 2023.

8. Ge L, Sadeghirad B, Ball G D C, da Costa B R, Hitchcock C L, Svendrovski A et al. Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials BMJ 2020; 369 :m696 doi:10.1136/bmj.m696

9. Leggio, M., Lombardi, M., Caldarone, E. et al. The relationship between obesity and hypertension: an updated comprehensive overview on vicious twins. Hypertens Res 40, 947–963 (2017).

10. Whelton, P.K., Carey, R.M., Aronow, W.S., Casey, D.E. Jr., Collins, K.J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner,  P., Ovbiagele,  B., Smith, S. C. Jr., Spencer,  C. C., Stafford, R. S., Taler,  S. J., Thomas, R. J., Williams, K.A. Sr., Williamson, J.D., & Wright,  J.T. Jr.(2018).  2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol.;71(19): e127-e248. DOI: 10.1016/j.jacc.2017.11.006. Epub 2017 Nov 13. Erratum in: J Am Coll Cardiol.;71(19):2275-2279. PMID: 29146535.

11. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. (2004). National High Blood Pressure Education Program. Bethesda, MD: National Heart, Lung, and Blood Institute (U.S.); Report No. 04–5230.

12. Staruschenko, A. (2018). Beneficial Effects of High Potassium. Hypertension. 71, 1015-1022.

13. Puig-Cotado F, Tursan d’Espaignet E, St Claire S, Bianco E, Bhatti L, Schotte K et al. Tobacco and coronary heart disease: WHO tobacco knowledge summaries. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.

14. Puddey IB, Beilin LJ. Alcohol is bad for blood pressure. Clin Exp Pharmacol Physiol. 2006 Sep;33(9):847-52. doi: 10.1111/j.1440-1681.2006.04452.x. PMID: 16922819.

15. Kulkarni, S., O’Farrell, I., Erasi, M., & Kochar, M.S. (1998). Stress and hypertension. WMJ.; 97 (11):34-8. PMID: 9894438.

Early Signs of Heart Disease

Early signs of heart disease can vary from person to person. However, it is important to recognize them as quickly as possible to receive early intervention and treatment. Some symptoms, such as chest pain, pain radiating down your arm, and chest pressure, are more easily recognized as heart disease. Other symptoms, such as digestive symptoms, fatigue, and difficulty sleeping, are more difficult to recognize as being associated with heart disease.

If you are currently experiencing symptoms that are associated with heart disease or think you may be having a heart attack, seek emergency care. It is critical to receive treatment as early as possible.

Understanding Heart Disease

According to data from the Centers for Disease Control and Prevention, heart disease is the leading cause of death in the U.S. for men and women and for people of most racial and ethnic groups. About one in every five deaths in 2021 was attributed to heart disease.

The World Health Organization reports that cardiovascular disease is the leading cause of death worldwide. Approximately 17.9 million people die from cardiovascular disease each year.

Heart disease encompasses arrhythmias, heart failure, valve disease, congenital heart disease, and coronary artery disease.

The heart is a four-chambered pump that delivers oxygen and nutrients to the body. Blood is collected and pumped throughout the body by the two upper chambers (atria) and the two lower chambers (ventricles). The left side of the heart pumps oxygenated blood to the body, while the right side pumps deoxygenated blood to the lungs for oxygenation.

When the heart’s muscular pump weakens or loses efficiency, it can cause heart failure. Heart failure is most often caused by cardiomyopathy, which is an abnormality in the heart muscle. Dilated cardiomyopathy, the most common form, occurs when the left ventricular muscle becomes stretched and thins, reducing its ability to pump blood.

Heart attacks, coronary artery disease, hypertension, congenital heart disease, valvular disorders, and endocarditis are all potential causes of heart failure.

If the heart cannot adequately pump blood, excess fluid accumulates in the lungs, abdomen, and lower extremities.

The sino-atrial (SA) node comprises specialized cells in the right atrium. The SA node sets a rhythmic pace for heart contraction. The heart rate varies based on demand. From the SA node, the electrical impulse travels to the AV node at the junction of the right atrium and ventricle. The impulse is slightly delayed at the AV node, allowing time for the atria to contract and the ventricles to fill with blood. Ventricular contraction follows this.

Abnormalities in the heart’s rhythm are called arrhythmias. Tachycardia is a condition in which the heart beats too quickly. Bradycardia occurs when the heart rate is too slow. An arrhythmia can cause some people to feel a racing, pounding, or irregular heartbeat in their chest. Sudden cardiac arrest is due to an electrical problem in the heart.

