Resistant Hypertension | FAQ with Oscar Cingolani
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Resistant Hypertension | FAQ with Oscar Cingolani

August 30, 2019

(mystical music)>>So resistant hypertension
is a hypertension that is not controlled with
three or more medications, including a diuretic,
which is a water pill. We don’t know exactly what causes it. There is multi genes
that can be responsible for resistant hypertension. But we do know that patients who have resistant hypertension
are more likely to have an identifiable cause. 20% of those patients there is a cause that we can define and
therefore treat accordingly. It’s diagnosed by accurate
measurement of blood pressure. And taking a thorough
history and physical exam. Most of the problems that we deal with in these days is that
patients rush to the office when their blood pressure is determined, and sometimes that blood pressure is not accurately reflecting
what the blood pressure is. So we reinforce different measurements. And we are now, in the last few years, encouraging to determine
blood pressure at home. Which is more important
than whatever reading we get in the office. It is estimated now that
100 millions peoples in the U.S. have hypertension. And approximately a fourth of that, that’s 20-25 million have
resistant hypertension. So those patients are at higher risk, so it’s important to
define that population and aggressively treat them. The treatment options,
and this is what we do in the Hypertension Center here at Hopkins is to first of all personalize
care of these patients. And try to educate the patient first. Try to modify habits and lifestyle. And then combine drugs
that are appropriate for that specific patient. So in our Hypertension Center, we are a multidisciplinary center with people who are really
obsessive compulsive about treating and managing hypertension. And we are now, not only educating people, and providing information on
how to measure blood pressure and what lifestyle modifications they do, we do some noninvasive testings, such as measuring central aortic pressure, which is the pressure closest
to the heart and to the brain. Which sometimes, in certain patients, do not reflect the pressure in the arm that we routinely measure. And we are also doing
something that is very new. We are doing a saliva or
blood sample of genes. And based on those genes,
we target the treatment. So to give you an example, there are certain patients
who are more responsive to medication A or B, and we are able to tell that by doing a genetic
profile of those patients. Something very new. And something that in Europe is being going on for a few years now. Last year in 2017, the
American College of Cardiology and the American Heart Association got together and decided to update our hypertension guidelines. And this created a little bit of confusion among physicians and as well as patients. And this is because before
we would call hypertensive that patient who will
have a higher number, a number above 140 over 90. Now we drop the bar to 130 over 80. Meaning that having normal
blood pressure remains the same. If you have 120 over 80 or less, your blood pressure is considered normal. But now, if you have 130 over 80 or more then you are hypertensive. (intense music)

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  1. I have had high blood pressure that they can't seem to get under control for several years now. I found this interesting. I can't even count the number of meds I've been on and switched to. THey now have me on two anti-anxiety meds, a statin, and 3 blood pressure meds. No one has put me on a diuretic. I still often have BP spikes in the critical range. It's quite scary.

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