Resistant Hypertension | FAQ with Oscar Cingolani
Resistant Hypertension | FAQ with Oscar Cingolani
Johns Hopkins cardiologist Oscar Cingolani answers questions about resistant hypertension and explains new high blood pressure guidelines. To schedule an appointment with the Johns Hopkins Center for Resistant Hypertension, call 443-997-0270. Learn more at hopkinsmedicine.org/heart_vascular_institute.
FAQ’s
0:02 What is resistant hypertension?
0:15 What causes resistant hypertension?
0:40 How is resistant hypertension diagnosed?
1:17 How many people in the U.S. have resistant hypertension?
1:39 How is resistant hypertension treated?
2:01 What is unique about the Center for Resistant Hypertension at Johns Hopkins?
3:04 What do the updated guidelines for high blood pressure mean?
Content
0.42 -> (mystical music)
4.48 -> >> So resistant hypertension
is a hypertension
6.88 -> that is not controlled with
three or more medications,
10.65 -> including a diuretic,
which is a water pill.
16.4 -> We don't know exactly what causes it.
18.366 -> There is multi genes
that can be responsible
21.93 -> for resistant hypertension.
23.47 -> But we do know that patients who have
25.69 -> resistant hypertension
are more likely to have
28.58 -> an identifiable cause.
29.976 -> 20% of those patients there is a cause
32.75 -> that we can define and
therefore treat accordingly.
40.58 -> It's diagnosed by accurate
measurement of blood pressure.
43.84 -> And taking a thorough
history and physical exam.
47.99 -> Most of the problems that we deal with
49.72 -> in these days is that
patients rush to the office
53.43 -> when their blood pressure is determined,
54.97 -> and sometimes that blood pressure
57.58 -> is not accurately reflecting
what the blood pressure is.
60.62 -> So we reinforce different measurements.
64.3 -> And we are now, in the last few years,
66.79 -> encouraging to determine
blood pressure at home.
70.1 -> Which is more important
than whatever reading
72.85 -> we get in the office.
77.08 -> It is estimated now that
100 millions peoples
80.85 -> in the U.S. have hypertension.
82.96 -> And approximately a fourth of that,
85.51 -> that's 20-25 million have
resistant hypertension.
90.06 -> So those patients are at higher risk,
92.16 -> so it's important to
define that population
96.1 -> and aggressively treat them.
100.99 -> The treatment options,
and this is what we do
102.95 -> in the Hypertension Center here at Hopkins
104.97 -> is to first of all personalize
care of these patients.
109.2 -> And try to educate the patient first.
112.01 -> Try to modify habits and lifestyle.
114.94 -> And then combine drugs
that are appropriate
117.34 -> for that specific patient.
122.06 -> So in our Hypertension Center,
123.68 -> we are a multidisciplinary center
125.99 -> with people who are really
obsessive compulsive
128.67 -> about treating and managing hypertension.
130.68 -> And we are now, not only educating people,
133.23 -> and providing information on
how to measure blood pressure
136.29 -> and what lifestyle modifications they do,
138.93 -> we do some noninvasive testings,
141.65 -> such as measuring central aortic pressure,
144.45 -> which is the pressure closest
to the heart and to the brain.
147.21 -> Which sometimes, in certain patients,
148.98 -> do not reflect the pressure in the arm
151.84 -> that we routinely measure.
153.97 -> And we are also doing
something that is very new.
157.19 -> We are doing a saliva or
blood sample of genes.
161.14 -> And based on those genes,
we target the treatment.
164.37 -> So to give you an example,
165.99 -> there are certain patients
who are more responsive
168.39 -> to medication A or B,
171.1 -> and we are able to tell that
172.47 -> by doing a genetic
profile of those patients.
174.81 -> Something very new.
176.66 -> And something that in Europe
178.16 -> is being going on for a few years now.
184.95 -> Last year in 2017, the
American College of Cardiology
188.51 -> and the American Heart Association
190.7 -> got together and decided to update
192.62 -> our hypertension guidelines.
194.49 -> And this created a little bit of confusion
198.34 -> among physicians and as well as patients.
200.53 -> And this is because before
we would call hypertensive
206.37 -> that patient who will
have a higher number,
209.11 -> a number above 140 over 90.
211.49 -> Now we drop the bar to 130 over 80.
214.94 -> Meaning that having normal
blood pressure remains the same.
218.15 -> If you have 120 over 80 or less,
221.66 -> your blood pressure is considered normal.
223.8 -> But now, if you have 130 over 80 or more
227.55 -> then you are hypertensive.
230.484 -> (intense music)
Source: https://www.youtube.com/watch?v=fwhwh1ONLhk