Blood vessels carrying oxygenated blood supply heart muscle with oxygen and nutrients. When cholesterol and fat (plaque) build up in the inner wall of these coronary blood vessels, the lumen of these vessels narrows, decreasing blood flow to the heart muscle. If a blood clot forms in the narrowed vessel, it can cause a heart attack.

Risk factors for coronary heart disease, such as smoking, high blood pressure, high cholesterol, and diabetes, can increase your risk of coronary heart disease and heart attack.

A graphic of a clogged heart blood vessel.

Warning Signs of Heart Disease

Many people envision a heart attack as crushing chest pain with shortness of breath, weakness, sweating, and pain in the left arm, shoulder, or jaw. While these are classic symptoms of heart disease, they are not found in all people having a heart attack, especially women. Women often develop symptoms of heart disease later in the disease process, 7 to 10 years later in life, and their symptoms are more non-specific.1

In fact, about one in every five heart attacks is silent. This means that heart muscle damage occurs without you even being aware.

Early signs of heart disease in men:

  • chest pain or discomfort
  • lightheadedness 
  • dizziness
  • palpitations
  • fatigue
  • shortness of breath
  • fainting

Early signs of heart disease in women:

  • pain in the arm, neck, shoulder, jaw, or back
  • nausea or vomiting
  • indigestion
  • shortness of breath 
  • fatigue
  • breaking out in a cold sweat
  • sleep disturbances
  • lightheadedness

Chest Pain

Chest pain or discomfort is a common symptom of heart disease for both men and women. The pain location may vary. Many people describe the pain as a sense of discomfort, pressure, fullness, or a squeezing pain.

Chest pain is found in many medical conditions, but it should always be taken seriously because the quicker you seek medical care for heart disease, the more quickly blood flow can be restored to your heart muscle, and the less heart muscle you may lose.

Shortness of Breath

Shortness of breath can indicate insufficient blood is pumped into the lungs to be oxygenated and then distributed to the body cells. Excess fluid can collect in the lungs when the heart does not pump effectively. This makes it difficult for oxygen to diffuse from the inhaled air into capillaries in the lungs.

Shortness of breath when doing moderate exertion, such as climbing a flight of stairs that did not cause symptoms before, can be an early sign of heart disease. New onset shortness of breath or shortness of breath when lying down should also be evaluated.

Fatigue and Weakness

When your heart is not working efficiently, body cells may not get the optimal levels of nutrients and oxygen. This can cause fatigue and weakness.

Heart Palpitations

Heart palpitations are the sensation of having a fast beating, fluttering, or pounding heartbeat. You may experience a flip-flopping sensation. Palpitations can be normal and harmless or caused by temporary triggers such as caffeine, stimulants, or environmental stressors. They may also be an indicator of heart disease.


Decreased blood flow to the brain can cause dizziness and lightheadedness. Many forms of heart disease, including heart attacks and palpitations, can decrease the heart’s ability to pump blood.

When your heart is beating too slow, it can decrease blood flow to the brain, but it can also occur when the heart is beating too fast. Excessively fast heartbeats can mean the heart does not have enough time to fill before it is pumped from the heart.


When the heart does not pump effectively, fluid collects in the abdomen, lungs, and lower extremities. This is called edema. More fluid leaves the blood vessels and enters the body tissue, collecting in the feet and ankles.

A personal medical history form

Common Risk Factors for Heart Disease

For most medical conditions, both modifiable and unmodifiable risk factors contribute.

Non-modifiable Risk Factors

Non-modifiable risk factors for heart disease include:

  • Older age
  • Sex: Men have a higher risk of heart disease earlier in life
  • Heredity: A family history of heart disease can increase your risk for heart disease

Family history and genetic factors are important to recognize because even though you cannot change them, it is important to know your history to evaluate your heart disease risk.

Some risk factors for heart disease are secondary to lifestyle choices. Modifying these risk factors can reduce your risk for heart disease and improve your overall health.

High Blood Pressure

Blood pressure is the force blood places on the inner walls of blood vessels. Systolic blood pressure is the upper number in blood pressure. It is measured when the heart is contracting. Diastolic blood pressure is the lower number and is measured when the heart relaxes.

Systolic blood pressure increases more steeply in postmenopausal women than in men. This may be related to a decline in estrogen levels post-menopause. Isolated systolic high blood pressure is more common in women over the age of 75. It is an important risk factor for heart failure and strokes.

Moderate to high blood pressure is associated with more risk for blood vessel dysfunction and cardiovascular disease in women than in men.1

High Cholesterol Levels

High levels of low-density lipoproteins (LDL) cholesterol can increase the build-up of cholesterol and fats in the inner lining of blood vessels. This narrows the lumen of arteries and increases the risk that a blood clot may form in the blood vessel and increases the risk of a heart attack or stroke.

Increased cholesterol in blood vessel walls can decrease their flexibility, which increases the risk of high blood pressure.

Low levels of high-density lipoproteins (HDL) cholesterol or “good” cholesterol can reduce your body’s ability to remove LDL cholesterol from blood vessel walls.


Under age 50, smoking is a greater risk factor for heart disease in women than men. The risk increases proportionately to the number of cigarettes smoked each day. Smoking increases the risk of a first heart attack more in women than men. Whether smoking remains a higher risk factor for women over men after age 50 is unclear.1

Obesity and Lack of Physical Activity.

Obesity is a risk factor for heart disease and a risk factor for metabolic syndrome, diabetes mellitus, high blood pressure, and high cholesterol, which are also risk factors for heart disease.

Central obesity, organ fat in the abdomen, increases risk and is more common in men and postmenopausal women.1

Unhealthy Diet

An unhealthy diet high in sodium, processed foods, refined carbohydrates, and saturated fats can increase your heart and blood vessel disease risk. Excessive alcohol consumption is also linked to an increased risk of heart disease.

Diagnostic Tests for Heart Disease

Depending on your symptoms and risk factors, your doctor may suggest that you have diagnostic tests to evaluate your heart function and structure.

Electrocardiogram (ECG)

An electrocardiogram is a device that records the electrical activity in your heart. An ECG (also called EKG) is a quick test that can be conducted in your doctor’s office. It is used to diagnose arrhythmias or irregularities in heart rhythm.

Echocardiogram (ECHO)

An echocardiogram is a diagnostic imaging technique that utilizes sound waves to examine the heart’s structure. It can also measure blood flow through the chambers. An ECHO is used in diagnosing heart valve abnormalities, defects in the heart muscle wall between chambers, and cardiomyopathy.

Blood Test

Blood tests can measure heart biomarkers, indicating damage to heart muscle cells. Blood tests may also be used to assess your risk of heart disease. Commonly ordered screening tests include blood glucose and lipid panels, which may include cholesterol levels and lipoproteins.

Magnetic resonance imaging (MRI)

A magnetic resonance imaging machine is used to construct an image of the heart and the surrounding structures. These detailed scans can be used to diagnose various structural heart diseases.

Exercise Stress Test

An exercise stress test uses exercise on a treadmill or medications that increase heartbeat and make the heart work harder to evaluate its ability to respond to increased exercise or stress. It is used to evaluate coronary artery disease.

Coronary Angiography

A coronary angiography or a cardiac catheterization is a test to evaluate blood flow through blood vessels in your heart. A thin tube is threaded through a blood vessel and into the heart. Once in the heart, it can measure pressures in the blood vessels and heart chambers, detect narrowed or blocked blood vessels in the heart, and check the function of heart valves.

A doctor explaining heart disease to a patient

When to Seek Medical Evaluation

Heart disease is preventable. Schedule a medical evaluation if you have risk factors for heart disease. Your doctor will discuss your modifiable and unmodifiable risk factors and run tests to assess the current condition of your heart and blood vessels. Your doctor can help you learn your important heart disease risk numbers, including blood pressure, blood cholesterol, resting heart rate, and body fat percentage.

If you have a family history of heart disease, schedule an online appointment with a TelegraMD doctor on call to discuss your risk factors, receive an online diagnosis, and develop an individualized plan to reduce your risk. If appropriate, your TelegraMD doctor can transmit an online prescription to your local pharmacy for pickup or delivery.

Many people find they can avoid costly doctor visits through telehealth, especially if they do not have insurance and want to discuss their symptoms with a healthcare professional.

TelegraMD doctors are available 24 hours a day, so you can access help when you need it, but they are not an appropriate source of healthcare if you are currently experiencing symptoms you attribute to a potential heart attack.


While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.


1. Maas AH, Appelman YE. Gender differences in coronary heart disease. Neth Heart J. 2010 Dec;18(12):598-602. doi: 10.1007/s12471-010-0841-y. PMID: 21301622; PMCID: PMC3018605.

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